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Gesundheitssysteme Im Wandel Das österreichische Gesundheitssystem Gesundheitssysteme im Wandel Akteure, Daten, Analysen Das österreichische Gesundheitssystem Akteure, Daten, Analysen Florian Bachner Julia Bobek Katharina Habimana Joy Ladurner Lena Lepuschütz Herwig Ostermann Lukas Rainer Andrea E. Schmidt Martin Zuba Wilm Quentin Juliane Winkelmann ISSN 1817 – 6127 Gesundheitssysteme im Wandel Das österreichische Gesundheitssystem Akteure, Daten, Analysen Florian Bachner Lukas Rainer Gesundheit Österreich GmbH (GÖG) Gesundheit Österreich GmbH (GÖG) Julia Bobek Andrea E. Schmidt Gesundheit Österreich GmbH (GÖG) Gesundheit Österreich GmbH (GÖG) Katharina Habimana Martin Zuba Gesundheit Österreich GmbH (GÖG) Gesundheit Österreich GmbH (GÖG) Joy Ladurner Wilm Quentin Gesundheit Österreich GmbH (GÖG) Europäisches Observatorium für Lena Lepuschütz Gesundheitssysteme und Gesundheitspolitik Gesundheit Österreich GmbH (GÖG) Juliane Winkelmann Herwig Ostermann Europäisches Observatorium für Gesundheit Österreich GmbH (GÖG) Gesundheitssysteme und Gesundheitspolitik Das Europäische Observatorium für Gesundheitssysteme und Gesundheitspolitik (European Observatory on Health Systems and Policies) unterstützt und fördert eine evidenzbasierte Gesundheitspolitik durch umfassende und gründliche Analysen der Dynamik der Gesundheitssysteme in Europa. Das Observatorium bringt Experten aus Politik, Forschung und Praxis zusammen, die Entwicklungen, Fragen und Themen der Gesundheitspolitik auf Basis von Erfahrungen europäischer Länder analysieren. Das Europäische Observatorium für Gesundheitssysteme und Gesundheitspolitik ist eine Partnerschaft zwischen der Weltgesundheitsorganisation – Regionalbüro für Europa; den Regierungen von Österreich, Belgien, Finnland, Irland, Norwegen, Slowenien, Schweden, Spanien, des Vereinigten Königreichs und der Region Venezien in Italien; der Europäischen Kommission; der Weltbank; UNCAM (Französischer Dachverband der Krankenversicherungsträger); der Health Foundation; der London School of Economics and Political Science (LSE) und der London School of Hygiene & Tropical Medicine (LSHTM). Das Europäische Observatorium hat sein Sekretariat in Brüssel sowie Hubs in London (an der LSE und der LSHTM) und an der Technischen Universität Berlin. SCHLAGWORTE: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration AUSTRIA © World Health Organization 2019 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies). Alle Rechte reserviert. Das Europäische Observatorium für Gesundheitssysteme und Gesundheitspolitik begrüßt Anfragen zur Genehmigung einer Vervielfältigung oder Übersetzung seiner Publikationen, in Teilen oder als Ganzes. Die in dieser Publikation geäußerten Meinungen der Autoren und Editoren geben nicht notwendigerweise die Beschlüsse und die offizielle Position des Europäischen Observatoriums für Gesundheitssysteme und Gesundheitspolitik oder seiner Partner wieder. Die in diesem Bericht verwendeten Bezeichnungen und dargestellten Materialien repräsentieren in keiner Weise die Ansicht des Europäischen Observatoriums für Gesundheitssysteme und Gesundheitspolitik oder seiner Partner hinsichtlich des rechtlichen Status von Staaten, Territorien, Städten, Gebieten oder ihrer Regierungen oder des Verlaufs von Grenzen. Wenn im Tabellenkopf die Benennung „Land oder Gebiet“ aufgeführt wird, bezeichnet dies Länder, Territorien, Städte oder Gebiete. Gepunktete Linien in Karten deuten annähernde Grenzlinien an, für die noch keine vollständige Übereinkunft getroffen ist. Die Erwähnung bestimmter Firmen oder Produkte spezieller Hersteller bedeutet nicht, dass sie vom Europäischen Observatorium für Gesundheitssysteme und Gesundheitspolitik befürwortet oder empfohlen werden und anderen Firmen oder Produkten ähnlicher Art vorgezogen werden, die nicht erwähnt werden. Geschützte Warennamen werden, von Irrtümern und Ausnahmen abgesehen, mit großem Anfangsbuchstaben gekennzeichnet. Das Europäischen Observatorium für Gesundheitssysteme und Gesundheitspolitik garantiert nicht die Vollständigkeit und Richtigkeit der Informationen dieser Publikation und ist nicht verantwortlich für Schäden, die aus ihrer Anwendung resultieren. Empfohlene Zitierweise: Bachner F, Bobek J, Habimana K, Ladurner J, Lepuschutz L, Ostermann H, Rainer L, Schmidt A E, Zuba M, Quentin W, Winkelmann J. Das österreichische Gesundheitssystem – Akteure, Daten, Analysen, 2019, 20(3): 1 – 288. Print ISSN 1817-6119 Vol. 20 No. 3 Web ISSN 1817-6127 Vol. 20 No. 3 INHALTSVERZEICHNIS Vorwort v Danksagung vii Abkürzungsverzeichnis x Tabellen und Abbildungen xv Abstract xix Zusammenfassung xxi 1 Einleitung 1 1.1 Geografie und Soziodemografie 2 1.2 Wirtschaftliche Rahmenbedingungen 3 1.3 Politische Rahmenbedingungen 