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Austria: Austria Health Profile 2012

2012/02/16

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Austria Health Profile 2012

Life expectancy

Austrians live as long as their Eur-A counterparts: girls born in 2002 can expect to live 82 years and boys, 76 years. By 2030, one in every four Austrians will be aged 65 or more. The country’s birth rate has fallen more sharply than the Eur-A average, and is now one of the lowest in this group of countries. In addition, the infant mortality rate is below the Eur-A average.
As the length of life increases, older people can respond with lifestyle changes that can increase healthy years of life. Correspondingly, health care systems need to shift towards more geriatric care, the prevention and management of chronic diseases and more formal long-term care. Since people are living longer, measures to improve health and prevent disease need to focus on people of working age. What are the main risk factors for disability in old age and how can disability be prevented? (Health Evidence Network, 2003a) Main causes of death As in other Eur-A countries, in Austria noncommunicable diseases kill eight out of ten people.  Cardiovascular diseases (CVD) account for almost one death in two; Austria has one of the highest mortalityrates for this cause in Eur-A, even though it has dropped by a quarter since 1990. Ischaemic heart disease is the single biggest killer, especially for women older than 64 years. Cancer mortality is relatively low for men; for women, mortality is just at the Eur-A average, although lung cancer is increasing. Cancer of the cervix has recently decreased to Eur-A levels, while breast cancer is in the same range.
Preventive care, delivered through a country's primary care system can improve all-cause mortality and premature mortality, particularly from CVD.

Excess weight

A 1999 survey found that 37% of the Austrian population aged 20 years and over were overweight: 54.3% of men and 21.3% of women; 9% of both sexes were considered obese (Statistik Austria, 2002). Compared with their Eur-A counterparts, Austrian boys have less pre-obesity and slightly more obesity, while Austrian girls have lower levels of both. Better eating habits can prevent premature death from CVD, but people’s chances for a healthy diet depend on what food is available and whether it is affordable. Food and nutrition policies need to cross sectors and be coordinated, so that non-health sectors give priority to public health. Preventive care, delivered through a country’s primary care system, can improve all-cause mortality and premature mortality, particularly from CVD.

Injuries and mental health

In Austria, fewer children die in road traffic accidents than the Eur-A average; the rate has fallen markedly since 1997.
Overall mortality from external causes accounts for 7% of deaths and is decreasing, but remains 17% higher than the Eur-A average. This is mainly due to suicide, for which Austria has one of the highest rates: 60% above that for Eur-A. More men than women take their lives, and the rate increases after age 65. The gender difference is more marked than in Eur-A as a whole. As in the rest of Eur-A, neuropsychiatric conditions account for the greatest share of the burden of disease on the Austrian population, owing to their impact on daily living. Better recognition and monitoring of depressive disorders can lead to positive effects, including reduced suicide rates. Comprehensive treatment programmes directed at the addictive and depressive features in alcohol abuse have been shown to be effective.

Alcohol

Austria has some of the highest death rates among Eur-A countries for chronic liver disease and cirrhosis for both men and women, even though mortality from this cause has decreased by a quarter since 1995. Death rates for alcohol-related causes are also high. While alcohol consumption is declining slowly in Austria, it remains 15% higher than the Eur-A average. Alcohol consumption varies among countries and between population groups within countries. The variation in drinking patterns affects the rates of alcohol-related problems and has implications for the choice of alcohol control policies. Measures that are generally effective in reducing alcohol consumption and the associated harm include pricing and taxation and restricting the availability of alcohol, opening hours for sales outlets and the legal drinking age. Most drink–driving countermeasures have been effective as well. International trade agreements and common markets have weakened the ability of national-level decision-makers to establish national alcohol policies. Most notable are the converging trends in alcohol taxation in several countries in the European Union.

Tobacco

Austrians typically smoke 20% less cigarettes than their Eur-A counterparts. Tobacco consumption is stable among adolescents, but higher for girls than boys. To reduce consumption across the whole population, policy-makers need permanently to raise prices for tobacco through taxes, and cessation policies need to target vulnerable groups. Increasing adults’ cessation of tobacco use is cost-effective for public health in the short and medium terms.

Communicable diseases

Few Austrians die from HIV/AIDS, and the incidence and mortality rates for tuberculosis (TB) are low as well. HIV prevalence among prison inmates, however, is estimated to be about five times that in the general population.
Prevention, treatment and care programmes need to reach all people affected by HIV/AIDS, particularly those whose language, culture or immigrant status might limit their access to health services. People are in general well informed about their health status, the positive and negative effects of their behaviour on their health and their use of health care services. Yet their perceptions of their health status can differ from what administrative and examination-based data show about levels of illness within populations. Thus, surveys results based on self-reporting at the household level complement other data on health status and the use of services.
Austrians are in general satisfied with their health, with three quarters of adults rating it as good or very good.

