Peter EichlerChart 1 Private Health Insurance with a Focus on the Austrian Modell

Peter EichlerChart 2 PHI acts within a field of great social relevance: Health steadily ranks among the top concerns of population Private Health Insurance (PHI)

Peter EichlerChart 3 Political consensus that  access to medicine shall be independent from wealth  thus the economic risk for being sick shall be shared in solidarity Private Health Insurance (PHI)

Peter EichlerChart 4 The state organizes systems of solidarity, either  national health services (Beveridge), or  „social“ insurance bodies (Bismarck) to be referred to as „Legal Health Insurance (LHI)“ Private Health Insurance (PHI)

Peter EichlerChart 5 The amount of „self insurance“ or PHI is determined by the „intensity“ of LHI Private Health Insurance (PHI)

Peter EichlerChart 6 What is PHI? Here: a business performed by a private enterprise with the intention of making profit! Private Health Insurance (PHI)

Peter EichlerChart 7 Motivation for accepting PHI:  Politics  getting more money into the system  reduce state spendings  get transfers  fighting black market by introducing a legalized market  freedom of choice Private Health Insurance (PHI)

Peter EichlerChart 8 Motivation for accepting PHI:  People  Expectations of getting more benefits (better access, better care...)  cover copayments of LHI Private Health Insurance (PHI)

Peter EichlerChart 9 Motivation for accepting PHI:  PHI enterprises  a business modell allowing for profit (transparency of benefits, sufficient volume, insurability, stable legal framework) Private Health Insurance (PHI)

Peter EichlerChart 10 PHI LHI level of benefit s population 100% Ideal types of PHI Private Health Insurance (PHI)

Peter EichlerChart 11 1.LHI is exhaustive (covering all necessary benefits) PHI covers „higher“ benefits with „luxury“ appeal (better rooms, complementary medicine....) Private Health Insurance (PHI)

Peter EichlerChart LHI is exhaustive, but there are copayments PHI covers copayments Private Health Insurance (PHI)

Peter EichlerChart 13 3.LHI is exhaustive only in theory, in reality there are deficiencies PHI acts in „grey“ area or becomes a duplicate insurance Private Health Insurance (PHI)

Peter EichlerChart 14 4.LHI is officially non exhaustive, but covers only „basic“ needs PHI covers more than „luxury“ benefits Private Health Insurance (PHI)

Peter EichlerChart 15 Private Health Insurance (PHI) PHI LHI level of benefit s population 100%

Peter EichlerChart 16 LHI covers only part of population (who needs social security) PHI is open for the remaining part Private Health Insurance (PHI)

Peter EichlerChart 17 in reality: mixed modells substitutive PHI is under political pressure Private Health Insurance (PHI)

Peter EichlerChart 18 tendency for „pseudo“-substitutive PHI  PHI is allowed to enter the market of „basic“ insurance  PHI and LHI compete  PHI has to adopt principles of LHI  profitability is reduced Private Health Insurance (PHI)

Peter EichlerChart 19 Conclusions:  complementary and duplicate PHI tend to be more profitable  substitutive PHI tends to be of bigger volume, but of less (if any) profitability Private Health Insurance (PHI)

Peter EichlerChart 20 AUSTRIA

Peter EichlerChart 21 Social Health Insurance

Peter EichlerChart 22 Social health insurance  is a compulsory insurance based on the solidarity principle  financed by income dependent contributions up to a certain limit  the cover provided by the social health insurance extends not only to the insured themself but to member of their family, provided they do not pay contributions on their own name  99 percent of the population are covered by the social health insurance  coverage extends to all „necessary and useful“ treatments Social health insurance

Peter EichlerChart 23 Private Health Insurance

Peter EichlerChart 24  register 2,6 mio. insured person (that is 32% of the Austrian population)  as substitute insurance (very small!)  as complementary insurance for expenses and other expenditures, which are not covered by the social insurance  hospital charges for private room in public hospitals and additional costs in private hospitals   1 mio insured persons (that is 13% of the Austrian population) Private health insurance

Peter EichlerChart 25 Principles of the private health insurance  Principles of the private health insurance  insurance for life – no regular cancellation by the insurer  premium includes the raising risk with raising age – no premium increases because of raising age or illness possible, therefore

Peter EichlerChart 26 Principles of the private health insurance  age provisions according to life insurance  adaption of premium to costs, frequency of use, expectation of life  risk assessment with additional premium, special waiting period, exclusion of insurance cover for preexisting conditions

Peter EichlerChart 27 Principles of the private health insurance  insured under private law  premiums calculated according to the principle of equivalence per insured person corresponding to the range of insurance cover, depend  on the age of entry  physical condition

Peter EichlerChart 28 Austrian Health Insurers  76 insurance companies are established in Austria – 9 companies of them offer private health insurance

Peter EichlerChart 29  Recent legislation  Has abolistred differing calculation according to sex (Unisex ruling of the ECJ)  Will regulate the insurance for handicapped persons (Antidiscrimination)

Peter EichlerChart 30 classes of insurance  The private health insurance offers for:

Peter EichlerChart 31 hospital expenses insurance  In-patient hospital treatments – special class  the insurance covers benefits for medically indicated hospital stays due to illness, accident, or childbirth  full guarentee of cost coverage and directly charging in a special class two bed room with partner hospitals  full guarentee of cost coverage and directly charging in a special class two bed room in public general hospitals in Europe

Peter EichlerChart 32  contracts with hospitals and physicans regulate  prices and  direct charging with „best price“ clause (most- favored status clause) = prerequisite for full guarentee of cost coverage  about 170 partner hospitals  multitude of negotiating partners (hospitals, physicans, communities...) association

Peter EichlerChart 33 out patient treatment  insurance coverage for outpatient treatment by private physicans  Reimbursement is made for 80% or 50% of the costs of medically treatment indicated due to illness, accident or pregnancy up to an annual maximum sum  out-patient medical treatment (including complementary medicine)  day clinic treatments  medically-indicated drugs (including homeopathic remedies)

Peter EichlerChart 34 out patient treatment  medically-indicated auxiliaries (treatment aids)  medically-indicated physiotherapeutic treatment (treatment aids), ergotherapy, logopedics  medically-indicated psychotherapeutic treatment provided by persons who are authorised to practice psychotherapy independently  for vaccinations (serum, medical fee) in accordance with vaccination recommendations of the senior Counsellor of Health (with the exception of travel vaccinations)

Peter EichlerChart 35 insurance of daily benefits during hospitalisation  Hospital daily benefits  double benefits after accidents  for stays in a hospice a rate per day will be paid

Peter EichlerChart 36 Thanks a lot for your attention