Key points
- Austria runs the Bismarck model: compulsory social health insurance (SHI), funded from payroll contributions and taxes.
- Coverage is near-universal: SHI covers 99.9% of the population, and all of the population is covered for a core set of services (OECD Health at a Glance 2025).
- Care is delivered by the Länder, which run about 75% of acute hospital capacity, and by private office-based physicians working under contracts with the SHI funds.
- Patients pay a fixed prescription fee of EUR 7.55 per reimbursed medicine, plus per-diem hospital charges; households paid 16.5% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database).
- Life expectancy at birth was 81.9 years in 2023, and health spending was 11.8% of GDP in 2024 (OECD Health at a Glance 2025).
Direct answer: Austria runs the Bismarck model: compulsory social health insurance (SHI), funded from payroll contributions and taxes. Coverage is near-universal — SHI covers 99.9% of the population — and a 2020 reform organised the funds into three bodies: the ÖGK for employees, the SVS for the self-employed and farmers, and the BVAEB for public sector, mining and railway employees. Care is delivered by the nine federal states (Länder), which run about 75% of acute hospital capacity, and by private office-based physicians working under contracts with the SHI funds. Patients pay a fixed prescription fee of EUR 7.55 per reimbursed medicine and a per-diem charge for hospital stays, and households paid 16.5% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 81.9 years in 2023 — and healthy life expectancy 69.9 years — and health spending was 11.8% of GDP in 2024 (OECD Health at a Glance 2025; WHO Global Health Estimates, October 2026).
At a glance
| Item | Detail |
|---|---|
| Model | Bismarck — social health insurance (SHI) |
| Who pays | Payroll contributions to the SHI funds, plus general taxation; hospital operating costs pooled through regional health funds |
| Who delivers | The Länder run about 75% of acute hospital capacity; outpatient care mostly by private office-based physicians under SHI contracts; no formal gatekeeping |
| What is free at the point of use | Most care covered by SHI; patients pay a prescription fee of EUR 7.55 per reimbursed medicine and a per-diem hospital charge, with exemptions and a means-tested cap |
| Life expectancy at birth | 81.9 years (2023, OECD Health at a Glance 2025) |
| Health spending | 11.8% of GDP (2024, OECD Health at a Glance 2025) |
| Source for the model and coverage | State of Health in the EU: Country Health Profile 2025: Austria (OECD and European Observatory on Health Systems and Policies) |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
Austria’s health system is built on comprehensive social health insurance, with governance split between the federal government, the nine Länder and corporatist stakeholders. The federal government sets the legal framework and regulates providers, while the Länder plan and regulate hospital care, fund capital investment and operate about 75% of the country’s acute hospital capacity. Hospital operating costs are financed separately through regional health funds (Landesgesundheitsfonds), which pool SHI contributions and taxes and pay hospitals through Austria’s diagnosis-related-group model. A 2020 reform consolidated the SHI system into three main bodies — the ÖGK for employees, the SVS for the self-employed and farmers, and the BVAEB for public sector, mining and railway employees — coordinated by an umbrella association, the Dachverband, which negotiates the binding collective contracts that set physicians’ fees and obligations.
Outpatient care is mostly delivered by private, office-based physicians who work under collective contracts with the SHI funds. A distinctive feature is the virtual absence of formal gatekeeping: patients can access specialists and hospital outpatient departments with no referral. Inpatient care is the largest spending category, at nearly 32% of current health expenditure in 2023, and a 2024–2028 reform aims to shift care towards digital, ambulatory and then inpatient services — “digital before ambulatory before inpatient” — to correct the hospital-heavy balance.
Who pays, and what people pay
Payroll contributions to the SHI funds and general taxation pay for most of it: public sources accounted for 76.7% of health spending in 2023, below the EU average of 80.0%. Mandatory prepayment covered 77% of spending (OECD Health at a Glance 2025). What patients pay is a fixed prescription fee of EUR 7.55 per reimbursed medicine — frozen at that level until 2026, with the exemption threshold set to fall from 2% to 1.5% of net annual earnings — plus a per-diem charge for hospital stays. Households paid 16.5% of health spending out of pocket in 2023, mostly for outpatient medicines, long-term care and dental services, and for direct payments to doctors without an SHI contract (Wahlärzte). Voluntary health insurance, mostly supplementary, accounts for nearly 7% of health spending.
What is free, and what is not
Most care covered by SHI carries no bill at the point of use beyond the prescription fee and the hospital per-diem charge, and exemptions and means-tested caps on prescription fees protect people on low incomes and certain population groups. What is not free is the margin: dental care, where only 45% of spending is publicly funded; private amenity upgrades in hospital; and care from non-contracted doctors, which patients pay for directly. The boundary moves by service: public sources covered 87% of inpatient care spending in 2023, while outpatient care, dental services and pharmaceuticals had higher public coverage rates than the EU averages.
How it compares
Austria spends 11.8% of GDP on health — above the OECD average of 9.3% — and $8,401 per person, above the OECD average of $5,967 (USD PPP, 2024). Its life expectancy of 81.9 years is 0.8 years above the OECD average of 81.1 years (OECD Health at a Glance 2025). Its spending share is tied with Switzerland for the third-highest in this set, after the United States (17.2%) and Germany (12.3%). Its distinguishing feature is the combination of near-universal insurance with a hospital-heavy, federally split system: 6.6 hospital beds per 1,000 people — well above the OECD average of 4.2 — and 5.5 practising doctors per 1,000, with patients free to see specialists without a referral. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Is Austrian healthcare free?
Most care is covered by social health insurance, but it is not free at the point of use: patients pay a fixed prescription fee of EUR 7.55 per reimbursed medicine and a per-diem charge for hospital stays, with exemptions and a means-tested cap on prescription fees for people on low incomes.
What is the ÖGK?
The Austrian Health Insurance Fund (Österreichische Gesundheitskasse), the SHI body for employees — one of three funds created by a 2020 reform, alongside the SVS for the self-employed and farmers and the BVAEB for public sector, mining and railway employees.
Do I need a referral to see a specialist in Austria?
No. There is virtually no formal gatekeeping in Austria: patients can go directly to specialists and to hospital outpatient departments without a referral.