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 2019. Health expenditure according to SHA consists of current health expenditure and gross capital formation in health care provider industries.
Additionally, the table “Health expenditure in Austria according to the System of Health Accounts (SHA) – Flash estimation 2020” includes provisional data on health expenditure for 2020.
The flash estimation for 2020 accounted for current health expenditure (according to SHA) of €43 181 million in Austria or 11.4% as a share of gross domestic product (GDP). Furthermore, the gross capital formation of health care provider industries amounted to €2 789 million.
The current health expenditure of central, federal, and local governments as well as social health insurances in 2020 amounted to €32 971 million. Public current health expenditure represented therefore a share of 76.4% of all current health expenditures. The public share of gross capital formation amounted to €1 509 million.
Private households, private insurance enterprises, non-profit institutions serving households (NPISHs) and corporations spent €10 210 million on health care services and goods. Additionally, gross capital formation of the private sector amounted to €1 280 million.
In 2020, provisional results for current health care
expenditure include health care expenditure related to the COVID
In contrast, due to restrictions during the lockdowns public as well as private health expenditure decreased in some areas in 2020 (eg. rehabilitation services, services in convalescent homes, medical and dental care, therapeutic appliances, etc.).
Current health expenditure based on the System of
Health Accounts (SHA) does not consider any subsidies or financial supports
concerning the COVID
The flash estimation covers the health expenditure on a higher aggregated level than the standard publication in February. Only current public and private health expenditure as well as public and private gross capital formation are published as results of the flash estimation. In particular, the three SHA dimensions financing schemes (HF), health care provision (HP) and functions of health care (HC) are not presented within the flash estimation.
In 2019, current health expenditure in Austria according to SHA accounted for €41 483 million or 10.4% as a share of gross domestic product (GDP). Furthermore, health care provider industries spent €2 675 million on gross capital formation. Current health care expenditure (at current prices) increased on average by 3.9% annually from 2004 to 2019. The nominal increase from the beginning of the time series in 1990 to 2019 is on average 4.8% per year. As a share of GDP, current health expenditure increased from 7.8% in 1990 to 10.4% in 2019.
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 2019, public current expenditure on health amounted to €31 209 million or a share of 75.2% of all current health care spending. Taking public gross capital formation into account, public expenditure amounted to €32 622 million.
The biggest share of general government expenditure on health (45.0%) in 2019 was spent on inpatient care (incl. inpatient long-term care). The other main spending categories were outpatient care (27.6%), pharmaceutical products, medical durables and non-durables (13.4%) and home-based health care (7.7%).
In the period from 2004 to 2019 public current health expenditure rose from €17 267 million to €31 209 million, which corresponds to an average annual growth rate of 4.0%. In the time series from 1990 to 2019 expenditure increased on average by 4.9% annually.
Over the time series from 2004 to 2019, the development was strongest for patient transportation and emergency rescue and for outpatient care (4.7% each). However, the yearly increase of pharmaceutical products, medical durables and non-durables and home-based health care (3.2% each) was considerably lower than the average annual growth rate of public current health expenditure (4.0%).
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 2019, the outpatient services are separated into outpatient care, home-based health care, patient transportation and emergency rescue and prevention.
In 2019, private households and private insurance enterprises spent €9 488 million on health care. With a share of 31.2%, the largest expenditure category of private households and private insurance enterprises was outpatient care. Another 29.7% were spent on pharmaceutical products, medical durables and non-durables, while the third largest share (26.8%) was allocated to inpatient care. 8.1% were spent on health administration, 2.5% on home-based health care, 1.3% 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 €9 488 million in 2019, which amounts to an average annual growth rate of 3.2%. From 1990 to 2019, expenditure per year grew by 4.6%.
Spending on home-based health care saw a relatively strong increase (17.3%) over the time series from 2004 to 2019. 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 7.4%. The expenditure category with the second largest growth rate was patient transport and emergency rescue with 4.0%, followed by pharmaceutical products, medical durables and non-durables with 3.3%.
Current health spending of non-profit institutions serving households (NPISHs) and corporations amounted to €692 million and €94 million, respectively. The average annual growth rate of 5.2% for NPISHs and 5.9% for corporations’ health care expenditure clearly overtook the relative gains of household’s and insurance enterprises’ health care spending (3.2%) over the period from 2004 to 2019.
Health care provider industries allocated €1 517 million to gross capital formation in 2004. In 2019, the amount increased to €2 675 million. This €2 675 million can be divided into a public share of €1 413 million (52.8%, e.g. for hospitals) and a private share of €1 262 million (47.2%, e.g. by medical practitioners, specialists and dentists). The average annual growth rate exhibited 3.9% between 2004 and 2019, the increase from 1990 to 2019 was 4.5% on yearly average.
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 €41 483 million in 2019, of which €12 646 million (30.5%) were borne by central, state and local governments (HF.1.1) and another €18 563 million (44.7%) by social health insurance (HF.1.2.1).
Private households (HF.3) spent €7 332 million on health care services and goods, which accounts for 17.7% of Austrian current health expenditure in 2019. 9.9% 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 5.2%, 1.7% and 0.2% of current health expenditure, respectively. In total, 7.1% 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, €16 028 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 47.4% and by government schemes (HF.1.1), with a share of 43.7%. The remaining 8.9% were spent mainly by voluntary health insurance schemes (HF.2.1) and private households (HF.3). Of the €16 028 million for services provided by hospitals €12 969 million were paid for services of curative and rehabilitative inpatient care (HC.1.1, HC.2.1), €206 million for day care services (HC.1.2) and €2 853 million for services of outpatient curative care (HC.1.3).
