Table 1 Policy context: Austria

Austria is a developed welfare state with an SHI system covering around 99% of the population. The provision of health services in Austria is characterised by relatively unrestricted access to all levels of care including GPs, specialists, and hospitals, and there is no formal gatekeeping system in place [10]. However, in practice, the density of specialists with an SHI contract is low in some rural areas [11, 12], and the proportion of private providers, i.e., without an SHI contract, is rising. In fact, out-of-pocket payments at the point of service are higher in Austria than in other countries with similar levels of health expenditure (17.7% of health expenditure in 2019) [13, 14]. The proportion of people with voluntary health insurance (VHI) is growing [11, 12]. The latter also enjoy shorter waiting times for elective surgery [15] than patients without VHI. Despite high coverage with SHI and being continuously among the countries with the lowest levels of unmet needs in Europe, some authors have reported that a greater proportion of Austrian households are faced with health spending that exceeds their ability to pay than in most high-income countries in the EU [16]. While overall life expectancy is above the EU average (81.7 years in 2017) and rising, healthy life years at birth are substantially below the EU average, with approximately 57 years free of disability at birth versus 64 years in the EU as a whole [11, 12]. Regional variation is substantial, with shorter healthy life expectancy among people living in eastern parts of Austria compared to western parts [17].