Organizational structure of the health system

The Austrian health system is shaped by statutory health insurance, which covers about 95% of the population on a mandatory basis and 2% on a voluntary basis. Of the 3.1% not covered in 2003, 0.7% had taken out voluntary substitutive insurance, while 2.4% were not covered at all: for example, some groups of unemployed people and asylum seekers. The 26 statutory health insurance funds are organized in the Federation of Austrian Social Security Institutions and do not compete with each other, since membe rship is mainly mandatory and based on occupation or place of residence. Since 2001, family coinsurance
requires a reduced contribution, but many household members are still exempt, such as children, childraising spouses or people needing substantial nursing care.


The Federal Ministry of Health and Women is the main policy-maker in health care and is responsible for supervising statutory health insurance actors and issuing nation-wide regulations on, for example, drug licensing and pricing. The governments of the nine Länder deliver public health services and have strong competencies in the financing and regulating of inpatient care. Capacity planning has increasingly been undertaken by a federal structural commission and nine Länder commissions, and is gradually being extended to all sectors and types of care.


Health care financing and expenditure

In 2002, Austria spent 7.7% of its gross domestic product (GDP) on health, below the average for the countries belonging to the European Union before May 2004. Total health expenditure remained stable between 1997 and 2002, although the share of public expenditure decreased from 5.8% of GDP in 1995 to 5.4% in 2002, accounting for 67% of the total expenditure in that year. The rise in private expenditure was mainly attributable to an increase of direct payments and co-payments. Expenditure per capita was US$ 2220 (Annex. Total expenditure on health).

In 2000, social security schemes financed 43% of total expenditure; government, 27%; user charges or direct payments, 19%; other private funds, 4%; and voluntary health insurance, 7%. The financing of statutory health insurance differs among sickness funds, but is always based on contributions of equal shares from employers and employees, accounting for 7.4% of the salary in 2004. Ceilings for maximum income and contributions apply. Until 2003, blue-collar workers paid higher contribution rates than white-collars. Rates for civil servants, self-employed people and farmers still differ from the main contribution rate.
Sickness funds make contracts with individual physicians on the basis of negotiations between the funds and medical associations on the Länder level. Physicians on contract in private practice are reimbursed by per capita flat rates for basic services and by fee-for-service remuneration for other services. The amount of both components and possible volume restrictions may vary by specialty and Land and partly by type of health insurance fund. Health insurance funds have to reimburse the people insured with them for visits to physicians without contracts, at 80% of the regular rate per billed service. Since 1978, the federal Government and the nine Länder have concluded fixed-term agreements on hospital financing. Since 1997, hospital care has been financed from funds at Länder level with separate divisions for recurrent and investment expenditures. The funds are financed by the federal Government, Länder governments, district governments and, most importantly, by lump sums from health insurance funds.
Public and non-profit-making hospitals that are accredited in hospital plans for acute care at Länder level (fund hospitals) are eligible for investments and reimbursement of services for people with statutory health insurance. The performance-oriented payment scheme, introduced in 1997, consists of a core component of national uniform diagnosis-related groups (DRGs) and a steering system to account for hospital characteristics. The latter may vary considerably among Länder. Fund hospitals derive additional income from co-payments, supplementary insurance or their owners. Private for-profit hospitals may contract selectively with health insurance funds and then be reimbursed according to DRGs.
Long-term nursing-care benefits are financed mainly from federal taxes and are granted to about 4% of the population, regardless of income, on the basis of seven categories of need that depend on the hours of nursing care required per month. Statutory pension funds are responsible for pooling and allocating benefits.

Health care provision

Primary and secondary outpatient care is mainly delivered by self-employed providers in single practices. Secondary outpatient care and dental care are also delivered by outpatient clinics that are owned by organizations providing hospital care or statutory health insurance funds. General practitioners coordinate care and referrals, and formally serve as gate-keepers to inpatient care, except in emergencies. In practice, however, patients often go directly to outpatient clinics. A co-payment for this type of service did not substantially affect fund revenues and care-seeking behaviour, and was abolished in 2003. The number of outpatient contacts was 6.8 per person in 2002. Public health authorities are responsible for the  delivery of antenatal, child health and screening services, many of which are financed by statutory health insurance finances.  Acute secondary and tertiary inpatient care is provided by fund hospitals or by private for-profit hospitals. In 2001, 28% of beds were provided by private hospitals and 73% by fund hospitals, which were owned either by municipalities, Länder or religious and other non-profit-making organizations. While numbers of acute hospital beds have decreased, the density of beds in Austria remains high compared with the average for the countries belonging to the European Union before May 2004 . Admission rates have increased further and reached the highest level in  the European Region: 29 cases per 100 population in 2002. This may be partly attributable to the introduction of the new DRG system, which attracted surgery cases to inpatient care that had previously been handled in ambulatory care. At the same time, the average length of stay was reduced from 13 days in 1990 to 6 days in 2002, when the occupancy rate was 76%.
The numbers of physicians and nurses have increased, but the level for the former is similar to that in Germany and below the average for the countries belonging to the European Union before May 2004 and that for the latter is substantially below neighbouring countries or the average.