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Healthcare Resource Guide: Austria

 

Austria Statistics


Summary

Market Entry

Current Market Trends

Main Competitors

Current Demand

Registration Process

Reimbursement

Barriers

Procurement and Tenders

Trade Events

Local Associations

FAQs

Government Links

Best Prospects

Statistics Snapshot

CS Contacts

 

Capital: Vienna

Population: 8.7 million

GDP*: $386.5 billion ($44,230 per capita)

Currency: Euro

Language: German

Summary

Total healthcare spending in Austria in 2015 was $41.7 billion. That includes both operating costs and investment, and adds up to 10.3% of GDP. Around three quarters of non-investment healthcare costs are covered publicly. Capital investment, which makes up around 7% of total healthcare spending, is financed 55% publicly and 45% privately.

Austria has 286 hospitals and clinics with around 65,300 available beds. In 2015, there were 44,892 medical doctors practicing in Austria, or 516 doctors/100,000 population, and 1,400 registered pharmacies. The statutory national health insurance program covers almost 100% of the population (over 8.5 million insured) and, together with the Federal Ministry of Health and the 9 Austrian Provincial Governments, plays a leading role in deciding which medicines and therapies are reimbursed. Private health insurance is also available in Austria, and around one third of the population carries supplementary insurance.

The main drivers of the Austrian healthcare sector are the ageing population, a high level of innovation, and the need to rein in public spending. U.S. medical devices and pharmaceutical products have an excellent reputation and a strong market position in Austria, second only to Germany.

Best prospects are Health IT, as well as products and medications for an ageing population (dental consumables, screening and early diagnostic technologies, cardiovascular treatments, bone health, orthopedics, cancer treatments, dementia care, mobility solutions, artificial joints, palliative and hospice care, etc.) and various products/methods that help cut costs (minimally invasive surgical methods/products, preventive medicine, cheaper and more efficient screening and diagnostic technologies, etc.).

Market Entry

Medical devices: market entry strategies depend on the nature of the product. For products that are covered by the statutory national health insurance or used in a clinical setting, it is essential to ensure reimbursement. If the product/therapy is already listed as approved for reimbursement by the main association of social insurance carriers (Hauptverband), distribution flows either through direct sales to healthcare providers and purchasing groups or through the Austrian or European tendering process. If the product is not listed, it will be necessary to petition the Hauptverband, a complex process that requires cooperation with a clinic. For products designed to be used outside the parameters of the statutory health insurance, market entry could follow through partners who call on bandagists, drug stores, physicians’ offices, health food stores, or pharmacies.

Drugs and Pharmaceuticals: Distribution of approved prescription and OTC medicines is through two channels: hospitals (around one-third) and pharmacies/dispensing doctors (around two-thirds). The over the counter (OTC) market is much more restrictive in Austria than in the United States, and even simple pain relievers and most nutritional supplements must be approved and can only be purchased in licensed pharmacies.

Current Market Trends

There are three main drivers in Austria’s healthcare market:

1. Ageing population. In 2005, 16% of the population was over 65. In 2016, that number had risen to 18.5% and it is estimated that by 2030 22,8% of the population will be over 65;

2. High level of innovation in the sector, accompanied by increasing patient and physician awareness about options; and

3. Desire on the part of public healthcare payers to rein in spending without losing quality of care means that reducing waste and improving efficiency are increasingly important.

Another interesting trend that deserves mention is the commonly held skepticism about what is called “school medicine” here, referring to medicines whose ingredients are known and have been proven to be effective. Surprisingly broad swathes of the population, including many physicians, trust unscientific natural remedies, homeopathic products, traditional Chinese medicine and other questionable treatments.

Main Competitors

Austria imports the lion’s share of its medical devices. Major players are Germany (around 31% of the market), the United States (15%), as well as Switzerland, South Korea, the Netherlands, China and Japan.

In the pharmaceutical sector, Austrian firms compete on the generics market and are successful in the sale of “natural” and homeopathic remedies. Patented and innovative pharmaceuticals tend to be imported from the major multinational pharmaceutical companies. U.S. products have seen excellent success and are considered to be at the cutting edge of medical technology. The U.S. holds around 18% of the import market and the Austrian operations of U.S. companies such as Pfizer are seen as local champions in the biotech sector.

