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Primary Care in Austria
By Dr. Reinhold Glehr
General Practitioner Styria /Austria
President of OEGAM (Austrian Society for GP/FM)
Some figures about Austria:
About 8.4 million inhabitants; life expectancy for a female at birth is 82.9 years; for a male this is 77.4 years (2009). An aging population by a falling fertility rate (1,39 in 2009) and by an increase of life expectancy by about 8 years over the past 30 years. Women' s average age at first birth about 28 years. As a consequence the need for long-term-care has increased.1
Density of physicians is 5 per 1 000 inhabitants; number of general practitioners about
12 000, number of specialists about 18 000, physicians in training about 6 000. Density varies from 7,3 / 1000 in Vienna to 3,5 / 1000 in rural areas. Of this number of physicians about 18 900 (general practitioners and specialists) are selfemployed working in own selfemployedworking in own practices.1
Health insurance is compulsory in Austria. 22 social security institutions exist under the umbrella of the Main Association of Austrian Social Security. There is no competition between these institutions. It is not possible for the people to choose the social security fund free, the membership depends on the kind of profession.
Out-patient care is mostly provided by self-employed physicians running their own-practices. Only a third of them have signed a contract with social health insurances. Insured patients consult contract physicians about 6.8 times a year on average. In contrast to many other European countries, there is no obligation to enrol with a specific physician or to consult them prior to accessing specialised treatment in the outpatient or inpatient sector. That means: General practitioners have no gate-keeping function.
The performance of the Austrian Health System is ranked by WHO on the 9th position globally2 and the satisfaction within the population is among the highest in Europe3. The high satisfaction might be explained by almost universal social insurance coverage (98% of the population) and by offering comprehensive services at brief waiting times.4 There is an emphasis on hospital centred care. With regard to the number of in-patient- stays Austria ranks first in Europe (28.4 hospital admissions per 100 inhabitants). In 2007, 10.3% of gross domestic product was spent on health. 33,5% was spent on in-patient care, 18,2% on out-patient care.3 A recent study5, based on an assessment tool created by Barbara Starfield, described the development of primary care in Austria as "low", ranking as 10th among 14 countries. This can be partly explained by the following points: A gate-keeping system is not implemented and "free choice of physician" is valued by the population. GPs are not considered as a specialty and earn much less than regular specialists. General practice training consists of 3 years which can be fully completed within a hospital setting. Two academic departments for general practice are implemented in Vienna and Salzburg, which gives hope for improvements of the scientific background of primary care.
Future: To improve out-patient-care the introduction of group practices for physicians of the same or different medical specialties was decided in 2010. Till now only few group practices exist because of difficulties in getting a social insurance contract.
Till now a long lasting debate on the reform of the post graduate training of general practitioners has not come to an end and a concept with more emphasis on a self-chosen personal doctor as entrance to the health system is similarly still in discussion.
1) GOG/OBIG 2010b; Statistics Austria 2010; OAK 2010, OZK 2010
2) Bjornberg, A. (2009). "Euro Health Consumer Index, Health Consumer Powerhouse."
3) OECD. (2010). "OECD Health Data 2010."
4) Hofmarcher, M. M. (2006). "Health Systems in Transition. Austria - Health system review." Copenhagen, WHO Europe.
5) Stigler, FL. (2010). "Masterthesis: The Future of Primary Care in Austria." The University of Manchester.