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Private Health Insurance with a Focus on the Austrian Modell

Private Health Insurance with a Focus on the Austrian Modell. Private Health Insurance (PHI). 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

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Private Health Insurance with a Focus on the Austrian Modell

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  1. Private Health Insurancewith a Focus on the Austrian Modell

  2. Private Health Insurance (PHI) PHI actswithin a fieldofgreatsocialrelevance: Healthsteadilyranksamongthe top concernsofpopulation

  3. Private Health Insurance (PHI) Political consensusthat • accesstomedicineshallbeindependentfromwealth • thustheeconomicriskforbeing sick shallbeshared in solidarity

  4. Private Health Insurance (PHI) The stateorganizessystemsofsolidarity, either • national healthservices (Beveridge), or • „social“ insurancebodies (Bismarck) tobereferredtoas „Legal Health Insurance (LHI)“

  5. Private Health Insurance (PHI) The amountof „selfinsurance“ or PHI isdeterminedbythe „intensity“ of LHI

  6. Private Health Insurance (PHI) Whatis PHI?Here: a businessperformedby a private enterprisewiththeintentionofmakingprofit!

  7. Private Health Insurance (PHI) Motivation foraccepting PHI: • Politics • gettingmoremoneyintothesystem • reducestatespendings • gettransfers • fightingblackmarketbyintroducing a legalizedmarket • freedomofchoice

  8. Private Health Insurance (PHI) Motivation foraccepting PHI: • People • Expectationsofgettingmorebenefits (betteraccess, bettercare...) • covercopaymentsof LHI

  9. Private Health Insurance (PHI) Motivation foraccepting PHI: • PHI enterprises • a businessmodellallowingforprofit (transparencyofbenefits, sufficientvolume, insurability, stable legal framework)

  10. Private Health Insurance (PHI) Ideal typesof PHI PHI levelofbenefits LHI population 100%

  11. Private Health Insurance (PHI) 1. LHI is exhaustive (covering all necessarybenefits) PHI covers „higher“ benefitswith „luxury“ appeal (betterrooms, complementarymedicine....)

  12. Private Health Insurance (PHI) 2. LHI is exhaustive, but therearecopayments PHI coverscopayments

  13. Private Health Insurance (PHI) 3. LHI is exhaustive only in theory, in realitytherearedeficiencies PHI acts in „grey“ areaorbecomes a duplicateinsurance

  14. Private Health Insurance (PHI) 4. LHI isofficially non exhaustive, but coversonly „basic“ needs PHI coversmorethan „luxury“ benefits

  15. Private Health Insurance (PHI) levelofbenefits PHI LHI 100% population

  16. Private Health Insurance (PHI) LHI coversonlypartofpopulation (whoneedssocialsecurity)PHI is open fortheremainingpart

  17. Private Health Insurance (PHI) in reality: mixedmodellssubstitutive PHI isunderpoliticalpressure

  18. Private Health Insurance (PHI) tendencyfor „pseudo“-substitutive PHI • PHI isallowedtoenterthemarketof „basic“ insurance • PHI and LHI compete • PHI hastoadoptprinciplesof LHI • profitabilityisreduced

  19. Private Health Insurance (PHI) Conclusions: • complementaryandduplicate PHI tendtobemore profitable • substitutive PHI tendstobeofbiggervolume, but ofless (ifany) profitability

  20. AUSTRIA

  21. Social Health Insurance

  22. Social health insurance Socialhealthinsurance • is a compulsoryinsurancebased on thesolidarityprinciple • financedbyincomedependentcontributionsupto a certainlimit • thecoverprovidedbythesocialhealthinsuranceextends not onlytotheinsuredthemself but tomemberoftheirfamily, providedthey do not paycontributions on theirownname • 99 percentofthepopulationarecoveredbythesocialhealthinsurance • coverageextendsto all „necessaryanduseful“ treatments

  23. Private Health Insurance

  24. Private health insurance • register 2,6 mio.insuredperson(thatis 32% ofthe Austrian population) • assubstituteinsurance (verysmall!) • ascomplementaryinsuranceforexpensesandotherexpenditures, whichare not coveredbythesocialinsurance • hospitalchargesfor private room in publichospitalsand additional costs in private hospitals • 1 mioinsuredpersons (thatis 13% ofthe Austrian population)

  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

  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

  27. Principles of the private health insurance • insuredunder private law • premiumscalculatedaccordingtotheprincipleofequivalence per insuredpersoncorrespondingtotherangeofinsurancecover, depend • on theageofentry • physicalcondition

  28. Austrian Health Insurers • 76 insurancecompaniesareestablished in Austria – 9 companiesofthemoffer private healthinsurance

  29. Recentlegislation • Hasabolistreddifferingcalculationaccordingtosex (Unisex rulingofthe ECJ) • Will regulatetheinsuranceforhandicappedpersons (Antidiscrimination)

  30. classes of insurance • The private healthinsuranceoffersfor:

  31. hospital expenses insurance • In-patient hospitaltreatments – specialclass • theinsurancecoversbenefitsformedicallyindicatedhospitalstays due toillness, accident, orchildbirth • fullguarenteeofcostcoverageanddirectlycharging in a specialclasstwobedroomwithpartnerhospitals • fullguarenteeofcostcoverageanddirectlycharging in a specialclasstwobedroom in publicgeneralhospitals in Europe

  32. association • contractswithhospitalsandphysicansregulate • pricesand • directchargingwith „bestprice“ clause (most-favoredstatusclause) = prerequisiteforfullguarenteeofcostcoverage • about 170 partnerhospitals • multitudeofnegotiatingpartners (hospitals, physicans, communities...)

  33. out patient treatment • insurancecoverageforoutpatienttreatmentbyprivate physicans • Reimbursementismadefor 80% or 50% ofthecostsofmedicallytreatmentindicated due toillness, accidentorpregnancyupto an annualmaximumsum • out-patient medical treatment (including complementary medicine) • day clinic treatments • medically-indicated drugs (including homeopathic remedies)

  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)

  35. insurance of daily benefits during hospitalisation • Hospital dailybenefits • double benefits after accidents • for stays in a hospice a rate per day will be paid

  36. Thanks a lot foryourattention

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