Gp in Europe

 

Austria

In Austria,the sum of all public and private healthcare expenditures amounted in1995 to 1,84,969 billion schilling,ie,approximately 8.1 per cent of the Gross Domestic Product (GDP).
In Austria,there is quite a distinct separation between the outpatient and the hospital sector.

Outpatient sector
Doctors who are listed with the Medical Register in Austria are able to establish themselves in a private practice wherever they want. However, if they have no contract with a health insurance fund, the patients have to pay the doctor's fee out of their own pocket and are then reimbursed by the social insurance in the recent past, however, co-payment was introduced for this procedure. Doctors holding contracts with health insurance funds are able to settle their accounts directly with the respective health insurance fund. For patients who are insured with larger health insurance funds there are no co-payments.The medical associations decide together with the health insurance funds on the placement of contracts with health insurance funds for doctors. Correspondingly, they decide which candidate will be awarded contracts due to newly created or vacant posts. In nearly all states, there is a point system according to which the candidates for such posts with contracts are listed.In June 1997, there were 32,392 doctors in Austria altogether, among them 10,299 general practitioners. A total of 16,666 doctors were at that time exercising their profession in a self-employed capacity, among them 9,004 doctors were holding a contract with the largest Austrian health insurance fund, the Regional Health Insurance Fund. Among these 9,004 doctors holding a contract with the Regional Health Insurance Fund were 3,916 general practitioners.In Austria, the patient has the free choice of his or her doctors. There is no system of lists in which the patient has to be registered. The patient also has the right to change his or her doctor on a regular basis.The free choice of the doctor concerns also specialists, who are consulted by patients after transferral by the general practitioner, but there is also open access for the patient to the specialist. General practitioners in rural areas also have the right to dispense medicines.A post for a general practitioner with contracts is in general being created for approximately 2,000 patients in the catchment area. The actual number of patients varies due to the free choice of the doctor by the patient and depending on the popularity of the doctor.The remuneration system of the health insurance funds is in general structured into two parts. Most collective agreementscontain a lump sum, which the general practitioner receives for each patient in general per quarterly period. Besides this lump sum, doctors receive an additional remuneration for special services provided to patients such as home visits, laboratory examinations, etc.As the establishment of group practices in Austria is not yet possible, all doctors are working in a single practice.On-call duty outside official consultation hours of general practitioners is in general done by a group of neighbouring doctors being alternately on duty. It is incumbent on tin' medical associations to organise this emergency duty.

 

Inpatient sector
With the exception of emergencies, only patients who have a transferral by a self-employed doctor are entitled to hospital care. Nearly all hospital departments also have outpatient departments. These outpatient departments, however, are only authorised to provide those services which are not in reasonable reach for the patient outside the hospital. In general, these outpatient departments provide exclusively specialised services, which cannot be offered by the self-employed doctor due to the high costs relating to investments and continuing medical education (CME).Most of the hospitals are operated by the states and municipalities, some of them belong to Church orders or have private owners. Hospital doctors receive their income by the entity, as well as additional pay for duties during the night and at weekends. Public hospitals have besides this the possibility to reserve up to one quarter of their beds for private patients, who have, in addition to compulsory health insurance, a private health insurance. Patients making use of this special class, and respectively their private insurance, pay so-called medical fees, which are distributed among the concerned doctors and increase the income of hospital doctors.

 

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