Current Demand

Healthcare spending in Austria in 2015 was $41.7 billion. That includes both operating costs and investment, and adds up to 10.3% of GDP. Viewed over time, healthcare spending in Austria has been increasing at a rate of 5% annually over the past twenty years. Around three quarters of non-investment healthcare costs are covered publicly. Capital investment, which makes up around 7% of total healthcare spending, is financed 55% publicly and 45% privately.

Austria has 286 hospitals and clinics with around 65,300 available beds (760 hospital beds/100.000 population, one of the highest in Western Europe). Around two-thirds of hospital beds are in general hospitals, 12% are in specialized clinics, 17% are in rehabilitation centers and 8% in long-term care facilities. In 2015, there were 44,892 medical doctors practicing in Austria, or 516 doctors/100,000 population, and 1,400 registered pharmacies.

Medical Technology

Austria accounts for around 2% of the European medical technology market, similar in size to Sweden and Belgium, with annual spending just under $2.5 billion. Recent growth has been less than the usual 5% longtime average due to austerity measures following the financial crisis in Europe, but we expect it to return to a normal trajectory in the coming years.

Best Prospects

Health IT (HIT). HIT solutions are estimated to make up around 2% of total healthcare spending, which in Austria translates to around $960 million/year. This market can be split into solutions for hospitals and clinics and solutions for practitioners. In addition, a national infrastructure for electronic health records (ELGA) is currently rolling out which will eventually allow healthcare providers to share patient information. While all hospitals and clinics have non-medical IT systems in place, the penetration of systems that record/share clinical data is uneven. We estimate that around 60-70% of hospitals have at least some form of clinical information system in place in one or more wards. Practitioners, especially small offices, are less likely to keep electronic patient data or use other HIT solutions; we estimate penetration to be around 50% and rising. The increasing penetration of HIT also has broader implications for the market, as interoperability and advanced communications options become standard requirements for a whole range of medical devices.

Cutting-edge HIT including artificial intelligence, clinical decision support, big data applications, telemedicine, etc., are attracting quite a bit of interest and initial pilot and research programs are starting to appear in specialized and teaching hospitals. The widespread use of smartphones predicts quick adoption of various health apps, and the Austrian startup scene includes scores of promising HIT applications.

Technology for treating age-related ailments. Austria’s ageing population predicts growing demand for technologies that are associated with advancing age, including dental consumables, screening and early diagnostic technologies, cardiovascular care, bone health, orthopedics, cancer care, dementia care, mobility solutions, artificial body parts and implants, palliative and hospice care, etc.

Technologies that can help cut costs. Reducing waste and improving efficiency are growing increasingly important as administrators work to reduce the high cost of healthcare. Examples include HIT solutions, preventive medicine, minimally invasive surgical methods/products, cheaper and more efficient screening and diagnostic technologies, etc.

Drugs and Pharmaceuticals

Pharmaceuticals and medical consumables together account for around 16% of Austria’s total healthcare spending, around $6 billion/year or $680 per capita. That is toward the high end of EU per capita spending, but only around half the U.S. per capita rate. The reason for the low cost pharmaceuticals compared to the U.S. is the negotiating prowess of the Hauptverband in setting reimbursement prices. Both imports and exports have risen significantly in recent years, and we estimate 4% annual market growth here in Austria over the next several years.

The most common indications for prescription medications are high blood pressure, chronic cardiac insufficiency, heartburn/acid indigestion, depression, ADHD, and high cholesterol. The most common over the counter treatments are cough/cold, vitamins/supplements, pain relievers, and indigestion.

In-demand products include:

  • Medication for cardiovascular conditions including high blood pressure, high cholesterol, chronic cardiac insufficiency
  • Medication for cancer treatment: breast, lung, prostate, colon, pancreas
  • Medication for coughs/colds, indigestion, pain relievers
  • Vitamins/food supplements
  • Psychopharmacological medications, all indications

Registration Process

For medical devices, EU certification and approval is required. The type of certification and registration required depends on the class of the device. For guidance on the classification process, please see:

http://ec.europa.eu/consumers/sectors/medical-devices/files/meddev/2_4_1_rev_9_classification_en.pdf

Competencies in the pharmaceutical sector are shared between EU and Austrian national actors. European Union-wide pharmaceutical legislation focuses on some aspects of marketing (e.g. packaging, labeling, and advertising), safety (e.g. pharmacovigilance inspections, Good Manufacturing Practices, and good clinical practices), transparency, and authorization procedures. Find information about registration at the EMA here:

http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_001595.jsp&mid=WC0b01ac0580b18a3d#Steps involved in obtaining an EU marketing authorisation.

