Module 3: Austrian Economic Status, Education, and Health Systems
Health & Education
The Austrian education system.
The education system in Austria follows an international format, International Standard Classification of Education (ISCED), for the purpose of allowing for comparison between different countries. The ISCED is composed of 34 member nations and was recently updated as in 2011. The system is comprised of 8 translatable levels of education. The classifying of levels is as follows:
Level 0: all early childhood education prior to primary education
Level 1: primary education
Level 2: four years of education immediately following primary education
Level 3: general or vocational education
Level 4: beyond the scope of secondary education
Level 5: post-secondary education focusing on professional skills and competencies
Level 6: beginning of tertiary education; Bachelor’s degree
Level 7: Master’s degree
Level 8: Doctoral and post-Doctoral degrees (“ISCED,” 2014).
The Austrian education system follows this basic eight tier international standardized system. Level 0 begins with early childhood education including crèches, kindergartens, after-school care, playgroups, and even early learning experiences provided by the care of nannies. Level 1 begins primary education and compulsory education at the age of 6 years and continues for four consecutive years. Compulsory education as a whole is a nine-year curriculum. Following this is level 2, which begins lower secondary education and continues for the four years following primary education. This level of education often has admission requirements. The ninth compulsory year is titled upper secondary education and includes either general or vocational training such as pre-vocational schools, apprenticeships, academic secondary school upper cycle, etc. These are level 3 courses. Level 4 education is a post-secondary, non-tertiary education cycle which includes nursing programs, continuing education, applied sciences, and teacher education programs. Level 5 are short-cycle tertiary education programs that include programs such as industrial master college, building craftsperson, etc. Tertiary education is included in level 6-8. The following diagram depicts the Austrian levels of education cross-referenced with the ISCED levels of education as well as the typical ages a child progresses from one level to the next (“The Austrian Education System,” 2015).
(“The Austrian Education System,” 2015)
Current statistics in education.
The current literacy rate for Austria is not published in any reliable data sources. However, in comparison with other Organisation for Economic Co-operation and Development (OECD) member countries, Austria has a low ranking of 24-35 year olds scoring satisfactorily on higher level reading comprehension examinations. In regards to education predicting future employment, 80% of persons achieving tertiary level education are employed as compared to only 60% of persons achieving less than post-secondary non-tertiary education. Furthermore, in comparison with other OECD countries, Austria ranks among the lowest in graduations from upper secondary and post-secondary non-tertiary level education with a graduation rate of 38.9%. In regards to mobility, only 29% of 25-64 year olds achieve a higher level of education as compared to their parent’s level of education. Within this regard, men are considerably more upwardly mobile with 33% of men achieving a higher level of education than their parents as compared to only 25% of females. In most other OECD countries, the opposite is true with females being more upwardly mobile. Additionally, Austria is the highest-ranking OECD country in terms of downward mobility in educational level in comparison to parental level (“Education at a Glance,” 2014). Overall, the average years of education among young persons ages 5-39 is a total of 17 years (“Better Life Index,” 2015).
Current statistics in health.
As a basic indicator of overall health in Austria, 69% self-report good health and satisfaction with their state of health. This is a subjective measure but it has been shown to be a rather accurate indicator of frequency of health care use. The current life expectancy at birth is an average of 81 years or 84 years for female and 78 years for men (“Better Life Index,” 2015). The infant mortality rate before the age of 5 has decreased in recent years to an average of 4 deaths out of every 1,000 live births and mainly attributable to congenital anomalies, prematurity, or birth asphyxia. Maternal mortality occurs in an average of 4 out of every 100,000 live births. Deaths related to HIV/AIDS, malaria, or TB are all individually less than 0.5/100,000 persons. The leading causes of adult deaths are cardiovascular, respiratory, or cancer related causes (“Austria: WHO Statistical Profile,” 2015).
**Analysis: The link between health and education.
The level of education has risen significantly over the past 40 years in Austria. Currently, 84.1% of the Austrian population has received greater than a compulsory level education. In 1971, the portion of the population receiving only a compulsory education was 57.8% compared to in 2008 the proportion was 19.5% (“Public Health in Austria,” 2011, p. 193). Low level of education is a strong indicator of lower health status and access to care. The sector of the Austrian population with a higher education level, usually tertiary-level, congregates in the more urban areas of the nation. Therefore, those in more rural areas of the country receiving lower levels of education are at higher risk for poverty and consequently more at risk for health issues (p. 194). This correlation could be a result of funding put into the education system at each level. The Austrian economic system feeds significantly more funds into tertiary education as compared with upper secondary or post-secondary non-tertiary level education (“Education at a Glance,” 2014). Furthermore, the affect of education level and poverty level on health status could additionally be related to access to equal education. Austria ranks below average in comparison to other OECD countries in regards to average differences in reading literacy, mathematics, and science scores between the top tier socioeconomic class and the lowest socioeconomic class. This indicates potential unequal access to quality education within the infrastructure of Austria (“Better Life Index,” 2015).
