Health Expenditure in Austria

Health expenditure in Austria according to “System of Health Accounts” – results

The table ‘Overview - Health expenditure in Austria’ based on the ‘System of Health Accounts (SHA)’ illustrates the development of Austrian health care spending for the years 2004 to 2018. Health expenditure according to SHA consists of current health expenditure and gross capital formation in health care provider industries.

In 2018, current health expenditure in Austria according to SHA accounted for €39 791 million or 10.3% as a share of gross domestic product (GDP). Furthermore, health care provider industries spent €2 781 million on gross capital formation. Current health care expenditure (at current prices) increased on average by 3.8% annually from 2004 to 2018. The nominal increase from the beginning of the time series in 1990 to 2018 is on average 4.8% per year. As a share of GDP, current health expenditure increased from 7.8% in 1990 to 10.3% in 2018.

Current health expenditure – public

Public current health expenditure consists of general government expenditure, which includes expenditure by central, state and local governments as well as social health insurance. In 2018, public current expenditure on health amounted to €29 725 million or a share of 74.7% of all current health care spending. Taking public gross capital formation into account, public expenditure amounted to €31 156 million.

The biggest share of general government expenditure on health (45.8%) in 2018 was spent on inpatient care (incl. inpatient long-term care). The other main spending categories were outpatient care (26.5%), pharmaceutical products, medical durables and non-durables (13.5%) and home-based health care (8.0%).

In the period from 2004 to 2018 public current health expenditure rose from €17 267 million to €29 725 million, which corresponds to an average annual growth rate of 4.0%. In the time series from 1990 to 2018 expenditure increased on average by 4.8% annually.

Over the time series from 2004 to 2018, the development was strongest for patient transportation and emergency rescue (5.0%) and for outpatient care (4.4%). However, the yearly increase of health administration (3.2%) and pharmaceutical products, medical durables and non-durables (3.1%) was considerably lower than the average annual growth rate of public current health expenditure (4.0%).

Current health expenditure – private

Private current health care expenditure consists of household out-of-pocket payments, expenditure by private insurance enterprises, non-profit institutions serving households (NPISHs) as well as expenditure by corporations on occupational health care.

Household out-of-pocket payments and expenditure by private insurance enterprises accounted for the largest share of private current expenditure on health. Their expenditure was spent on inpatient care, outpatient care, pharmaceutical products, medical durables and non-durables and health administration (private health insurance). Within the table containing the time series from 2004 to 2018, the outpatient services are separated into outpatient care, home-based health care, patient transportation and emergency rescue and prevention.

In 2018, private households and private insurance enterprises spent €9 348 million on health care. With a share of 31.3%, the largest expenditure category of private households and private insurance enterprises was outpatient care. Another 28.7% were spent on pharmaceutical products, medical durables and non-durables, while the third largest share (28.3%) was allocated to inpatient care. 7.7% were spent on health administration, 2.2% on home-based health care, 1.4% on prevention and 0.4% on patient transportation and emergency rescue.

Health care expenditure by private households and insurance enterprises grew from €5 900 million in 2004 to €9 348 million in 2018, which amounts to an average annual growth rate of 3.3%. From 1990 to 2018, expenditure per year grew by 4.7%. 

Spending on home-based health care saw a relatively strong increase (17.6%) over the time series from 2004 to 2018. Among other things, this increase can be explained with data for 24-hour care, which are included since 2008. Home-based health care without 24-hour care increased by 7.8%. The expenditure category with the second largest growth rate was patient transport and emergency rescue with 4.0%, followed by prevention and inpatient care with 3.5% each.

Current health spending of non-profit institutions serving households (NPISHs) and corporations amounted to €633 million and €85 million, respectively. The average annual growth rate of 4.9% for NPISHs and 5.6% for corporations’ health care expenditure clearly overtook the relative gains of household’s and insurance enterprises’ health care spending (3.3%) over the period from 2004 to 2018.

