The Austrian health care system is solidaristic in the sense that people contribute on the basis of their capabilities, as specific portions of the labour force’s wages and salaries are deducted automatically and the population receives services based on their individual needs (Ter Meulen 2017; Spahl & Prainsack 2021). Austria is characterised by its Bismarckian social and public health system, which relies on social insurance in general and on statutory health insurance more precisely. The Austrian public health care system’s core funding source is compulsory social security contributions that are directly or indirectly tied to employment and to occupational status. In relying on such a reciprocal exchange Austria has achieved very high health insurance coverage of about 99% of its population, while Austrian residents also report comparatively few unmet medical needs (Toth 2019).
Income-related inequalities in health care in Austria are on relatively low levels among EU and OECD countries (Devaux 2015; Ásgeirsdóttir & Ragnarsdóttir 2013). However, there seems to be potential for ‘institutional corruption’ that undermines the principles of good health, equity and efficiency in the Austrian health care system (Sommersguter-Reichmann & Stepan 2017). Specifically, corruption in the Austrian health care system, which includes bribery and misuse of advantageous positions and networks, is enabled especially by the possibility of dual-practice and in part by the supplementary role of voluntary private health insurance (Sommersguter-Reichmann et al. 2018), which approximately 33% of Austrians possess as an addition to statutory health insurance (Hagenaars et al. 2017).
Socio-economic determinants of health had already become a concern prior to the COVID-19 pandemic in Austria (Bachner et al. 2018). The Austrian health care system has been increasingly subjected to pressures for liberalisation (Hofbauer 2006), cost-reductions (Reeves et al. 2015) and efficiency gains (Czypionka et al. 2014). Inertia, such as systematic over-utilisation of some services (Pichlhöfer & Maier 2014), and also global trends like increased labour mobility (Österle 2007), put additional stress on the Austrian health care system.