peter eichlerchart 1 private health insurance with a focus on the austrian modell

Peter Eichler Chart 1

Private Health Insurancewith a Focus on the Austrian

Modell


PHI acts within a field of great social relevance:

Health steadily ranks among the top concerns of population

Private Health Insurance (PHI)


Political consensus that

access to medicine shall be independent from wealth

thus the economic risk for being sick shall be shared in solidarity



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)“



The amount of „self insurance“ or PHI is

determined by the „intensity“ of LHI



What is PHI?

Here: a business performed by a private enterprise with the intention of making profit!



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




People Expectations of getting more benefits

(better access, better care...) cover copayments of LHI




PHI enterprises a business modell allowing for profit

(transparency of benefits, sufficient volume, insurability, stable legal framework)



PHI

LHI

level of benefits

population 100%

Ideal types of PHI



1. LHI is exhaustive (covering all necessary benefits)

PHI covers „higher“ benefits with „luxury“ appeal (better rooms, complementary medicine....)



2. LHI is exhaustive, but there are copayments

PHI covers copayments



3. LHI is exhaustive only in theory, in reality there are deficiencies

PHI acts in „grey“ area or becomes a duplicate insurance



4. LHI is officially non exhaustive, but covers only „basic“ needs

PHI covers more than „luxury“ benefits




PHILHI

level of

benefits

population 100%


LHI covers only part of population (who needs social security)

PHI is open for the remaining part



in reality: mixed modells

substitutive PHI is under political pressure



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



Conclusions: complementary and duplicate PHI

tend to be more profitable substitutive PHI tends to be of bigger

volume, but of less (if any) profitability



AUSTRIA


Social Health Insurance


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


Private Health Insurance


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


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



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



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


Austrian Health Insurers

76 insurance companies are established in Austria – 9 companies of them offer private health insurance


Recent legislation Has abolistred differing calculation

according to sex (Unisex ruling of the ECJ) Will regulate the insurance for handicapped

persons (Antidiscrimination)


classes of insurance

The private health insurance offers for:


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


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


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)


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)


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


Thanks a lotfor your attention

peter eichlerchart 1 private health insurance with a focus on the austrian modell

Documents

copayments phi

duplicate phi

pseudosubstitutive phi

phi enterprises

peter eichlerchart

market of basic insurance

necessary benefits phi

social security phi