Special class (hospital)

from Wikipedia, the free encyclopedia

In Austria, a special class or special fee class is a form of care in a hospital and thus a form of health insurance . The special class relates primarily to the type of accommodation, not to medical services.

Financial flows in the Austrian healthcare system
      Bonuses → Private insurance   Special services    
                             
                        Catalog services ( after DRG )      
        Contributions → Health insurance (
compulsory insurance) 		         
                         
        Taxes FA →                        
          → BM (Fin) countries → BGA          
       
                Art. 15a BV-G   ↓ budget   ←      
Country Fund (
LGF) 		   
                →   →          
             ↓    
population   Deductibles   Fund KA ←                  
     
 AN , AG (←) → ←   fee   ←    
        Private KA                
    some deductibles *   ← PRIKRAF ←      
     
              Expense coverage        
or. (←) → Outpatient clinic ←        
                   
    some deductibles *           Flat rate
+  individual services 		       
  (←) → (practicing)
doctor 		←        
          Exp. f. Drugs
+  of pharmacy services 		 
    Prescription fee **                          
patient (←) → pharmacy ←        
                   
    ↑                        
        reimbursement        

(Fin) Ministry of Finance distributes the budget for the Ministry of Health ;
* flows directly to KV carriers;
** flows via pharmacy to health insurance providers;
(←) partly direct reimbursement or exemption for mandatory verse.
Reds: Government Sector,
Yellows: Private Sector

Diagram according to Ziniel (2005)

Basics

In Austria there is a legal obligation to have health insurance, the general, statutory compulsory insurance . In addition, residents (citizens as well as other residents) are free to take out voluntary private supplementary insurance that provides certain additional benefits.

The benefits covered by compulsory insurance for inpatient hospital stays are referred to as the general fee class . This usually includes accommodation in a 6-bed room. Patients with private insurance can set a contractual condition with their insurance company that includes accommodation in a single or double room. This type of insurance and accommodation is called special class (in Austria generally only called "class", therefore one speaks of "class patients")

Today, some of the compulsory insurance carriers also offer this contractual clause (according to the Social Insurance Institution for Commercial Businesses - SVA).

Conditions and services

There are two basic variants of private insurance, hospital cost insurance and daily allowance insurance . Special class is only covered by the first form. This class - like the general class - is offered by state fund-financed hospitals as well as by private contract hospitals .

The special fees for the stay include an institution fee and, if applicable, the doctor's fee and midwife fee . These are regulated by law at the state level , but they differ from region to region.

Other options are also associated with the special class, in particular the free choice of doctor and more freedom of design for non-medical services. The person with additional insurance usually also has the option of foregoing the special class, opting for the general fee class and only taking advantage of the other additional services.

Services from private health insurance are generally income tax-free for the patient (as of 2011).

In Austria, according to the Association of Insurance Companies Austria  (VVO), 12% of the population are privately insured.

To the new regulation 1996

Up until 1996, the supplementary insurance not only had to pay for the actual additional services provided by the hospitals for the special class, but in most federal states also had to pay considerable parts of the fees for the general class. However, the insured had already paid for these benefits with his taxes and social security contributions - these funds flowed through the Ministry of Finance and health insurance funds into the hospital funds of the time (today the state health fund and private hospital financing fund ) and from there to the hospitals, so that the special class patient paid twice. In a ruling by the Constitutional Court (for the public hospitals of Upper Austria) it was established that private patients or their special class insurance may only be charged for the actual additional service.

For the discussion of two-class medicine

In principle, the special class must not bring any disadvantage to general patients. It represents a pure additional service in terms of comfort. Nonetheless, the special class always creates a discussion about two-class medicine in Austria.

In general, it is at the discretion of the hospital operator how many beds he provides for the special class. The share is capped by law. If all common beds are occupied, there may be waiting times for those who are not privately insured, although special-class beds would be free. This is less due to the institution of the special class itself than to the economic aspects of hospital financing.

Another point of criticism is that due to the free choice of doctor - and the flexible scheduling - the experienced doctors primarily operate on special-class patients. General patients are operated on by less experienced doctors or have longer waiting times for an operation if specialists are necessary. It is inadmissible if, contrary to medical necessity, special class patients are preferred to general patients or if doctors do not treat a general patient under false pretenses.

On the problem of medical fees for the medical profession

Problems can also arise within the medical profession. In particular, the additional doctor's fees earned through the special class are divided in the hospital in each department according to an internal key between the primary doctor , specialist doctors and assistant doctors . This agreement must be made by mutual agreement between the doctors and approved by the hospital management. It is not subject to any special regulation. Doctors who are new to a department usually have no choice but to accept the existing agreement. Therefore, some institutions (such as medical associations) have issued non-binding guidelines or recommendations on the fair distribution of the special fees.

Individual evidence

  1. ↑ Reproduced in: Ch. Herber; J. Weidenholzer (Ed.): Assessment approach of the implementation of the health reform 2005 . Linz 2007, p. 133 (PDF, ooegkk.at, accessed on July 20, 2014) - there “Ziniel (2005)” without further details.
  2. ↑ a b c Compulsory insurance / compulsory insurance  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. → Differences between social insurance and private insurance,@1@ 2Template: Dead Link / www.sozialversicherung.at   row in the hospital table, Sozialversicherung.at , accessed July 26, 2014.
  3. ↑ Beneficiaries / option special class  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. @1@ 2Template: Dead Link / www.sozialversicherung.at   , Sozialversicherung.at, Sozialversicherungsanstalt der Gewerbewirtschaft → Health Insurance → Getting Healthy Again → Hospitalization , accessed July 26, 2014.
  4. ↑ Association of Insurance Companies Austria (VVO): Health Insurance in Austria ( Memento of the original from August 15, 2014 in the Internet Archive ) Info: The @1@ 2Template: Webachiv / IABot / www.vvo.at archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Information sheet, dated August 25, 2014 (pdf, vvo.at, accessed July 26, 2014).
  5. ↑ For example:
    Ordinance of the Styrian state government of January 31, 2013 on the determination of the special fees in the special class of the state hospitals . Stf: LGBl. No. 19/2013 (as amended online, ris.bka ).
  6. ^ VVO: Health insurance in Austria: Tax treatment of private health insurance , p. 7.
  7. ↑ a b c The double standards of "two-class medicine" , diePresse.com, 25 August 2011.
  8. ↑ VVO: Health Insurance in Austria , p. 5.
  9. ↑ and also the private doctor's fees for visiting a doctor
  10. ↑ In Vienna, for example, it must not include more than 25% of the beds (Section 26 in conjunction with Section 32 Wr. Specified by information on special class ( Memento of the original August 8, 2014 Internet Archive ) Info: The archive link is automatically inserted and not yet tested. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.aekwien.at, Medical Association for Vienna, aekwien.at, accessed July 26, 2014.
  11. ↑ See, for example, the distribution of the special fees ( memento of the original from August 11, 2014 in the Internet Archive ) Info: The @1@ 2Template: Webachiv / IABot / www.aekooe.or.at archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , Information sheet, Medical Association for Upper Austria, undated (pdf, aekooe.or.at, accessed July 26, 2014);
    Information on the subject of special class ( Memento of the original from August 8, 2014 in the Internet Archive )     Info: The     @1@ 2Template: Webachiv / IABot / www.aekwien.at archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Medical Association for Vienna, aekwien.at.