Germany has the oldest universal healthcare system, dating back to the Bismarck Republic social legislation. It is financed by the government through taxes and private contributions to sickness funds (Krankenkassen) or social health funds, where employees’ wages are deducted. Compulsory insurance is paid for by joint contributions from employers and employees and negotiated in complex corporatist social bargaining at state level.
It is divided into the GKV (“Gesetzliche Krankenversicherung”- Statutory Health Insurance) and the private insurance (PV). The mandatory basic health insurance for employees earning up to around €50,000/year (around 85 per cent of the population), which can be supplemented with private plans. It covers (non-working) family members and are independent on age or health status. There are 132 Health Insurance providers (www.destatica.com) offering benefit packages covering prevention, screening, treatment and sick pay not covered by employers.
Private Insurance (44 providers, 2014) are selected by high income workers and self-employed professionals. They opt out of the public system, preferring private policies with a higher reimbursement and service beyond the standard of the mandatory statutory insurance.
Statutory Health Insurance service is run by doctors at practice level and most hospitals are non-profit organisations or private offering in-patient care. Patients have high expectations of the healthcare system. They can visit any doctors they wish. Charges for non-prescription drugs at the pharmacy and alternative practitioners are paid by patients.
At federal level, the key player and decision maker is the BMG (“Bundesministerium für Gesundheit” – Federal Ministry of Health). Attached to the BMG is the BfArM (“Bundesinstitut für Arzneimittel und Medizinprodukte“- Federal Institute for Pharmaceuticals and Medical Devices ), the major licensing body for pharmaceuticals, supervising the safety of both pharmaceuticals and medical devices. Biomedicines, vaccines and sera are licensed and supervised by the Paul-Ehrlich-Institute www.pei.de. In many cases, authorisation of medicinal products is granted by the European Medicines Agency in a centralised authorisation procedure.
After Luxembourg, Ireland and the Netherlands, Austria is the next richest country in the European Union (EU). In 2011 total GDP amounted to EUR 300.7 billion.
The 8.4 million Austrian inhabitants experience a high living standard. The healthcare system is open to innovations. Austria has had a health care system based on solidarity for a long time. It ensures high-quality medical care for all citizens, independent of their social status or income. Austria has a generous systems of social security services for children and families. The Austrian health care system is characterised by a high density of easily accessible health care facilities. In 2011 a total of nearly 300 hospitals with more than 60 000 beds were available for in-patient care.
The Federal Ministry of Health is responsible for legislation, the protection of the public health as well as overall health policy. Facilitating in processes as well as between the different stakeholders, the ministry is also supervisory authority.
The Austrian social insurance system is based on the principles of compulsory insurance, solidarity and self-governance and is primarily funded through insurance contributions. It includes the branches of health, accident and pension insurance and consists of 22 social security institutions with the Main Association of Austrian Social Security (HVB) as their umbrella organisation.
The responsible authority for granting marketing authorization for pharmaceuticals (human and veterinary), assessing the efficacy and safety of pharmaceuticals and medical devices, market surveillance, inspection of manufacturers is the Austrian Medicines and Medical Devices Agency BASG. It is directly subordinated to the Austrian Federal Ministry of Health – BMG and thus carries out sovereign tasks.