7.2 Administration and governance
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Health care in Austria is characterised by the cooperation of a large number of actors. Competences in the health care sector are generally regulated by law. The main actors with regard to health at federal level are the Austrian Parliament, the Federal Ministry of Social Affairs, Health, Care and Consumer Protection (Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz), the social security institutions and advocacy groups (social partners: employers’ and employees’ representatives, as well as professional associations).
All insurers convene in the Main Association of Austrian Social Security Institutions (Hauptverband der österreichischen Sozialversicherungsträger). This umbrella organisation is responsible for safeguarding general social security interests and for representing the social security institutions in matters of common concern (e.g. concluding contracts with doctors, hospitals, etc.). It also represents the Austrian social security system in dealings with similar organisations abroad and, in an international context, acts as a focal point and liaison body in matters of health, accident and pension insurance.
Gesundheit Österreich GmbH (GÖG) is the research and planning institute of the health service and the agency for health promotion in Austria, which has been established by federal law (Bundesgesetz über die Gesundheit Österreich GmbH). Its sole shareholder is the Republic of Austria, represented by the Federal Ministry of Social Affairs, Health, Care and Consumer Protection.GÖG works by order of the federal state, the federal health commission (Bundesgesundheitskommission, BGK), and the federal aim control commission. It is divided into three business units:
- Austrian Federal Institute for the Health Sector (Österreichisches Bundesinstitut für Gesundheitswesen, ÖBIG)
- Fund for a Healthy Austria (Fonds Gesundes Österreich, FGÖ)
- Federal Institute for Quality in the Healthcare System (Bundesinstitut für Qualität im Gesundheitswesen, BIQG)
Fonds Gesundes Österreich (FGÖ) is the national competence centre and central funding office for health promotion. The federal, provincial and local governments jointly cover its annual budget of EUR 7.2 million.The GÖG works by order of the federal state, the federal health commission (Bundesgesundheitskommission, BGK) and the federal aim control commission. Fonds Gesundes Österreich (FGÖ) is the national competence centre and central funding office for health promotion and one of the three business units of Gesundheit Österreich GmbH. The federal, provincial and local governments jointly cover its annual budget of EUR 7.2 m.
General distribution of responsibilities
As far as legislation and its enforcement are concerned, the Federal Government plays a central role. The Federal Ministry of Social Affairs, Health, Care and Consumer Protection(Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz)prepares laws and is responsible for theprotection of public health and the overall health policy. It also acts as a facilitator between the different stakeholders of the health care system, as a decision maker, and as a supervisory authority. However, many competences are delegated to the federal states or the social security institutions.
The Federal Government is in charge of defining the legislation for out-patient care (physicians in individual practices). Responsibility for in-patient care (provided in hospitals) is shared between the federal and the regional level: the Federal Government lays down the legislative framework whilst the federal states are in charge of defining implementing legislation and ensuring implementation. All regulations regarding pharmaceuticals, pharmacies, medical devices and health professions (e.g. education of physicians) and structural policy are the responsibility of the Federal Government.
In 2011, the Federal Health Commission (Bundesgesundheitskommission) and the Austrian Council of Ministers (Ministerrat) requested the development of health targets at federal level. The Austrian Health Targets were then formulated by all relevant stakeholders. They provide a framework for coordinated action that is backed by all institutions involved. Intersectoral working groups made up of representatives of all relevant institutions and organisations define sub-targets and concrete actions, which allows a systematic, consistent and sustainable implementation of the measures within all institutions.
Furthermore, a coordination unit for child and youth health has been established and delegated to the Austrian Public Health Insititute (Gesundheit Österreich GmBH, GÖG) and a coordination unit for health promotion has been installed at the Federal Ministry of Education, Science and Research (Bundesministerium für Bildung, Wissenschaft und Forschung).
The Austrian Health Targets
Since population health is profoundly influenced and determined by many sectors other than the health care sector, the Austrian health targets (Österreichische Gesundheitsziele) were defined in a broad and participatory process that involved more than 40 stakeholders from relevant institutions and civil society.
