Strengthening Social Dialogue in the Hospital Sector Strengthening social dialogue in the hospital sector in the new Member States and candidate countries A project for EPSU and HOSPEEM Final report May 2008 Final/29/05/2008 1 Strengthening Social Dialogue in the Hospital Sector AUSTRIA Economic and labour market context Economic growth Austria is one of the European Union’s most developed countries. In 2006, the country ranked 4 th in terms of GDP per capita (behind Luxembourg, Ireland and the Netherlands. However, economic growth was below the EU average in the first half of the decade, until a recent revival in 2006, with the pace of growth surpassing the 3% mark. This is fuelled by exports (9.2% change on previous year), and related investments (gross fixed capital formation rose by 5.6%). Table: Key economic indicators, 2000-2006 Indicator 2000 2001 2002 2003 2004 2005 2006 GDP per capita in PPS (EU-25 = 100) 125.5 122.0 120.0 123.4 123.4 122.8 122.9 Real GDP growth rate (%) 3.4 0.8 0.9 1.1 2.4 2.0 3.1 Source: Eurostat Employment The employment rate is very high in Austria with 70.2% in 2006, following a significant increase from the previous year. This figure is the fifth highest in the EU, behind Denmark, the Netherlands, Sweden, and the UK only (the EU-25 average was 64.7). Table: Key employment indicators, 2000-2006 Indicator 2000 2001 2002 2003 2004 2005 2006 Number of people employed (annual average, in thousands)* 3,710 3,746 3,712 3,793 3,744 3,824 3,928 - male 2,090 2,082 2,044 2,094 2,061 2,095 2,147 - female 1,620 1,664 1,668 1,700 1,682 1,729 1,781 Employment rate (percentage) 68.5 68.5 68.7 68.9 67.8 68.6 70.2 - male 77.3 76.4 76.4 76.4 74.9 75.4 76.9 - female 59.6 60.7 61.3 61.6 60.7 62.0 63.5 Source: Eurostat, * Eurostat LFS, break in time series at 2004 Although the participation of women in the labour market is lower than that of men by 13 percentage points, Austria has high levels of female employment. The corresponding figure of 63.5% in 2006 strongly exceeded the EU average of 57.3%. Male employment was 76.9% in 2006, which is also much higher as the European average of 72.0%. The figures also indicate that the employment gap in Austria is only slightly narrower than in the European Union in general. Final/29/05/2008 2 Strengthening Social Dialogue in the Hospital Sector Unemployment The unemployment rate in Austria is below the EU average and declined in 2006. Table 1: Key unemployment indicators, 2000-2006 Indicator 2000 2001 2002 2003 2004 2005 2006 Unemployment rate 3.6 3.6 4.2 4.3 4.8 5.2 4.8 - male 3.1 3.1 4.0 4.0 4.4 4.9 4.4 - female 4.3 4.2 4.4 4.7 5.3 5.5 5.2 Source: Eurostat Employment trends in hospital sector Employment in the hospital and social care sector has witnessed a small decline in 2006 after a significant increase in the previous year. While female employment in the sector continued to increase, male employment declined significantly. There is also an increasing trend towards an ageing workforce, with employment in the 15-49 age groups declining while employment in the over 50 age group increased. Table 2: Employment in the health and social work sector (NACE N), 2000-2006 Indicator 2000 2001 2002 2003 2004 2005 2006 Number of people employed in the health and social work sector (annual average, in thousands) 293.2 303 315.6 319.8 314.8 349.7 347.8 - male 72.6 74 71.8 76.3 76.8 88.4 80.2 - female 220.5 229 243.7 243.5 238 261.3 267.6 Employment in the health and social sector, as share of total employment (percentage) 8.0 8.2 8.6 8.5 8.6 9.1 8.9 Source: Eurostat LFS Table 3: Employment in the health and social work sector (NACE N), broken down by age (percentage), 2000-2006 Indicator 2000 2001 2002 2003 2004 2005 2006 Between 15 and 24 years 8.9 8.9 9.7 9.3 8.0 9.8 8.6 Between 25 and 49 years 75.4 76.9 75.3 76.0 76.2 72.3 71.4 Between 50 and 64 years 15.2 13.7 14.6 14.2 15.4 17.6 19.6 Over 65 years 0.5 0.5 0.4 0.5 0.4 0.4 0.4 Source: Eurostat LFS Final/29/05/2008 3 Strengthening Social Dialogue in the Hospital Sector Structure and organisation of hospital sector and key recent reforms Funding and expenditure According to estimates by the national statistical office (Statistik Austria), expenditure on health care amounted to € 25.1 bn, or 10.2% of the country’s Gross Domestic Product (GDP) in 2005 1. Estimates published by the WHO and OECD 2 set expenditure in 2004 at between 7.5-9.6% of Austria’s GDP. The latter would rank Austria 6 th in the European Union (behind Germany, France, Belgium, Portugal, and Greece) in terms of health care expenditure. The level of expenditure in nominal terms grew steadily between 2000 and 2005, but only to maintain a relatively stable expenditure/GDP ratio of 10.0 to 10.3 percent. Table 5: Health care expenditure, key figures, 2000-2005 2000 2001 2002 2003 2004 2005 Gross Domestic Product (GDP) (billion euro) 210.4 215.9 220.8 226.2 235.8 245.1 Total expenditure on health care (billion euro) 20.9 21.6 22.2 23.1 24.3 25.1 - without long-term care 18.4 19.0 19.5 20.2 21.3 22.0 Total expenditure as percentage of GDP (%) 10.0 10.0 10.1 10.2 10.3 10.2 - without long-term care 8.7 8.8 8.8 9.0 9.0 9.0 Total health expenditure as percentage of GDP* 7.5 7.4 7.5 7.5 7.5 .. Total health expenditure, PPP$ per capita* 2,170 2,162 2,240 2,306 2,365 .. Public sector expenditure as percentage of total health expenditure* 68.1 67 67.8 67.6 67.6 .. Source: Statistik Austria * Source: WHO-HFA estimates Public funding of health care is still dominant in Austria (accounting for 71% of all expenditure in 2004 3), although its share is decreasing, and is already below the EU average. The main source of financing is the statutory health insurance system, which provided 45.3% of all resources in 2004. The system is decentralised, and comprises of nine territorial health insurance funds for the nine provinces (Bundesländer), and five national institutions for particular occupational groups. Nine major companies have their own traditional company health insurance funds, but it is not permitted to set up new company insurance funds by federal law. The funds’ revenues are made up predominantly from members’ contributions, which were, in the basic case, a proportion of between 7.1% and 9.1% (depending on the respective insurance 1http://www.statistik.at/fachbereich_03/gesundheit_ausgaben_tab.shtml 2 I.e. the WHO ‘Health for All’ (WHO-HFA) database (http://www.euro.who.int/hfadb ), and ’OECD in Figures’ (http://www.oecdobserver.org/news/get_file.php3/id/25/file/OECDInFigures2006-2007.pdf ), based on OECD’s Systems of Health Accounts (SHA) methodology. 3 Data from ‘OECD in Figures’; corresponding WHO-HFA estimates set the level of public resources at 67%. Final/29/05/2008 4 Strengthening Social Dialogue in the Hospital Sector fund) of their taxable personal income in 2005 4. For employees, the contribution is shared between them and their employers. Membership of the statutory insurance system is compulsory for employees and the self- employed with a monthly income above a minimum threshold, for pensioners and those receiving other kinds of transfer benefits (e.g. unemployment benefits and childcare allowances), trainees, citizens performing their military or alternative service, as well as their dependants domiciled in Austria. The system covers 98% of the Austrian population. Employees earning below the income threshold and students can participate in a voluntary insurance scheme. As some of the funds ran into major deficits (that may exceed 5% of their budget), a national compensation fund has been established by the federation of the social insurance funds themselves to close such finance gaps. Other public funds include direct contributions from the federal government, the provinces and local authorities. This contribution accounted for about 25% of all health care expenditure in 2004, and is financed from VAT revenues. Private resources play an increasing role in Austria. In 2005, around 28% of health-related spending was funded by private households, outside the statutory scheme. The majority of this expenditure involves the costs of health services not covered by health insurance (indirect cost- sharing) and co-financing (direct cost-sharing). There are legal agreements, based on the Constitution between the federal level and the Länder, to share the financing of hospitals – from social insurance revenues and general taxation. Table 4: Key indicators of inpatient care, 2000-2005 2000 2001 2002 2003 2004 2005 Total inpatient expenditure as percentage of total health expenditure 39.3 41.1 41.6 41.4 41.7 .