6 1.4 Gesundheitszustand der Bevölkerung 9 2 Organisation und Steuerung 18 2.1 Überblick über das Gesundheitssystem 19 2.2 Historischer Hintergrund 22 2.3 Organisation 28 2.4 Dezentralisierung und Zentralisierung 39 2.5 Planung 40 2.6 Intersektoralität 43 2.7 Gesundheitsinformationen und -berichterstattung 51 2.8 Regulierung 55 2.9 Stärkung der Patienten 73 3 Finanzierung 79 3.1 Gesundheitsausgaben 80 3.2 Mittelherkunft und Finanzierungsströme 85 3.3 Finanzierung des Krankenversicherungssystems 90 3.4 Ausgaben privater Haushalte 105 3.5 Private Krankenzusatzversicherung 111 3.6 Andere Finanzierungsquellen 114 3.7 Vergütungsmechanismen 117 iv Gesundheitssysteme im Wandel 4 Infrastruktur und Personal 129 4.1 Infrastruktur 130 4.2 Personal 142 5 Erbringung von Gesundheitsdiensten 161 5.1 Öffentliche Gesundheit 162 5.2 Behandlungspfade 170 5.3 Primärversorgung und fachärztliche niedergelassene Versorgung 173 5.4 Intramurale Versorgung 176 5.5 Notfallversorgung 181 5.6. Arzneimittelversorgung 182 5.7 Rehabilitation 186 5.8 Langzeitpflege 189 5.9 Leistungen für betreuende An- und Zugehörige 195 5.10 Hospiz- und Palliativversorgung 197 5.11 Psychosoziale Gesundheitsversorgung 199 5.12 Zahnmedizinische Versorgung 201 5.13 Komplementär- und Alternativmedizin 202 5.14 Gesundheitsleistungen für ausgewählte Bevölkerungsgruppen 203 6 Gesundheitsreformen 205 6.1 Analyse der Reformen 207 6.2 Zukünftige Entwicklungen 225 7 Bewertung des Gesundheitssystems 227 7.1 Angestrebte Ziele des Gesundheitssystems 229 7.2 Finanzielle Absicherung und finanzielle Gerechtigkeit 230 7.3 Patientenerfahrungen und Chancengerechtigkeit beim Zugang zur Gesundheitsversorgung 234 7.4 Gesundheitszustand, Versorgung und Versorgungsqualität 238 7.5 Effizienz des Gesundheitssystems 245 7.6 Transparenz und Verantwortlichkeit 249 8 Schlussfolgerungen 253 9 Anhänge 257 9.1 Literaturverzeichnis 257 9.2 HiT-Methodik und Produktionsprozess 283 9.3 Der Review-Prozess 286 9.4 Über die Autoren 286 VORWORT Die Profile „Health Systems in Transition“ (HiT, Gesundheitssysteme im Wandel) sind länderspezifische Berichte, die die Gesundheitssysteme und die laufenden bzw. geplanten Reforminitiativen der jeweiligen Länder beschreiben und analysieren. Jeder Bericht wird von Länderexperten in Zusammenarbeit mit den Mitarbeitern des Europäischen Observatoriums erstellt. Um eine größtmögliche Vergleichbarkeit zwischen den einzelnen Ländern zu ermöglichen, liegt den verschiedenen HiT-Profilen ein gemeinsamer Leitfaden zugrunde, der in regelmäßigen Abständen aktualisiert wird. Dieser dient als Orientierungshilfe zur Erarbeitung eines HiT-Profils und enthält detaillierte Leitlinien und spezifische Fragen, Definitionen und Beispiele, die zur Erstellung des Berichts herangezogen werden. Die HiT-Profile haben zum Ziel, relevante und vergleichbare Informationen darzustellen, um Entscheidungsträger und Analysten bei der Weiterentwicklung von Gesundheitssystemen in Europa zu unterstützen. Sie sind Bausteine, die verwendet werden können, um: Einzelheiten über verschiedene Ansätze bei der Organisation, Finanzierung und Erbringung von Gesundheitsversorgung sowie über die Rolle der Verantwortlichen im Gesundheitssystem zu erfahren; Prozess und Inhalt von Programmen zur Reformierung der Gesundheitsversorgung und deren Umsetzung genau zu beschreiben; gemeinsame Aufgaben und Gebiete herauszustellen, die einer genaueren Analyse bedürfen; Informationen über Gesundheitssysteme zu verbreiten und den Erfahrungsaustausch über Reformstrategien zwischen Entscheidungsträgern und Experten in verschiedenen Ländern zu fördern; und Forschungsvorhaben in der vergleichenden Gesundheitssystemanalyse zu unterstützen. vi Gesundheitssysteme im Wandel Die Erstellung der HiT-Profile bringt einige methodologische Probleme mit sich. In vielen Ländern liegen wenig Informationen über das Gesundheitsversorgungssystem und die Auswirkungen von Reformen vor. Mangels einer einheitlichen Datenquelle, basieren quantitative Daten über die Gesundheitsversorgung auf einer Reihe unterschiedlicher Quellen, einschließlich der Datenbank „Health for All“ des WHO-Regionalbüros für Europa, nationalen Statistikämtern, Eurostat, Internationalen Währungsfonds (IWF), auf gesundheitsbezogenen Daten der Organisation für wirtschaftliche Zusammenarbeit und Entwicklung (OECD) und der Weltbank sowie diversen anderen Quellen, die von den Autoren als zweckdienlich erachtet werden. Die Methoden der Datensammlung und zugrunde liegende Definitionen unterscheiden sich zum Teil, sind jedoch üblicherweise innerhalb der jeweiligen Datenserie konsistent. Standardisierte Profile haben auch gewisse Nachteile, da Finanzierung und Leistungserbringung der Gesundheitsversorgung in den verschiedenen
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