Alfons F. Hammerle
Dept. of Anaesthesiology and Intensive Care Medicine,
Medical University of Vienna
Dr Alfons Hammerle gives an account of statistics profiling the general health care in Austria, and outlines recommendations for reform.
The population in Austria increased between 1991 and 2001 by 3%, to around 8 million, primarily due to an increase in the age groups over 45; the birth rate has declined continuously since 1991. By the year 2020 the population of Austria will have grown to 8.3 million, with a demographic profile of one out of five Austrians older than 64.
State of Health
The most recent data show that life expectancy in Austria is 78.5 years for men and 81.2 years for women. The average death rate per year is 79,000 (36,000 for men, 43,000 for women). The most significant causes of mortality are cardio-vascular diseases and cancer. Regarding potential years of life lost (death under 65 years), men have lost significantly more years of life than women due to accidents, injuries and poisoning, whereas in women cancer predominates.
In contrast to the trend of decreasing mortality, the number of hospital admissions has risen to around 2.4 million. For men the most frequent causes of hospital stays are injuries and poisoning, whereas the leading indications for women are pregnancy-related.
The cancer incidence rate is about 38,000 new cases per year (18,500 men and 19,500 women). In men, the most frequently localised tumours are the prostate (3,700 cases), lungs (2,600), colon/rectum (1,500) and the urinary bladder (1,200). In women, breast cancer (4,500) is followed by colorectal cancer (1,600) and pulmonary cancer (1,100).
Absence from work due to illness is primarily caused by colds or upper respiratory infections (970,000 cases in 2001), orthopaedics, rheumatology (460,000) and intestinal infections (23, 500).
In 2002 around 348,000 persons (4.3%) received nursing benefits. Levels of need are rising with age and thus the demand for nursing care is growing: the relevant share is more than 50% among persons over 80 years. The majority, i.e. 3 out of 4 of the population, believe that their own state of health is very good or good, and the better educated a person is, the more satisfied they are with their state of health.
Factors Influencing Health
The share of overweight persons aged over 15 years (Body-Mass-Index BMI 26-30) has risen to 27.6% in men and 17.1% in women (total about 1.5 million people). 10.8% of men and 10.2% of women (total around 700,000 people) are massively overweight (BMI over 30). Approximately 8.3% of the Austrians over 15 years are suffering from arterial hypertension (530,000 people). Around 11% have total cholesterol levels of more than 200 mg/dl. According to experts more than 500,000 persons in Austria suffer from diabetes mellitus.
30% of the population are daily cigarette smokers (men 36%, women 27%). The share and number of female smokers, in particular young people, is rising. The number of chronic alcoholics is estimated to be around 330,000 (20% of them female).
Health Promotion and Prevention
The national expenditures for health promotion and preventive care are 85% covered by the social insurance funds (722M Euros). A further 66M Euros are sourced from the Federal Government. Additional contributions of 46M Euros are supplied by the provinces and 13.5M Euros by Local Governments.
Implemented measures of health care and preventive health care differ between the provinces.
Between 1997 and 2001, 569,000 women and 370,000 men on average underwent precautionary medical examinations (10.1% of men and 14.1% of women).
Health Care Institutions
Approximately 150 hospitals of the Provincial Hospital Funds and 7 accident hospitals of the Austrian Social Insurance for Occupational Risks provide for inpatient care of acute cases in Austria. Besides the Fund hospitals, health care services are offered by about 40 private hospitals. In the year 2000, Fund hospitals had a total number of 50,500 beds, an occupancy rate of 84% and treated 2.4 million inpatients with an average length of stay of 5.9 days. Inpatient staff comprises about 7,400 full-time equivalents (FTEs) of physicians and 39,300 FTEs of occupation groups.
Extramural medical care is covered by a total of approximately 16,400 established physicians
The Austrian Red Cross leads the ambulance services, which has 460 centres. Around 100 have cars or ambulances for emergency physician`s services. These centres pay for 4,000 staff and have about 30,000 voluntary workers and around 2,200 young men performing social military service. In the field of mobile nursing and social services, approximately 7,900 FTE skilled nurses and other skilled care staff, nursing assistants or assistants for elderly patients work throughout the whole of Austria.
Austria has approximately 1,200 public pharmacies, which equates to 1 public pharmacy for every 6800 inhabitants. Additionally pharmacy services are provided by 8,200 doctor`s pharmacies of established physicians. In 2001, health expenditures in Austria amounted to approximately 16.4 billion Euros, or 7.7% of the gross domestic product. About 68% of this budget is accounted for by public health expenditures.
The following characteristics and trends are apparent in the Austrian Health Service:
• An uneven regional distribution of acute beds and hospitals;
• A continuously increasing number of hospital admissions, despite the gradual reduction in acute beds;
• An increase in the number of outpatient contacts;
• An uneven regional distribution of rehabilitation capacities;
• A rapidly expanding need for long-term care, and institutions dedicated for this purpose;
• Continuously increasing costs in the health and social sectors.
An integrative planning of the health care sector therefore seems advisable. According to Article 15a of the Federal Constitutional Act, this integrative planning should include all sectors of health care.