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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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