Health, Economic Status, and Poverty
Economic indicators.
According to the World Health Organization (WHO), in 2013 Austria’s gross net income (GNI) per capita averaged in US dollars to be $43,840 (“Austria: WHO Statistical Profile,” 2015). The total gross domestic product (GDP) was 301.31 billion Euro. In 2010, 11% of the GDP was spent on the health care industry compared to the average in the European Union (EU) of 10.6% (Hofmarcher & Quentin, 2013, p. 5). Furthermore, this can be compared to spending in other sectors. For instance, between 2008-2012 the average spending on education equaled 6% of the GDP and spending on the military averaged 1% (“State of the World’s Children,” 2015). Between the years 1995-2010, total federal spending decreased 3.8%. On the other hand, spending on the health care sector increased by 1.6% over this same time period indicating a potential increased value and focus on health (Hofmarcher & Quentin, 2013, p. 77).
In comparison to the United States, the GNI per capita in 2013 was $53,670. Between the years 2008-2012, the average spending of the GDP on health care was 8%, on education was 5%, and on the military was 5% (“State of the World’s Children,” 2015). This provides a relevant cross-reference perspective.
Health, productivity, and expenditure analysis.
The Austrian economy, like most all world economies, took a drastic hit in 2008 with the international economic crisis. However, unlike some other countries, the Austrian economy had entered steep upward progression by 2010 (Hofmarcher & Quentin, 2013, p. 4). Currently, Austria holds its rank as having one the lowest unemployment rates in the EU (p. 5). In relation to health and productivity, between the years 1999-2004, the prevalence of employee illnesses decreased but then has been on the rise again since 2005. Additionally, the duration of these sick leaves declined between the years 1999-2006 but have also been increasing since 2006 (p. 13).
Overall productivity and health care expenditure is relatively high but this does not necessarily translate into higher levels of health among the overall population. In comparison with other EU15 countries, Austria ranks among the highest for percentage of GDP spent on health care. However, the average number of total “healthy” years within a lifespan is 3 years, which is lower than the average for EU15 (Hofmarcher & Quentin, 2013, p. xxx). In fact, total number of healthy years in the average adult in Austria has been on the decline since 1995, with a steep decline between 2000-2005 (p. 12). Additionally, there have been some causes of mortality and illness that have been on the rise including infectious and parasitic diseases, Diabetes Mellitus, mental illnesses, and behavioral disorders (p. 11).
Nevertheless, Austria has seen significant progress in the state of the population’s health in recent years. Between 1980-2010, Austria has
experienced an increase in life expectancy by 8 years as an average for male and female ((Hofmarcher & Quentin, 2013, p. 1). Furthermore, Austria has achieved a decrease of 40% in the mortality rates for circulatory illnesses in general since 1995, which are among the leaders in causes of death in Austria along with certain cancers (p. 1).
These statistics as a whole show both progress and weaknesses in the system. However, there is evidence that health care expenditure could
either be used more efficiently or reduced. At the current rate of health care expenditure, life expectancy could be ultimately increased by 2.5 years when compared with the efficient use of resources by other “benchmark” EU countries. Furthermore, to achieve the current life expectancy of 81 years, spending could theoretically be reduced by 25% (Hofmarcher & Quentin, 2013, p. 251). Austria’s 2020 goal for health care expenditure is to reduce GDP spending to 8% while still maintaining the current life expectancy or even continuing to increase it (p. 256).
(Hofmarcher & Quentin, 2013, p. 258)
Health Systems
The current health care system.
The Austrian health care system can be defined by a theme of “equal access to care for all, independent of income, age, and gender” (Hofmarcher & Quentin, 2013, p. 242). This system provides universal coverage for most all benefits and high-quality care at all levels regardless of income (p. x).
Organizationally, planning, oversight, and delegation are all decentralized (Hofmarcher & Quentin, 2013, p. x). Austria is divided in to nine regions, each called a Lander, and the Lander is responsible for writing and implementing legislation. This is only restricted if the legislation steps outside the general boundaries and guidelines set by the federal delegations (p. xxii). Ambulatory and rehabilitation care centers are under the oversight of both social security institutions and the Chambers of Physicians and Pharmacy Boards, whereas hospital management is allocated to private companies within the Lander and Church institutions, especially the Catholic and evangelical churches. The Church is particularly responsible for social welfare and palliative care (p. xxii-xxiii).