Gross capital formation

Health care provider industries allocated €1 517 million to gross capital formation in 2004. In 2018, the amount increased to €2 781 million. This €2 781 million can be divided into a public share of €1 431 million (51.5%, e.g. for hospitals) and a private share of €1 350 million (48.5%, e.g. by medical practitioners, specialists and dentists). The average annual growth rate exhibited 4.4% between 2004 and 2018, the increase from 1990 to 2018 was 4.8% on yearly average.

Health care expenditure according to the SHA dimensions: HF, HP, HC

The three SHA-dimensions financing scheme (HF), health care provision (HP) and functions of health care (HC) establish an accounting framework for health care expenditure. On the basis of these dimensions one three-dimensional and three two-dimensional tables can be generated to efficiently illustrate a country’s health care expenditure.

Current health care expenditure in Austria amounted to €39 791 million in 2018, of which €12 032 million (30.2%) were borne by central, state and local governments (HF.1.1) and another €17 693 million (44.5%) by social health insurance (HF.1.2.1).Private households (HF.3) spent €7 308 million on health care services and goods, which accounts for 18.4% of Austrian current health expenditure in 2018. 9.7% thereof were cost sharing with social health insurance schemes (HF.3.2.1).

Voluntary health insurance schemes (HF.2.1), NPISH financing schemes (HF.2.2) and enterprise financing schemes (HF.2.3) financed 5.1%, 1.6% and 0.2% of current health expenditure, respectively. In total, 6.9% of current health expenditure was borne by voluntary health care payment schemes (HF.2).

By health care provider industries (HP), the largest share of current health expenditure, €15 368 million (38.6%), was spent on services provided by hospitals (HP.1). These were mainly financed by social health insurance (HF.1.2.1) with 47.6% and by government schemes (HF.1.1), with a share of 43.1%. The remaining 9.3% were spent mainly by voluntary health insurance schemes (HF.2.1) and private households (HF.3). Of the €15 368 million for services provided by hospitals €12 645 million were paid for services of curative and rehabilitative inpatient care (HC.1.1, HC.2.1), €278 million for day care services (HC.1.2) and €2 444 million for services of outpatient curative care (HC.1.3).

Services by ambulatory health care providers (HP.3) accounted for €9 147 million or 23.0% of current health expenditure. Thereof, €4 098 million were allocated to services provided by physicians (HP.3.1) and €1 936 million to services by dentists (HP.3.2). The remainder of €3 113 million was spent on services provided by other health practitioners (HP.3.3), ambulatory health care centres (HP.3.4) and providers of home health care services (HP.3.5). Ambulatory health care providers were mainly financed by social health insurance (HF.1.2.1), with a share of 56.5% (5 168 million). Private households (HF.3) spent  €2 832 million (31.0%) – including 259 million cost sharing with social health insurance schemes (HF.3.2.1) – while the remaining 12.5% were borne by government schemes (HF.1.1), voluntary health insurance schemes (HF.2.1) as well as NPISH financing schemes (HF.2.2).

A share of 15.5% of current health expenditure was spent on pharmacies and other providers of medical goods (HP.5), with €4 255 million for pharmacies (HP.5.1) and €1 926 million for all other retailers and suppliers of medical goods (HP.5.2, 5.9), respectively. The goods within this category (HP.5) were largely paid for by social health insurance (HF.1.2.1), with a share of 57.4%, and by private households (HF.3) with 39.6% or €2 448 million. Cost sharing with social health insurance (HF.3.2.1) made up 14.6% of the latter.

In 2018, a total of €3 456 million or 8.7% of total current health expenditure was spent on services of residential long-term care facilities (HP.2), of which 90.8% were spent on inpatient long-term care services (HC.3.1). The remaining 9.2% were spent on services of inpatient rehabilitative care (HC.2.1) and day long-term care (HC.3.2). Government schemes (HF.1.1) were the dominant financing scheme for residential long-term care facilities (HP.2) with a share of 58.3% followed by private households (HF.3) with 36.5%. Another 5.2% were contributed by NPISH financing schemes (HF.2.2).

