Hofmarcher Maria M, Quentin Wilm
European Centre for Social Welfare Policy and Research.
Berlin University of Technology and European Observatory on Health Systems and Policies.
Health Syst Transit. 2013;15(7):1-292.
This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry. One of the key weaknesses of the health-care system is in the prevention of illness. Spending on preventive medicine, at 2% of total health spending, is significantly lower than the EU15 and OECD average (both 3%), and also shows a below-average rate of growth. It remains to be seen whether the focus on health promotion and prevention of the 'framework health goals' approved in 2012 will be translated into concrete measures, whether clear responsibilities for implementation can be assigned, and whether sufficient funding will be made available. This would be likely to improve the health of the Austrian population and would help to reduce costs associated with preventable diseases.
对奥地利卫生系统的这一分析审视了组织与治理、卫生筹资、医疗服务提供、卫生改革及卫生系统绩效方面的近期发展情况。奥地利卫生系统为广泛的福利和高质量医疗提供全民覆盖。自由选择医疗服务提供者以及不受限制地使用所有医疗层级（全科医生、专科医生和医院）是该系统的特色。不出所料，民众满意度远高于欧盟平均水平。自2005年以来，与收入相关的健康不平等有所增加，不过与其他国家相比仍相对较低。医疗系统受到国家联邦结构以及将责任委托给自治利益相关方这一传统的影响。一方面，这使得规划和治理能够分散化，以适应地方规范和偏好。另一方面，这也导致责任分散，经常造成协调不足。因此，数年来一直在努力在联邦和地区层面实现医疗系统更多的联合规划、治理和筹资。与任何卫生系统一样，仍存在一些挑战。医疗系统的成本无论从绝对值还是占国内生产总值的百分比来看都远高于欧盟15国平均水平。医疗服务提供方面存在重要的结构失衡，医院部门规模过大，而门诊护理和预防医学可用资源不足。这还伴随着在治疗服务（医院病床和专科医生）以及预防服务（如预防性健康检查、门诊康复、心理社会和心理治疗护理及护理）的利用上存在明显的地区差异。在医疗服务的使用上，如预防性健康检查、免疫接种或牙科，存在明显的社会不平等。医疗系统的一个关键弱点在于疾病预防。预防医学支出占卫生总支出的2%，显著低于欧盟15国和经合组织平均水平（均为3%），且增长率也低于平均水平。2012年批准的“框架健康目标”对健康促进和预防的关注能否转化为具体措施、能否明确分配实施责任以及能否提供足够资金，仍有待观察。这可能会改善奥地利民众的健康状况，并有助于降低与可预防疾病相关的成本。
