Krankenhäuser

Hospitals, according to the law on hospitals (Krankenanstaltengesetz) hospitals are institutions staffed and equipped for the diagnosis and surveillance of the physical well-being of people by way of examinations, for the performance of operations, for the prevention, improvement and cure of diseases by way of treatment, for childbirth and artificial fertilisation. Hospitals treat in-patients and out-patients.

General hospitals are intended to serve all people without regard to sex, age or form of medical treatment. In terms of services rendered 3 types of hospitals are distinguished: general hospitals providing basic medical care for an area with about 50,000 to 90,000 inhabitants, special hospitals for special medical care for about 250,000 and 300,000 inhabitants and central hospitals, which are equipped according to the latest medical knowledge. University hospitals are always central hospitals.

Specialised health and medical care facilities are designed for a certain group of people, for certain diseases (e.g. lung diseases), certain age groups (e.g. hospitals for children) and certain purposes (e.g. military hospitals) Public hospitals must be open to the public and are non-profit making. Private hospitals can be profit-making or non-profit making.

The largest hospitals in Austria are: the Vienna General Hospital (AKH, with university centre, 2,055 beds), the Landeskrankenhaus (Provincial Hospital) in Graz (with university centre, 1,988 beds), the Landeskrankenhaus Klagenfurt (1,733 beds), the Landeskrankenhaus Innsbruck (with university centre, 1,485 beds) and the Landeskrankenhaus Salzburg (1,282 beds).

Historical background: In early Christianity a "hospital" was an accommodation for travellers, which later became a religious and social institution of the church. In the Middle Ages monastic orders (Cistercians), orders of knighthood (Knights Hospitallers of the Order of St. John) and reformed orders were dedicated to medical care. Hospitals resembled churches (they had a large hall with niches for the beds and an altar at the eastern side). In the towns "citizens' hospitals" were founded as institutions for the poor. In the High Middle Ages isolated institutions were established for people with infectious diseases (leprosy, plague) on the outskirts of towns. Since the middle of the 16^th century the order of the Brothers Hospitallers has been dedicated to hospital work; hospital were given their own surgeons and trained medical staff. The Vienna General Hospital was opened under the reign of Joseph II in 1784; this meant a final separation of almshouses from hospitals. From the middle of the 19^th century onwards hospitals were founded in most district capitals, based on the imperial sanitary laws. During the 2^nd half of the 20^th century, most hospitals have been extensively enlarged and modernised.

The provinces of Austria have the duty to guarantee medical service in hospitals by operating public hospitals or by agreements with carriers of other hospitals.

Hospital financing: Hospitals have a permanent income from standard daily charges (paid by the social insurance agency per patient-day; these charges differ from province to province and in 1995 already covered less than 40% of the cost of hospital accommodation and treatment), hospital accommodation and treatment charges, special charges (for higher categories, mostly paid by private insurance agencies), and contributions made by the patients. For out-patient treatment hospitals receive out-patient benefits.

As the income does not cover costs, until 1996 losses were compensated by the Krankenanstaltenzusammenarbeitsfonds, the provinces, municipalities, legal entities and hospital catchment areas delineated by the provinces and required to pay contributions. A system of performance-related hospital financing (LKF) came into force in 1997. Provincial hospital finance funds, drawing on resources provided by the federal government, the provinces, the municipalities and social insurance institutions, were set up to implement the system. The services rendered by the hospitals are paid according to a points system. Pending further notice the LKF system is valid until December 31, 2000. University centres in hospitals are paid for teaching and research.

Teaching and training in hospitals: General practitioners are required to pass at least 3 years of training in a hospital. For medical specialists on-the-job training in hospitals lasts several years. Medical staff with a diploma, midwives, various kinds of medical technologists and nursing staff can only be trained in a hospital. Hospitals also provide further education and special training for medical staff.

In 1996 2,271,660 patients were treated in Austrian hospitals, totalling 21,351,162 patient-days. Whereas from 1970 to 1996 the hospitalisation rate increased from 132 to 249 (patients per 1,000 people), the average duration of hospitalisation fell from 17 to 9.6 days.

Literature: Gesundheitswesen in Österreich, ed. by Verband der Versicherungsunternehmungen Österreichs; H. Ingruber, Krankenhausbetriebslehre, 1994; M. Binder, in: T. Tomandl, System des österreichischen Sozialversicherungsrechts, 1994; Federal Ministry for Labour, Health and Social Affairs, Das Gesundheitswesen in Österreich, ²1998.