Austria: #23 in the 2022 World Index of Healthcare Innovation
Though Austrian patients enjoy a broad range of private choices, the country is slipping on measures of quality and fiscal sustainability.
By Gregg Girvan and Avik Roy
Introduction
Austria ranks 23rd in the 2022 World Index of Healthcare Innovation, with an overall score of 45.33, down from 19th in 2021 and 18th in 2020. Austria performed adequately in Science & Technology (16th), partly because of its research and development sector.
On the flip side, Austria ranks 24th for Quality, weighed down by the worst ranking for patient-centered care in the Index. For Choice, Austria ranks 21st, with a high level of freedom to choose healthcare services that counters relatively low access to new treatments.
Austria also performed poorly on Fiscal Sustainability (25th), largely because of its score for public healthcare spending.
Background
Austria, like many countries in central Europe, has a private health-insurance-oriented healthcare system based on “Bismarckian” principles, so-called because the first of these systems was built in Germany by chancellor Otto von Bismarck in 1883. The Austro-Hungarian Empire followed suit in 1887. Many other countries descended from the Austro-Hungarian Empire — including Hungary, the Czech Republic, and Slovakia — also trace their lineage to the Bismarckian model.
Today, healthcare in Austria is governed both at the federal level and at the state (Länder) level. In 2020, Austria merged one regional health insurer from each of the country’s nine Länder into one Austrian health insurance fund (Die Österreichische Gesundheitskasse).
Maximum drug prices are capped by the federal government, but direct negotiation of drug prices is done by the health insurers’ trade association, the Main Association of Austrian Social Security Institutions (Hauptverband der österreichischen Sozialversicherungsträger). For drugs that are not reimbursed by insurance, pricing is unregulated until a specific drug exceeds €750,000 in revenue in Austria. Austrian utilization of generic drugs is low, because pharmacies are not allowed to substitute generic drugs for branded ones if the doctor prescribes the branded version.
Quality
Much like most of western Europe, Austria’s life expectancy is among the highest in the world, at about 82 years. Even so, its Quality ranking of 24th is mixed. Austria receives higher marks for disease prevention (16th), due to lower rates for both hospital admissions and treatable mortality. In contrast, Austria fell to dead-last in the Index for patient-centered care (32nd), with especially low ratings on transparency and physician consultation time.
Choice
Austria comes in at 21st for Choice. Austria ranks in the middle of the Index on provider choice, while the cost of insurance is growing increasingly less affordable. It also ranks behind most countries in the Index in access to new treatments (26th). Not only does Austria have one of the lowest generic drug market shares in Europe, but it is now lagging in bringing low-cost biosimilars to market.
Science & Technology
Though Austria is no longer the medical innovation powerhouse it was during its imperial heyday, the central European nation nevertheless holds its own, ranking 16th overall for Science and Technology. The Science and Technology ranking includes rankings of 12th for medical innovation, 18th for scientific innovation, and 22nd for health digitization. Even so, Austria has not had any Nobel laureates in chemistry or medicine or physiology over the last 20 years, either by nationality or within Austrian institutions.
Fiscal Sustainability
Austria ranks 23rd overall for Fiscal Sustainability. In particular, Austria has a relatively high amount of public healthcare spending (8.0 percent of GDP, 24th). Austria’s overall fiscal situation is also uncertain, with a debt-to-GDP ratio of 83.2 percent (21st). On the bright side, its growth in public healthcare spending has been somewhat stable, having increased 0.7 percent of GDP over the last 10 years (17th).
