The principle of statutory health insurance, combined with the co-insurance of children and non-working partners, ensures that 99% of the entire population enjoy health insurance coverage.
With the introduction of the minimum income scheme, its beneficiaries are covered by compulsory social health insurance as well.
Public expenditure on healthcare (according to ESSPROS) was almost USD 30.3 billion (EUR 22 billion) in 2011, i.e. roughly 7% of GDP or 25% of social expenditure. Outpatient and inpatient care account for most (81%) of this expenditure. Another 15% are spent on income support provided by employers and by social health insurance schemes in cases of temporary incapacity to work due to illness. Irrespective of their individual amount of health insurance contributions, all individuals covered by any one of Austria’s social health insurance schemes are entitled to medical care by office-based physicians or hospitals.
In case of temporary incapacity to work, employees are entitled to sickness benefits which follow on the contin¬ued payment of wages by the employer (employers are obliged to continue paying wages for six to twelve weeks). If their illness continues, depending on an employee’s insurance record, sickness benefit receipt may vary between six months and one year. The minimum level of monthly sickness benefits is 50% of the previous gross pay. Eight weeks before and eight weeks af¬ter the birth of a child, mothers generally receive maternity allowance equivalent to their current income from work.
Conditions for entitlement to health insurance benefits
Although statutory health insurance is linked to gainful activity, it goes far beyond the scope of an insurance for workers. Insurance cover relates not only to direct insu¬rees but also to family members. Roughly one fourth of health insured individuals are co-insured family members (e.g. children, housewives or househusbands). Co-insurance is non-contributory for the following groups:
- individuals who care for the children or have done so for at least four years (e.g. non-working partner)
- nursing family members and beneficiaries of long-term care benefits
- particularly vulnerable individuals in need of social pro¬tection
Co-insured parties may opt into a voluntary insurance scheme to have an insurance of their own. On an annual average, around 130,000 persons were covered by such a voluntary self-insurance scheme in 2010.
Benefits in kind by statutory health insurance
Most of the benefits available under health insurance schemes are benefits in kind provided by insurance-run facilities (mainly clinics) or – primarily – by entities (hospitals) or office-based doctors under contracts con¬cluded with statutory health insurance (SHI). If patients consult other (i.e. non-SHI) physicians or entities, the costs incurred will be refunded (in part). Basically, all those covered by SHI are free to choose their physicians. If, however, insurees choose treatment by non-SHI phy¬sicians (‘doctor of choice’), they will have to prefinance this service. Up to 80% of the amount the SHI would be required to pay to SHI physicians for the same treatment will be refunded ex-post at the insuree’s request.
Furthermore, there are private insurance companies, which cover an even larger number of services and treatment options than public health insurance.