Austria: #19 in the 2021 World Index of Healthcare Innovation
Though Austrian patients enjoy a broad range of private choices, public health care spending is rising at a troubling rate.
By Gregg Girvan and Avik Roy
Introduction
Austria ranks 19th in the World Index of Healthcare Innovation, with an overall score of 45.33. Austria performed adequately on several dimensions. For Quality, it ranks #16 (score: 50.86), highlighted by a developed health care infrastructure; for Choice, it ranks #18 (55.45), bolstered by its strength in offering affordable options for coverage and care; and for Science & Technology, it ranks #16 (29.84), in part because of a developed system of electronic health records.
On the flip side, Austria was poor in Fiscal Sustainability (#23, 45.16), owing to the scale of its public health care spending obligations.
Background
Austria, like many countries in central Europe, has a private health insurance-oriented health care 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 owe their lineage to the Bismarckian model.
Today, health care in Austria is governed both at the federal level and at the state (Länder) level. Austria has 18 private insurers, known as “sickness funds,” including at least one in each of the nine Länder.
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, or HVB). For drugs that are not reimbursed by insurance, pricing is unregulated until a specific drug exceeds €750,000 in revenue in Austria. The utilization of generic drugs is low in Austria, because pharmacies are not allowed to substitute generic drugs for branded ones if the doctor prescribes the branded version.
Quality
Much like the rest of western Europe, Austria’s life expectancy is among the highest in the world at 81.5 years. Even so, its Quality ranking of #16 is mixed. While Austria has handled its response to the pandemic relatively well, its ranking in measures of preventable disease (#19) is driven by lower scores in acute care survival, hospital admission rates, and cancer survival rates. Austria ranks about average in patient-centered care (#15), while its infrastructure scores higher (#10), with a high number of primary care doctors per capita complimenting efficient hospital capacity.
Choice
Austria comes in at #18 for Choice. Austria ranks in the middle of the Index on health insurance affordability and provider choice. It also ranks around average for access to new treatments; given its above-average access to new novel drugs as well as biosimilars, it would rank higher if not for having one of the lowest generic drug market shares of all the countries in the Index.
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 #16 overall for Science and Technology. The Science and Technology ranking includes #11 for medical innovation, #18 for scientific innovation, and #14 for health digitization. Even so, Austria has not had any Nobel laureates in chemistry or medicine/physiology over the last 20 years, either by nationality or within Austrian institutions.
Fiscal Sustainability
Austria ranks #23 overall for fiscal sustainability. In particular, Austria has a relatively high amount of public health spending (7.6% of GDP, #25). Austria’s overall fiscal situation is also uncertain, with a debt-to GDP ratio of 70% (#20). On the bright side, its growth in public health spending has been stable, having remained at virtually the same percentage of GDP over the last 10 years (#15).
