Austria

The organization of the Austrian health system is complex. The federal government is responsible for the legislative framework, including regulation of social health insurance (SHI). SHI funds have operational responsibility for ambulatory and rehabilitative care (outside hospitals) and outpatient medicines, and they negotiate contracts with providers. The states (Länder) regulate hospital care in their jurisdictions within the framework defined by federal legislation and are mainly responsible for the organisation and financing of inpatient and outpatient care in hospitals. Financing is mixed and fragmented because SHI funds, the federal government, the Länder and municipalities all contribute to the health budget. 

Provision of health services in Austria is characterized by relatively unrestricted access to all levels of care including general practitioners, specialists, and hospitals. There is no formal gatekeeping system in place. For ambulatory care, patients can choose between independently practising physicians, group practices, hospital outpatient departments and outpatient clinics. Patients also have the choice between SHI contracted physicians (45%) and those without contract (55%). In general, health care provision remains strongly focused on hospital care.