Providers of ancillary services (HP.4) were responsible for 3.0% of current health expenditure in 2018, which amounts to 1 184 million. The expenditure for providers of patient transportation and emergency rescue (HP.4.1) amounted to 681 million and was financed with 36.4% by social health insurance schemes (HF.1.2.1), with 37.6% by NPISH financing schemes (HF.2.2) and with 20.4% by government schemes (HF.1.1). The remaining 503 million were allocated to medical and diagnostic laboratories, which were mainly (81.2%) paid for by social health insurance (HF.1.2.1).

Current expenditure on prevention (HC.6) amounted to €838 million in 2018. Government schemes (HF.1.1) financed 49.1% of expenditure on prevention, while social health insurance schemes (HF.1.2.1) and private households (HF.3) contributed 22.9% and 15.1%, respectively. The remaining amount was covered by enterprise financing schemes (HF.2.3), NPISHs (HF.2.2) and voluntary health insurance schemes.

Governance, and health system and financing administration (HC.7) accounted for €1 570 million of current health expenditure in 2018, 6.8% of which were borne by government schemes (HF.1.1), 47.4% by social health insurance (HF.1.2.1) and 45.9% by voluntary health insurance schemes (HF.2.1).

The category rest of economy (HP.8) comprised €2 279 million in total. On one hand, it includes private households as providers of long term care (HP.8.1) and on the other hand health care facilities of other economic sectors, e.g. of the military or judicial system. The larger share of the sum, namely €2 066 million, can be considered “remuneration” of households by long-term care allowance, whereas €213 million was spent in other economic sectors.

The category rest of the world (HP.9) is composed of all non-resident units carrying out transactions with the reference country. For this category the expenditure was €310 million in 2018, with 74.6% for outpatient health care (HC.1.3) and 19.5% for inpatient health care (HC.1.1, HC.1.2). 67.5% or €156 million from the outpatient care were spent on dental curative care.

Public current health expenditure for State Health Funds financed hospitals (SHF hospitals)

Public current expenditure for SHF hospitals is available by financing scheme and by functions of in- and outpatient health care for all nine provinces. SHF hospitals are acute care hospitals of public and private ownership, which are (partially) financed by the nine State Health Funds. These hospitals are responsible for 87.3% (2018) of all hospital stays of patients and thus represent the most important category of hospitals in Austria.

Public current expenditure for SHF hospitals amounted to €11 485 million in 2017 and €11 945 million in 2018. This is a growth rate of 4.0% since 2017. The largest share of expenditure was borne by social health insurance schemes (HF.1.2.1) adding up to 45.0% or €5 380 million in 2018, respectively. Central (HF.1.1.1), state (HF.1.1.2.1) and local governments (HF.1.1.2.2) spent €1 333 million, €3 956 million and €1 276 million. All in all, government schemes (HF.1.1) were responsible for 55.0% of the public spending for SHF.

Out of the total public current expenditure for SHF hospitals in 2018 80.8% (€9 650 million) were allocated to inpatient (incl. day care) (HC.1.1, HC.1.2) and 19.2% (€2 295 million) to outpatient health care (HC.1.3). The share spent on inpatient health care (incl. day care), thereby, varied between 86.4% in Vorarlberg and 78.0% in Vienna.