Services by ambulatory health care providers (HP.3) accounted for €9 550 million or 23.0% of current health expenditure. Thereof, €4 243 million were allocated to services provided by physicians (HP.3.1) and €2 029 million to services by dentists (HP.3.2). The remainder of €3 277 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 57.1% (€5 458 million). Private households (HF.3) spent €2 851 million (29.9%) – including 267 million cost sharing with social health insurance schemes (HF.3.2.1) – while the remaining 13.0% 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 15.6% of current health expenditure was spent on pharmacies and other providers of medical goods (HP.5), with €4 379 million for pharmacies (HP.5.1) and €2 091 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 57.3%, and by private households (HF.3) with 39.5% or €2 557 million. Cost sharing with social health insurance (HF.3.2.1) made up 14.3% of the latter.
In 2019, a total of €3 534 million or 8.5% of total current health expenditure was spent on services of residential long-term care facilities (HP.2), of which 90.4% were spent on inpatient long-term care services (HC.3.1). The remaining 9.6% 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 61.5% followed by private households (HF.3) with 33.1%. Another 5.3% 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 2019, which amounts to €1 237 million. The expenditure for providers of patient transportation and emergency rescue (HP.4.1) amounted to €723 million and was financed with 35.9% by social health insurance schemes (HF.1.2.1), with 40.9% by NPISH financing schemes (HF.2.2) and with 17.8% by government schemes (HF.1.1). The remaining €514 million were allocated to medical and diagnostic laboratories, which were mainly (83.0%) paid for by social health insurance (HF.1.2.1).
Current expenditure on prevention (HC.6) amounted to €869 million in 2019. Government schemes (HF.1.1) financed 50.1% of expenditure on prevention, while social health insurance schemes (HF.1.2.1) and private households (HF.3) contributed 22.6% and 13.7%, 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 €1 681 million of current health expenditure in 2019, 6.3% of which were borne by government schemes (HF.1.1), 47.7% by social health insurance (HF.1.2.1) and 46.0% by voluntary health insurance schemes (HF.2.1).
The category rest of economy (HP.8) comprised €2 286 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 €2 062 million, can be considered “remuneration” of households by long-term care allowance, whereas €224 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 €383 million in 2019, with 72.6% for outpatient health care (HC.1.3) and 20.7% for inpatient health care (HC.1.1, HC.1.2). 66.5% or €185 million from the outpatient care were spent on dental curative care.
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 86.4% (2020) 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 €12 575 million in 2019 and €13 433 million in 2020. This corresponds
to a growth rate of 6.8% since 2019 which is above the average annual
growth rate of 4.4% since 2004 (€6 747 million). The COVID
The largest share of expenditure was borne by social
health insurance schemes (HF.1.2.1) adding up to 43.3% or €5 821 million
in 2020, respectively. Central (HF.1.1.1), state (HF.188.8.131.52) and local
governments (HF.184.108.40.206) spent €1 512 million, €4 747 million and
€1 353 million. All in all, government schemes (HF.1.1) were responsible
for 56.7% of the public spending for SHF hospitals, which amounts to
a higher share than 2019 (55.3%). This is manly driven by additional
pandemic related spending which was mostly financed by the state governments
and the central government. State governments and central government
also exhibited the highest growth rates since 2019 with 12.1% and 8.4%.
The state governments provided additional financial resources to cover
pandemic related expenditure. The central government refunded certain
amounts of this spending according to the COVID
Out of the total public current expenditure for SHF
The largest amount of public current expenditure was
spent on SHF hospitals in Vienna with €3 803 million, followed by Upper
Austria with a sum of €2 276 million and Lower Austria with €2 175
million. At the low end of the scale Vorarlberg’s and Burgenland’s
SHF hospitals received €531 million and €307 million, respectively.
Concerning the financial sources within each federal state, large variations
of shares exist: In 2020 the fraction of the total public current expenditure
for SHF hospitals financed by the state governments (HF.220.127.116.11) was
within a range of 47.7% in Vienna and 25.7% in Upper Austria. Local
governments (HF.18.104.22.168) had shares between 19.5% in Lower Austria on
the one hand and on the other hand 1.2% in Vienna, respectively. More
stable throughout the country were the contributions of social health
insurance (HF.1.2.1) that varied between 53.9% in Burgenland and 37.1%
in Lower Austria. The central government (HF.1.1.1) financed between
12.9% of total public current expenditure for SHF hospitals in Upper
Austria and 9.7% in Carinthia. 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 and, in 2020, is also affected by the mentioned effects of
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
At present, Austrian health expenditure according
to SHA is available based on the original manual (OECD; 2000) for the
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.
|Health expenditure in Austria according to the System of Health Accounts (SHA) – Flash estimation 2020|
|Overview - Health expenditure in Austria according to the System of Health Accounts (SHA), 2004-2019|
|Health expenditure in Austria according to System of Health Accounts (SHA), 1990 - 2019|
|Current expenditure on health care by functions, providers and financing schemes in Austria, 2019|
|Current expenditure on health care by functions and providers in Austria, 2019|
|Current expenditure on health care by providers and financing schemes in Austria, 2019|
|Current expenditure on health care by functions and financing schemes in Austria, 2019|
|Public current health expenditure for State Health Funds Hospitals by financing schemes and by state, 2019|
|Public current health expenditure for State Health Funds Hospitals by financing schemes and by state, 2020|
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