The responsibility in Austrian health care has
been divided between the federal and nine autonomous provincial
authorities. This division is defined in the federal constitution.
The federal authorities are responsible for basic legislation
concerning health care but the executive regulations and implementation
are in the hands of the provincial authorities.
The federal government has been responsible on
reform process in order to control the cost but prevailing the
principles of equal access for all and solidarity in financing
trough public compulsory health insurance. The core of the reform
is an Austrian Health Care Plan and the introduction of a performance
related hospital financing system.
Individual physicians in private practices provide
the most part of primary health care under contract with the health
insurance agencies. Hospitals are mostly in private ownership.
Healthcare financing is based to social insurance and subsidised
by taxes (12%). The Regional Health Funds get their incomes based
on federal and regional taxes and public health insurance contributions
which are budgeted for the next three years. Funds may also finance
alternative health care facilities. The social insurance system
is compulsory and covers nearly everyone. Some 40% of the population
have supplementary private health insurance.
Primary care is free f charge for 80% of population
and the rest has co-insurance or they are exempted due to the
low income. In institutional care out of pocket liability is limited
to first 28 days. Specialised care and prescribed drugs include
both co-payments and co-insurance.
Primary care providers get their incomes based
on fee-for service system. They do not have a gate keeping role.
Simultaneously, with the introduction of the performance related
hospital financing system (Austrian Diagnosis Related Groups)
whole hospital financing has been reformed. They are now financed
jointly by the owners and by the public Regional Funds, one in
each of the nine provinces. In some provinces, these Funds provide
all the public money for the hospitals, while in others there
is additional financing available from provincial and local governments.