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Sarah Owen Lesson 2 Written Assignment HA 500
The health system that I have chosen to compare to the United States’ system is
that of Austria. Austria has been ranked among the absolute best in the world when it
comes to health care and with the exemplary service comes high prices, although still
less expensive than in the U.S. In response to the cost, the Austrian federal
government, the Länder (the states of Austria), and social insurance institutions have
agreed upon a reform “to be able to ensure optimal structures of health care provision
and more services” while trying to reduce cost (Health Care, n.d.) with the goal being:
the wellbeing of patients. This goal is similar to that of the United States’ Reform as the
U.S. works to decrease patient expenses and increase the quantity and quality of
services provided (i.e. eliminating lifetime limits, Medicaid free services, employer tax
breaks to cover employees, etc.).
One way to reduce patient cost in health care is health insurance. Similar to the
United States, Austria provides a multitude of coverage options to its residents. While
92-percent of American’s have health insurance (Bureau, 2020), 99-percent of Austria’s
population is currently covered. Austria’s options include, but are not limited to:
Universal Insurance (U.S. similar versions HMO, PPO, EPO, POS)
Social Insurance
Unemployment
Social Protection, and
Private Insurance
While these are only a few options offered in Austria, they are incredibly beneficial plans
and share comparable, as well as different, characteristics to the plans offered in the
United States. The Universal insurance in Austria provides allowance for families and
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Sarah Owen Lesson 2 Written Assignment HA 500
childcare, tax credit for children, and long-term care benefits. All emergency procedures
and treatments for serious medical conditions are covered; however, certain electives
are not, such as abortion and psychotherapeutic services (Expat Focus, 2019). This
type of coverage is not affected by the patients’ work or income status and is funded by
wage-related contributions made by employers and employees, meaning it is taken
directly out of the paycheck. Compared to Austria’s Universal coverage, the United
States’ major medical plans include coverage for certain services and treatments
regardless of what company the patient purchases through and no one can be turned
down for medical reasons, including pre-existing conditions. Social insurance in Austria
includes social pensions, health insurance and work accident coverage. It is mandatory
insurance financed by the employers’ and employees’ contributions under a pay-as-you-
go system (The Welfare State, n.d.). Unemployment includes unemployment benefits,
financial-assistance and active labor market policies, and is financed by wage-related
contributions made by employers and employees. As unemployment in Austria provides
assistance to those with little to no income, Medicaid in the U.S. is a program for low-
income residents who cannot afford coverage through a “typical” insurance plan, or
qualified health plan (QHP). Medicare is also an option in the U.S. for those who are 65
and older and those with certain disabilities preventing them from working. Social
protection is coverage in Austria for tenured public-service employees (civil servants)
since they are not covered by unemployment or social pension, this is because they
accrue direct entitlements through their employers. It is funded by state budgets of
territorial authorities.
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Sarah Owen Lesson 2 Written Assignment HA 500
All of the previously mentioned Austrian options fall under the umbrella of public
health insurance which is not optional. Once employed, residents are automatically
enrolled and the employer is obligated to register the employee within seven days.
Healthcare is only free to those who are pensioners, spouses of workers, out of work
and on unemployment benefits, and those who have extenuating conditions preventing
them from working (Internations, 2020). Additional insurance is available to purchase on
top of the public insurance with added benefitsprivate insurance. This insurance gives
the patient the ability to see the physician of their choice and have life-long coverage
without restrictions or termination. There are two types of private insuranceSpecial
Class and Comfort Classthat offer certain benefits, such as access to exclusive
physicians not available through public healthcare, private hospital room and bathroom,
internet, and shorter wait times (with the exceptional rating of Austria’s health care
comes medical tourism, meaning more and more people each year, residents and
tourists, seek medical diagnosis and treatment from the world-renowned physicians in
Austria significantly increasing wait times in the majority of facilitieshospital, clinic or
private practitioner (Expat Focus, 2019)). Below are example plans from Internations,
2020 for the two types of Private insurance.