Financially, the health care system operates on a “mixed model of financing, where the state and social health insurance companies contribute almost equal shares” (Hofmarcher & Quentin, 2013, p. 17). The breakdown of financial provision is as follows: 75% of financing derives from social insurance and taxation while 25% derives from private sources including direct payments by patients, private health insurance companies, non-profit organizations, etc. (p. 18). In 2011, 99.9% of the Austrian population was health care insured. Insurance providers are determined on an individual basis in correlation with place of permanent residency and/or employment. This eliminates any source of competition among health care insurance providers (p. xxiv).
(Hofmarcher & Quentin, 2013, p. 18)
Accessibility to health care services.
The Austrian health care system has many features of it that promote widespread accessibility. The system is comprised of 270 hospital buildings throughout the country and 178 of those include inpatient care services. These structures account for a very high bed-to-person ratio for the current Austrian population. Among the EU nations, Austria ranks only second, behind Greece, in physician-to-population ratio providing a high number of health care providers. The Austrian population has the advantage of universal access to virtually all levels of care (Hofmarcher & Quentin, 2013, p. xxv). In addition, this system has access to some of the highest quality of medical-technical equipment worldwide, especially in terms of CT and MRI machinery (p. xxiv).
Financially, the system proves to be very accessible despite income variations. Low-income patients diagnosed with one or more chronic illness(es) have the advantage of potentially being exempt from all prescription and other fees ((Hofmarcher & Quentin, 2013, p. xxiv). Furthermore, for the population as a whole, during a single calendar year, if prescription fees accumulate to 2% of the patient’s net annual income, then the patient is exempt from any further prescription fees and maximum payment is capped at 2% (p. xxviii).
The health care system also provides other services that increase its availability to a wider population. The Austrian Health Portal launched online in 2010 and provides free, quality-guaranteed information to the general public. This portal includes research and information on maintaining a healthy lifestyle, general health promotion, disease prevention, varying diagnoses, treatments, indications of lab values, maternal and perinatal care, and different health care institutions throughout the nation (p. 66). Finally, a nationwide 24-hour telephone care hotline is available for non-licensed or non-professional caregivers (p. 67).
Barriers to health care services.
Despite the fact that only 2% of the Austrian population reports any sort of complaints of barriers to the accessibility of health care, and even less of these complaints derive from cost-related barriers, there has been a recent rise in income-related inequality in care since 2005 (Hofmarcher & Quentin, 2013, pp. x, xxix). Lander of greater income per capita generally have a greater availability of services and this inequality is even greater in regards to long-term care facilities (p. 250). The income-related inequality can be seen in the following comparison: The risk of experiencing an impairment for the overall population is 8%, yet for the population at risk for poverty, the risk for impairment is 14% (p. 255).
The Austrian health care system also poses barriers to the population because of the prevalence of some imbalances in the infrastructure. The overall system heavily emphasizes hospitalized care; while there is insufficient spending in the ambulatory and preventative care sectors. Spending on preventative care comprises only 2% of the expenditure on health care (Hofmarcher & Quentin, 2013, p. xx). For instance, by the age of 2, only 80% have received the necessary standard vaccinations. Vaccination rates are particularly low for some specific diseases. The vaccination for measles only has a 74% compliance rate and pertussis an 84% compliance rate (p. xxv). Much of these imbalances and inefficiencies can be attributed to the fragmentation of delegation, responsibilities, and financing along with poor care coordination (p. 242).
References
The Austrian Agency for International Cooperation in Education and Research (OeAD GmbH) (27 August 2015). The Austrian education system.
Retrieved from https://www.oead.at/welcome_to_austria/education_research/the_austrian_education_system/EN/
The Austrian Education System (2014). International standard classification of education (ISCED). Retrieved from
The European Observatory on Health Systems and Policies (2011). Public health in Austria: An analysis of the status of public health. Retrieved from
http://www.euro.who.int/__data/assets/pdf_file/0004/153868/e95955.pdf
Hofmarcher, M. & Quentin, W. (2013). Austria: Health system review. Health Systems in Transition, 15(7), 1-291. Retrieved from
http://www.euro.who.int/__data/assets/pdf_file/0017/233414/HiT-Austria.pdf
Organisation for Economic Co-operation and Development (OECD) (2014). Education at a glance 2014. Retrieved from
http://www.oecd.org/edu/Austria-EAG2014-CountryNote.pdf
Organisation for Economic Co-operation and Development (OECD) (2015). Better life index. Retrieved from
http://www.oecdbetterlifeindex.org/topics/health/
UNICEF (2015). State of the world’s children 2015 country statistical information. Retrieved from data.unicef.org
World Health Organization & UN Partners (January 2015). Austria: WHO statistical profile. Retrieved from http://www.who.int/gho/countries/aut.pdf