The largest amount of public current expenditure was spent on SHF hospitals in Vienna with €3 271 million, followed by Upper Austria with a sum of €2 043 million and Lower Austria with €1 939 million. At the low end of the scale Vorarlberg’s and Burgenland’s SHF hospitals received €479 million and €255 million, respectively. Concerning the financial sources within each federal state, large variations of shares exist: In 2018 the fraction of the total public current expenditure for SHF hospitals financed by the state governments (HF.1.1.2.1) was within a range of 42.7% in Vienna and 24.1% in Tyrol. Local governments (HF.1.1.2.2) had shares between 20.7% in Lower Austria on the one hand and on the other hand 1.6% in Styria and Vienna, respectively. More stable throughout the country were the contributions of social health insurance (HF.1.2.1) that varied between 52.2% in Carinthia and 38.3% in Lower Austria. The central government (HF.1.1.1) financed between 13.0% of total public current expenditure for SHF hospitals in Tyrol and 9.7% in Burgenland. The heterogeneity in the financing structure of SHF hospital, that becomes apparent in the numbers above, is mainly driven by differences in the state specific laws of the nine Austrian provinces.

Notes on health expenditure in Austria

The results presented here are compiled according to the “System of Health Accounts”. This system of comprehensive, consistent and internationally comparable health accounts was first published in May 2000 by the OECD in the manual „A System of Health Accounts“. In the meantime, the three organisations OECD, Eurostat and WHO have jointly published a revised version of the SHA manual (A System of Health Accounts, 2011 Edition).

In accordance with the European Commission implementing regulation (EU 2015/359) the Austrian health accounts have been compiled on the methodological basis of the revised manual for the first time in 2015/2016. The data to be provided by the Member States pursuant to this Regulation has to be structured according to the three SHA-dimensions health care financing (HF), providers (HP) and functions (HC) as defined in the revised version of the SHA-manual (2011). The 6 year validity period provided in the regulation (2016-2022) corresponds to a health expenditure time series covering the period from 2014 to 2020. The topics of this regulation’s renewal are currently subject to discussions in the European context.

At present, Austrian health expenditure according to SHA is available based on the original manual (OECD; 2000) for the period 1990-2003 and based on the revised manual (OECD, Eurostat, WHO; 2011) for the period 2004-2018.

In both versions of the SHA manual the compilation of current health expenditure data is based on the core dimensions financing (HF), providers (HP) and functions (HC) of health care. The definitions of the dimensions are, however, subject to some revisions. While the categories providers (HP) and functions (HC) of health care are only subject to minor changes (e.g. definition clarifications or conversion of subcategories into stand-alone categories), the category financing (HF) underwent a conceptual adaption. According to the original version of the manual the classification of financing arrangements was based on the source of financing and the financing agent concept, respectively. In contrast, under SHA 2011 financing arrangements are allocated on the basis of financing schemes. Health care financing systems are perceived as the key types of financing arrangements through which health services are paid for and people can get access to health care. Amongst others the following criteria can be used to distinguish financing systems: the mode of participation (mandatory or voluntary), the basis of benefit entitlement (e.g. universal or contributory), the basic method of fundraising (e.g. tax revenues or insurance contributions) and the pooling level (e.g. subnational or individual).

Even though some of the revisions are conceptually substantial, the implications of these changes for the compilation of Austrian health expenditure time according to SHA are only minor and comparability of the data is to the largest extend ensured. Apart from the minor increase in spending on prevention, minor shifts between categories – for instance due to the new financing concept or the conversion of subcategories into stand-alone categories - can be observed in the health expenditure tables by SHA dimensions HF, HP, HC.

While, on the one hand, the results derived from SHA provide a basis for political decision-making, they represent an essential input for researchers, on the other hand. Statistics Austria annually calculates Austrian health expenditure statistics. The data is reported to OECD, Eurostat und WHO and thus part of an international comparable database of health expenditure.

Overview - Health expenditure in Austria according to the System of Health Accounts (SHA) 2004-2018
Health expenditure in Austria according to System of Health Accounts (SHA), 1990 - 2018
Current expenditure on health care by functions, providers and financing schemes in Austria, 2018
Current expenditure on health care by functions and providers in Austria, 2018
Current expenditure on health care by providers and financing schemes in Austria, 2018
Current expenditure on health care by functions and financing schemes in Austria, 2018
Public current health expenditure for State Health Funds Hospitals by financing schemes and by state, 2018


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