Pricing and reimbursement levels, on the other hand, are firmly in the hands of the (Austrian) Hauptverband.

Reimbursement

Austria’s statutory national health insurance program covers almost 100% of the population (over 8.5 million insured) and is built around 16 different insurance carriers with slightly different fee and coverage structures. Membership is mandatory and based on geographic or professional status, and fees are a function of income/salary. All 16 carriers are members of a powerful national umbrella organization called the Hauptverband der oesterreichischen Sozialversicherungstraeger (Main Association of Austrian Social Insurance Carriers) that coordinates various coverage decisions and plays an important role in deciding which therapies are reimbursed.

In the case of medical devices, reimbursement is based on a determination by a commission organized by the Ministry of Health that includes various stakeholders, including physicians, insurance carriers, and public administrators. This is a long and arduous process, and it often takes two years or more until the device is officially recognized as a reimbursable treatment option under the Austrian DRG (known in Austria as LKF, this system of hospital financing relies on a flat fee charged per procedure according to diagnosis and recognized treatment choice).

The process of obtaining reimbursement status for pharmaceuticals is equally arduous and includes tough price negotiations with the Hauptverband.

Barriers

While there are no specific barriers to market entry, access to reimbursement can present a significant challenge for companies with innovative therapies.

Procurement and Tenders

The central procurement agency in Austria is the “Bundesbeschaffung GmbH”, a limited liability company owned by the ministry of finance. Follow this link for more detailed information: http://www.bbg.gv.at/english/about-the-fpa/

There are three thresholds to keep in mind when considering public tenders:

  • Procurements worth less than €100.000 are not subject to tendering regulations and can be purchased directly by the healthcare provider/holding company.
  • Procurements worth more than €100.000 but less than €209.000 are subject to Austrian tendering regulation.
  • Procurements that exceed a value of €209.000 must be tendered through the EU. EU tenders can be found in the TED database: http://ted.europa.eu/TED/main/HomePage.do

There are no restrictions barring U.S. companies from participating in these tenders, but expect to be asked to demonstrate the capacity reliably fulfill the contract. The most common way to establish that is to have your company’s eligibility assessed by The Austrian Register of Tenderers (ANKÖ) and be included in their database:

https://www.ankoe.at/en/homepage.html

While there are no special regulations for the procurement of healthcare related goods, procurements and tenders of healthcare related services may be subject to very specific laws under the “Bundesvergabegesetz” appendix IV:

https://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=20007693

Trade Events

Currently there is no significant international medical or pharmaceutical trade show in Austria. Austrian participation in the large German shows, however, is strong. Here is a list of German shows that are supported by the U.S. Commercial Service:

http://2016.export.gov/germany/TradeShowsEvents/FeaturedGermanTradeShows/index.asp

Vienna is also a lively conference location, and every year there are numerous medical conferences. Follow this link for a current list of conference planned in Vienna: http://conferences-in-vienna.info/en/conference-calendar.html

Local Associations

Austromed (Association of medical device production/supply companies)

www.austromed.at

LISA Austria (Austrian Life Sciences Cluster)

http://lifescienceaustria.at

Bundesministerium für Gesundheit (Austrian Federal Ministry for Health)

http://www.bmg.gv.at/

Gesundheit Österreich GmbH (Austrian Federal Institute for Health)

http://www.oebig.at

Fachverband der Chemischen Industrie (Austrian Chemical Industry Association)

http://www.fcio.at

PHARMIG (Austrian Association of Pharmaceutical Enterprises)

http://www.pharmig.at

Apothekerkammer (Austrian Pharmacists Association)

http://www.apotheker.or.at

FOPI (Association of Research-Based Pharmaceutical Companies in Austria)

Web: http://www.fopi.at

FAQs

Is it a good idea to use a distributor in Germany to serve the Austrian market?

That depends on your product. If your device is designed for a clinical environment, or if you are selling any product that should be covered by the national medical insurance system, keep in mind that the registration and approval process for reimbursement will be labor-intensive and require good local contacts. Make sure that any German distributor has a physical presence in Austria and a strong track record for getting products approved for reimbursement in this country.

Are there any large hospital construction projects in the pipeline?

Austria has one of the most favorable hospital bed-to-population ratios in the EU and the number of beds has actually been falling in recent years. Most current construction projects are in the renovation, repurposing or extension of existing facilities. That being said, there are significant renovations planned for Vienna’s General Hospital, one of the largest hospitals in Europe. The most recent plan (2016) estimates €1.4 billion in modernization spending between now and 2030.

