Austria holds a leading position in international quality of life and healthcare rankings. Legislation defines that social insurance is compulsory and based on the principle of solidarity. Income-based social insurance payments are made in return for benefits, regardless of the amount contributed. Once personal insurance is secured, a wide range of doctors and hospitals become available.
Social insurance applies to:
Social insurance registration
The registration to the responsible social insurance authority is performed by the employer for non-self-employed workers. The employer also takes care of the monthly payment of mandatory contributions, which include contributions from both employer and employee. The latter are deducted directly from the gross salary and indicated on the pay slip.
Those covered by social insurance receive an e-card. By presenting this card, it is possible to receive medical services at panel doctors without advance payment, provided the person is covered by the insurance. Services covered by the social health insurance are divided into four groups:
PRIVATE (SUPPLEMENTAL) HEALTH INSURANCE
In addition to the compulsory social insurance, it is also possible to take out private health insurance.
These contributions cover insurance services for accidents at the workplace or work-related injuries. Accidents at the workplace include those in the immediate locality of the workplace, within working hours, those caused in relation to work or accidents on the way to or from work.
The insurance agency is usually the AUVA (Allgemeine Unfallversicherungsanstalt– the Austrian Workers’ Compensation Board).
>> www.auva.at (English Information)
The e-card is a smartcard that can be used to obtain services (for example medical treatment and hospital care) without payment in cash. Panel doctors bill the services directly with the social insurance authority on presentation of the e-card.
An e-card is given to all those insured and serves as proof of insurance. It must be presented at every visit to a healthcare facility. The yearly service charge for the Card is deducted from the salary in November and is indicated on the pay slip.
General practitioners (GP)
The GP is a general doctor and first point of contact for illnesses and complaints of all kinds. GPs are free to choose from and many provide house calls in the local area if necessary.
Referral: After confirmation of the complaint, the GP refers the patient, if necessary, with a written referral (called ‘Überweisung’) to an appropriate specialist or a Hospital.
So-called panel doctors (called ‘Kassenärzte’ or ‘Vertragsärzte’), independent of specialization, have contracts with one or multiple insurance funds and bill treatment costs directly to them. There are no costs for patients, unless a deductible is payable. To find out if a doctor has a contract with a health insurance fund, access www.aekooe.at/arztefinder.
+ Direct billing to the health insurance fund (without deductible in most cases)
- Potentially longer waiting times due to the high demand (appointments, visits) if the complaint is not acute, or shorter doctor-patient sessions.
Doctors of one’s choice
A doctor of one’s choice (known as ‘Wahlarzt’) does not have a contract with a health insurance fund and bills the treatment costs directly to their patients. Up to 80 % of the costs which a panel doctor would receive for the same services can be claimed back from the health insurance, provided it is a scientifically recognized treatment. As there are many exemptions, the actual reimbursement from the health insurance fund is often only 20 % to 30 % of the list price for the treatment.
+ Prompt allocation of appointments/short waiting times
+ More time for discussing the diagnosis
- Treatment costs are to be paid by the patient, and only partly reimbursed
All patients are entitled to admission to the ‘standard class’ of care in a public hospital.
Please note the days of admission (‘Aufnahmetage’) of the respective public hospitals in Linz
State hospitals in rural areas, on the other hand, always allow admission.
For every medication listed on a prescription from a panel doctor, a prescription fee is payable at the time of purchase at the pharmacy for each package. Medication can be obtained directly from some doctors or from a pharmacy.