- 4 provincial representatives, nominated by the provincial liaison offices
- Forum of Austrian working groups on health (Forum österreischischer Gesundheitsarbeitskreise, Aks Austria)
- Association of Patients' Ombudspersons (ARGE Patientenanwälte)
- Austrian Association of Cities and Towns (Österreichischer Städtebund)
- Austrian Association of Municipalities (Österreichischer Gemeindebund)
- Austrian Chamber of Pharmacists (Österreichische Apothekerkammer)
- Austrian Economic Chamber (Österreichische Wirtschaftskammer)
- Austrian Health Care and Nursing Association (Österreichischer Gesunden- und Krankenpflege Verband)
- Austrian Health Insurance Fund (Österreichische Gesundheitskasse)
- Austrian League for Children's and Young People's Health (Liga für Kinder und Jugendgesundheit)
- Austrian Medical Association (Österreichische Ärztekammer)
- Austrian National Youth Council (Bundesjugendvertretung)
- Austrian Senior Citizens' Council/Retiree Association of Austria (Österreichischer Seniorenrat)
- Austrian Society of Public Health (Österreichische Gesellschaft für Public Health)
- Austrian Trade Union Federation (Österreichischer Gewerkschaftsbund)
- BAG federal free welfare association (Bundesarbeitsgemeinschaft freie Wohlfahrt)
- European Anti-Poverty Network Austria (Armutskonferenz)
- Federal Chancellery of Austria (Bundeskanzleramt)
- Federal Ministry of Agriculture, Regions and Tourism (Bundesministerium für Landwirtschaft, Regionen und Tourismus)
- Federal Ministry for Climate Action, Environment, Energy, Mobility, Innovation and Technology (Bundesministerium für Klimaschutz, Umwelt, Energie, Mobilität, Innovation und Technologie)
- Federal Ministry of Defence (Bundesministerium für Landesverteidigung)
- Federal Ministry of Education, Science and Research (Bundesministerium für Bildung, Wissenschaft und Forschung)
- Federal Ministry of Europe, Integration and Foreign Affairs (Bundesministerium für Europa, Integration und Äußeres)
- Federal Ministry of Finance (Bundesministerium für Finanzen)
- Federal Ministry of Labour, Social Affairs, Health and Consumer Protection (Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz)
- Federal Ministry for Digital and Economic Affairs (Bundeministerium für Digitalisierung und Wirtschaftsstandort)
- Federal Parents' Association (Bundesverband der Elternvereine)
- Federation of Austrian Industries (Industiellenvereinigung)
- Health-care institution of the City of Vienna (Krankenfürsorgeanstalt der Stadt Wien, KFA)
- Main Association of Austrian Social Security Institutions (Hauptverband der österreichischen Sozialversicherungsträger)
- Umbrella organisation of technical medical services (Dachverband der gehobenen medizinisch-technischen Dienste Österreichs, MTD Austria)
- Professional Association of Austrian Psychologists (Berufsverband Österreichischer PsychologInnen)
- Social Insurance Institution for Austrian Railway and Mining Industries (Versicherungsanstalt für Eisenbahn und Bergbau)
- Vienna Chamber of Labour (Arbeiterkammer Wien)
- Providing health-promoting living and working conditions for all population groups through cooperation of all societal and political areas
- Promoting fair and equal opportunities in health, irrespective of gender, socio-economic group, ethnic origin and age
- Enhancing health literacy in the population
- Securing sustainable natural resources such as air, water and soil and healthy environments for future generations
- Strenghtening social cohesion as a health enhancer
- Ensuring conditions under which children and young people can grow up as healthy as possible
- Providing access to a healthy diet for all
- Promoting health, safe exercise and activity in everyday life through appropriate environments
- Promoting psychosocial health in all population groups
- Securing sustainable and efficient health care services of high quality for all
For the implementation of the Austrian Health Targets, intersectoral working groups define sub-targets and concrete actions. All relevant institutions and organisations are represented in these working groups, for the proposed objectives and measures to be adequately implemented in the respective institutions/organisations. In this way, a systematic approach and consistency as well as sustainability in the realisation of the measures are ensured.
The implementation of the Austrian Health Targets is accompanied by a monitoring process. This serves the purpose of strategic management and is intended to contribute towards optimised strategy and action plans. The goals and key elements of the monitoring process were drawn up by the Austrian Public Health Institute (Gesundheit Österreich GmbH, GÖG), coordinated with the Health Targets plenary, and adopted by the Federal Health Commission (Bundesgesundheitskommission).
The monitoring process acts contains three levels:
- At the level of the 10 Austrian Health Targets, meta indicators were defined with experts which enable statements to be made on the achievement of goals.
- At the level of objectives, indicators are to be drawn up in the respective working groups.
- At the level of measures, the responsible institutions in the working group define at least one benchmark which is designed to make the level of implementation of the measure visible. At regular intervals, the current state of affairs is ascertained. Thereby, the working groups and the Health Targets plenary are able to reflect upon the monitoring results regularly and to use this information to plan the next steps.
The monitoring of the Austrian Health Targets takes place in coordination with the monitoring of other strategies such as the health reform process, the health promotion strategy and the health strategy for children and young people.
The Austrian Child and Youth Health Strategy (Kinder- und Jugendgesundheitsstrategie)
In order to sustainably improve the health of children and adolescents, the former Federal Ministry of Health, now the Federal Ministry of Social Affairs, Health, Care and Consumer Protection (Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz), conducted the Child Health Dialogue with a total of 180 experts from various fields of child and adolescent health and developed a Child and Youth Health Strategy.
The strategy is composed of five thematic areas with a total of 20 objectives. The thematic areas are:
- The Social framework
- A Healthy start in life
- Healthy development
- Health equity
- Care for sick children and adolescents in specific areas