1. Effiency and distribution in Austrian healthcare: An attempt of benchmarking Walter Habacher Advisor: Prof. Dr. Gerald Pruckner

2. Austrian Health System Austrian patients are very satisfied with their health care system. The WHO ranks the system among the best in the world. (WHO 2000) Comprehensive admission Nearly no limitation Comparably short waiting time for elective operations But expensive Health costs since 1990 have tripled and GDP has only doubled, now 11,0% of GDP, Netherlands 12,0%, Poland 7,4% In absolute figures of public health expenditures: 1990 8,372 billions, 2010 23,957 billions

3. Results OECD health data 2011 Life expectancy Austria 80,4 years Switzerland 82,4 years Hungary74,0 years Healthy life years at birth Austria 60 years Sweden70 years Slovak republic51 years Infant mortalityAustria 3,8% Island 1,8% Slovak republic5,7% Mortality of cancer per 100.000 male Austria 194 Sweden 165 Hungary316

4. Results Lung cancer maleAustria 45 Sweden 29 Breast cancer Austria21 Spain 16,4 Denmark28,6 Ischemic heart disease Austria124 France 50 Slovak republic324

5. Smoking OECD 2009 Daily smoker Austria 23,6%Sweden 13,8% Teenager below 15 years, girls Austria 30%Sweden 9% AlcoholAustria 12,2 l per yearsNorway 6,7% Teenager below 15 years at least twice drunks Austria 36% girls, 41% boys Switzerland 18% girls, 29% boys Italy 8% girls, 22% boys Obesity Austria 12,4% Switzerland 8,1% UK 23%

6. Thesis Comprehensive descriptions Austria health care system is of high quality, comparable equitable, but costly Why? Potential reforms (best practice)

7. Health Care Systems Taxfinanced (Beveridge) NHS Social security system (Bismarck) Austrian health system is mixed 58% of public expenditures from social security 42% tax financed

8. Problems 1.Utilisation of health care services 2. Financing 3. Prevention

9. Utilisation of health care services Consultations with doctors per year Austria 6,9 Sweden 2,9 Slovak republic12,1 Hospital discharges per 1000 Austria 26,5 Netherlands 11,7 OECD-average15,8 Hip and knee replacement, MR and CT high above OECD-average Drug expenditures have quadrupled since 1990

10. Financing Austrian health care system is complicated 35 different sickness funds Central government delegates responsibility for primary care to regional sickness funds Laender are responsible for secondary care, receive the money from central government and sickness funds Disadvantage: no single payer

11. Prevention No general plan to reduce the consum of alcohol and tobacco Health care system is concentrated on treatment, while neglecting prevention, which would be more efficient

12. Reform options General  One single payer  Managed care  Reducing of consuming excess health care services  Quality management Outpatient  Sickness funds  Reducing drug use  Care of chronic diseases  Financing of outpatient departments

13. Reform options Inpatient  Improvment of efficieny of hospitals  Reducing hospital beds  Specialising of hospitals Lifestyle  Promoting al healthy life style  Less alcohol and tobacco  Healthy nutrition  More exercise