If you could recommend one trade show in this sector where a U.S. company is likely to find an Austrian partner, what would it be?

For medical products, that is easy: Medica in Germany (http://www.medica-tradefair.com/). Many Austrian companies attend either as exhibitors or as visitors, and there is an enormous effort on the part of the U.S. Commercial Service to help with matchmaking and logistics. For Health IT, the recommendation is another German show, conHIT (http://www.conhit.de/en/).

I am seriously considering expanding my presence into Austria. What should be my first step?

Talk to your local Export Assistance Center and enlist their expertise. The consultation is free of charge. Find an office near you here: http://export.gov/usoffices/index.asp

Government Links:

Healthcare Procurement:

http://ted.europa.eu/TED/main/HomePage.do

http://www.bbg.gv.at/english/about-the-fpa/

Government Health Plans:

http://www.hauptverband.at/

Best Prospects (medical devices)

Health IT (HIT). HIT solutions are estimated to make up around 2% of total healthcare spending, which in Austria translates to around $960 million/year. This market can be split into solutions for hospitals and clinics and solutions for practitioners. In addition, a national infrastructure for electronic health records (ELGA) is currently rolling out which will eventually allow healthcare providers to share patient information. While all hospitals and clinics have non-medical IT systems in place, the penetration of systems that record/share clinical data is uneven. We estimate that around 60-70% of hospitals have at least some form of clinical information system in place in one or more wards. Practitioners, especially small offices, are less likely to keep electronic patient data or use other HIT solutions; we estimate penetration to be less than 50%.

The increasing penetration of HIT also has broader implications for the market, as interoperability and advanced communications options become standard requirements for a whole range of medical devices. We expect this to speed the replacement of aging imaging devices, especially CT and MRI scanners, which are among the oldest in Europe.

Technology for age-related ailments. Austria’s ageing population predicts growing demand for technologies that are associated with advancing age, including dental consumables, screening and early diagnostic technologies, cardiovascular care, bone health, orthopedics, cancer care, dementia care, mobility solutions, artificial body parts and implants, palliative and hospice care, etc.

Technologies that can help cut costs. Reducing waste and improving efficiency are growing increasingly important as administrators work to reduce the high cost of healthcare. Examples include HIT solutions, preventive medicine, minimally invasive surgical methods/products, cheaper and more efficient screening and diagnostic technologies, etc.

Best Prospects (drugs/pharmaceuticals)

  • Radiation therapy equipment: a 2017 report notes that 62% of cancer patients in Vienna have dangerously long wait times. The city has 11 machines but needs 18 to guarantee sufficient coverage.
  • Minimally invasive surgical equipment and infrastructure (day surgery): lower costs and faster recovery times are appealing to patients and payers alike
  • Renovation of Vienna’s General Hospital: the city plans to spend $1.6 billion between now and 2030 to modernize Vienna’s most important teaching hospital.
  • HealthIT solutions: healthcare is rapidly digitalizing, now is the time to get in on the ground floor
  • Dental Products: popular expectations for both cosmetic and functional dental health are rising

Statistics Snapshot

Market Size (2015)

Healthcare spending (including investment)

$41.7 billion

... as percent of GDP

11.1%

... of which spent on inpatient services (including long-term care)

$16 billion

... of which spent on pharmaceuticals/consumables

$6.6 billion

... of which spent on investments

$2.8 billion

... of which spent on outpatient services

$10.7 billion

Hospitals, Procedures, Healthcare Professionals (2016 est)

Number of hospitals

286

Number of hospital beds

65,314

... available beds per capita

7.6/1,000

...of which in general hospitals

63%

...of which in specialized clinics and rehabilitation centers

37%

Number of surgical procedures

1.3m

...of which cataract surgery

106,619

...of which births

82,630

Physicians

44,892

...of which surgeons

1,746

...of which internists

4,204

...of which pediatricians

1,396

Dentists

4,982

Demographics (2016)

Population

8.7m

Life expectancy men/women

79.1/84.0

Infant mortality

3,1/1000

Percent of population older than 65

18.9%

...projection, 2030

22.8%

Annual deaths

80,669

...caused by heart disease

41%

...caused by cancer

25%

Prevalence of diabetes

6.75%

U.S. Commercial Service Contact Information

Name: Marta Haustein

Position: Senior Commercial Specialist

Email: marta.haustein@trade.gov

Phone: +43 1 31339-2205


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