Basic Private Insurance Plan Example
Up to six months of gym memberships or free 5-star hotel accommodation (up to
4 days) available from the start of your insurance plan and then once every two
years
Coverage in European public hospitals
Worldwide coverage in private hospitals while travelling up to four weeks up to
150,000 EUR (165,500 USD)
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Sarah Owen Lesson 2 Written Assignment HA 500
Worldwide coverage for out-patient treatment while travelling up to four weeks up
to 15,000 EUR (16,550 USD)
Treatments in specialized hospitals worldwide if treatment is not possible in
Austria
Emergency transport to Austria
High-tech check-up once a year
Second opinion
Change to a higher insurance plan without new health questions
Special class in-patient treatment in private hospitals and public hospitals
Cover in case of accidents, in case of illness, surgery, and medically prescribed
cosmetic surgery
Maternity coverage up to 8 weeks before and after birth
A shared hospital room (maximum two beds, instead of 8-9 patients per room as
with public insurance)
No deductible in case of accidents or maternity
0 EUR deductible in case of illness for 4 days
Outpatient surgery
Premium Private Insurance Plan Example
A typical premium plan includes the same benefits as the basic plan, plus:
Private hospital room
0 EUR deductible in case of illness
Private outpatient medical treatment
11,706 EUR (12,916 USD) per year in coverage
587 EUR (648 USD) sublimit for medically prescribed adjuvants
587 EUR (648 USD) sublimit for medically prescribed medicines
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Sarah Owen Lesson 2 Written Assignment HA 500
587 EUR (648 USD) sublimit for medically prescribed physical therapy,
midwives, alternative medicine, and massages
As shown above, the private plans offer a great deal of benefits to those who are able to
afford the additional 200 EUR (243 USD), this is an average as the cost varies with
agethe more mature the patient, the more expensive the plan becomes. To break
down the cost a bit more for the Austrian health system, the average fee for public
insurance per person is 11 EUR (12 USD) annually, this allows them outpatient visits at
no added cost, as well as prescriptions on the “positive list” (those covered by
insurance) being under 6 EUR (7 USD). This is significantly lower than the United
States as our costs are in the hundreds, even thousands at times, for health coverage
and prescriptions, although the Austrian Private insurance cost nearly makes up for the
difference.
In my opinion, implementing the idea of Private Insurance from Austria into the
United States would be beneficial in the fact that patients would be able to see any
provider that they wish with little to no wait time, this is especially applicable to those
with chronic illnesses and need to visit specialists regularly. If these patients are not
able to get the care they need here in the States, international travel is costly and many
people cannot afford it. With the Austrian Private Insurance, worldwide coverage and 5-
star hotel accommodations for four nights would benefit these individuals greatly, cutting
down the cost of travel and making their care more accessible. Most plans in the United
States require the patient to be seen by in-network providers, limiting their choice in who
to receive help from, and if the patient chooses to be seen by a provider who is out-of-
network, the price can be incredibly high. This also creates difficulty when the patient
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Sarah Owen Lesson 2 Written Assignment HA 500
decides to search for a second opinion related to their possible diagnosis and/or
treatment plan. Private plans allow the patient to receive a second opinion from the
provider of their choice at no additional cost. Although implementing similar Private
Insurance would allow a multitude of benefits for patients, I feel that it would reverse our
Reform goal of reducing patient costthe benefits themselves come at no cost,
however the overall plan does require a hefty fee.
References
Health Care. (n.d.). Retrieved December 17, 2020, from https://www.austria.org/health-
care
The Welfare State. (n.d.). Retrieved December 19, 2020, from
https://www.austria.org/the-welfare-state
How Does The Quality Of Healthcare In Austria Compare With The USA? (2019,
September 26). Retrieved December 17, 2020, from
https://www.expatfocus.com/austria/health/how-does-the-quality-of-healthcare-in-
austria-compare-with-the-usa-5664/
Healthcare in Austria. (2020, March 25). Retrieved December 17, 2020, from
https://www.internations.org/go/moving-to-austria/healthcare
Published: Sep 23, 2. (2015, November 23). Health Reform Hits Main Street. Retrieved
December 17, 2020, from https://www.kff.org/health-reform/video/health-reform-
hits-main-street/
Naylor Association Management Software. (n.d.). Retrieved December 19, 2020, from
https://www.4hcm.org/content.asp?contentid=226
Bureau, U. (2020, September 15). Health Insurance Coverage in the United States:
2019. Retrieved December 19, 2020, from
https://www.census.gov/library/publications/2020/demo/p60-271.html
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Sarah Owen Lesson 2 Written Assignment HA 500

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