Sozialmedizin#

Health Care (sanitation, health system) comprises all institutions and measures designed and implemented on the basis medical and scientific insight with the objective of maintaining and protecting the health of the entire population, identifying and treating sick individuals and administering care to the sick and convalescent.

Legislation and implementation are overwhelmingly within the remit of the federal authorities; the provinces have jurisdiction over relatively few matters concerning health care. Regarding Hospitals, the enactment of fundamental legislation is within federal jurisdiction while the provincial legislatures enact and execute implementing laws and regulations. The federal authorities also supervise the activities of all entities engaged in health care.

The supreme public health authority which prepares and executes laws, issues regulations, and regulates and supervises activities is the Ministry of ( Health) and Consumer Protection, which was spun off from the Federal Ministry of Social Affairs in 1973; all matters of Social Insurance are still within the remit of the latter. At provincial level, health care matters are in the hands of political health officers and departments headed by medical directors to whom the district health offices report.

These authorities are supported by a number of advisory bodies. The Oberster Sanitaetsrat is a scientific body composed of leading personalities representing all medical disciplines; it advises the Health Ministry on all basic issues of medical care and issues expert opinions. Similarly, there are Sanitaetsraete at provincial level, whose tasks include the evaluation of members of the medical profession who are candidates for important positions, such as department heads in hospitals etc.

Other bodies that exercise advisory functions for the Ministry are the Vaccination Board, the Austrian Codex Alimentarius Commission, the Radiation Protection Commission, the Advisory Board on Mental Hygiene, and the Advisory Board on Alcohol and Drug Abuse.

Physicians form the most important element of health care. Their activities in private surgeries, hospitals, clinics, medical institutes, spa centres and rehabilitation centres constitute the front line of health care.

The Medical Profession Act (Aerztegesetz ) of 1949 (as amended) says that the exercise of the medical profession comprises whatever direct or indirect measures based on medical and scientific knowledge (i.e. results confirmed by the collective experience of the practice of medicine) are applied to human beings in the interest of their health. Only fully trained physicians can exercise this profession on their own responsibility; non-medical practitioners, healers and other individuals who base their diagnostic or therapeutic actions on mere opinions, beliefs or unconfirmed assertions, are not admitted to practice in Austria.

Training for the medical profession begins with university studies of Medicine, which take a minimum of twelve semesters (six years) and lead to the award of the title Doctor of General Medicine. This is, as a rule, followed by three years of practical training (Turnus - internship) in the chief departments of a hospital, with minimum stipulated periods of training in each of these specialities. In the last few years it has also been possible for a trainee to spend a maximum of one year of that training period in the surgery of a general practitioner or consultant. After completion of internship, the trainee receives his/her diploma as general practitioner and is authorised to practise his/her profession without supervision and on his/her own responsibility.

This phase can be followed by a six-year period of training in a medical speciality, which focuses on one major discipline and a number of secondary disciplines. In some specialities trainees can "subspecialise" and acquire a number of additional titles. The diplomas of medical specialisation (consultancy) authorise their holders to exercise their profession as specialists on their own responsibility in their own practice.

Institutions which intend to train individuals for the medical profession are subject to evaluation and will only be recognised if they meet certain criteria.

The right to open a practice is not conditional on the conclusion of a contract with any of the various sickness insurance institutions. The number of surgeries which obtain contracts with insurance institutions is fixed in the individual regions in negotiations between the Austrian Medical Association and the Austrian Social Insurance Authorities.

The medical profession is broken down, according to different criteria, into trainee physicians (interns), self-employed general practitioners and specialists, employed physicians and self-employed physicians, though overlaps are possible. Physicians may serve in special (mostly additional ) functions such as schools physician, company physician, emergency physician, spa doctor, community doctor, medical expert, forensic expert, or police medical officer. The Amtsarzt, a public medical officer who exercises his/her functions in a variety of capacities for public authorities, has to pass an additional examination (Physikatspruefung) and is mainly responsible for those parts of the health care system that directly concern the public administration.

Medical specialists can exercise their profession in the following disciplines: accident surgery, anaesthesiology, dentistry, dermatology and venereology, gynaecology and obstetrics, internal medicine, neurology, neurosurgery, ophthalmology, orthopaedics, otorhinolaryngology, paediatrics, physical medicine, psychiatry, pulmonary diseases, radiology, surgery and urology (for dentistry, the post-doctoral practical training is only 2 years) and others. In addition, there are a number of therapeutic specialities, partly bordering on clinical medicine (pathology, laboratory medicine), partly on theoretical disciplines (pharmacology, immunology).

All physicians are members of official interest groups, the Medical Associations of the provinces in which they reside, which in turn have an overhead organisation, the Austrian Medical Association. These associations defend the interests of their members, keep professional registers, have consultative status with legislative bodies, negotiate with the public authorities and other institutions and support further training.

In exercising their profession, physicians have to rely on the cooperation of a great many other professions, including nurses (fully-trained nurses, auxiliary nurses), ambulance services, Midwives and medico-technical services (physiotherapy assistants, medicotechnical laboratory assistants, X-ray assistants, ergotherapists, dieticians etc.), whose number totalled 63,912 in 1994. Others are pharmaceutical staff in pharmacies and pharmaceutical companies, surgery receptionists and other non-medical personnel in public authorities, administrative bodies and offices.

A special situation prevails in respect of Dentisten, a group of professionals in non-surgical dentistry who exercise their profession on the basis of state examinations. Their training was abolished in 1975, but practising Dentisten make continue in practice until their retire.

Health care system is subject to a variety of checks, tests and control mechanisms: Medicinal drugs cannot be sold unless they have undergone detailed scrutiny including safety tests and have been officially licensed for sale at a stipulated price. Subsequent monitoring is frequent. The same provisions are also applied to other medicinal products, vaccines and appliances.

There are special institutions for the care for pregnant women and infants ("Mutter-Kind-Pass", a document issued to all pregnant women in which the results of all ante-natal and post-natal examinations are recorded), for school children, tuberculotic and venereal patients, institutions that cater for individuals affected by AIDS, and institutions involved in the care for mental patients ( Psychiatric Hospitals). Other important aspects of public health care are health education, preventive measures, cancer prevention, and socio-medical aspects of public health.

Another aspect of public health care, whose importance has somewhat diminished is the prevention of transmissible diseases and epidemics through the imposition of hygienic conditions for drinking water and sewerage, street sweeping, building regulations and Vaccinations. Epidemic control measures are ordered whenever necessary.

The public health service and the veterinary administration also supervise and control legal transport and trade in poisons.

The Ministry of Health regulates natural health resorts, supervising Spas, health resorts with medicinal springs or mud baths, and climatic health resorts.

Lastly, the health care system deals with deaths and funeral services, which fall within the jurisdiction of the provinces. The competent authorities issue death certificates, order post mortems, and regulate funerary services, the hygienic aspects of laying out bodies and of ground burials as well as the transport of bodies from the place of death to the burial site.

History: From the 13th century onwards princes and bishops kept physicians-in-ordinary. In the late Middle Ages, severely sick persons such as lepers were accommodated in "hospices" outside the city walls. In some larger settlements, operators of public baths (Bader) have been documented from the 13th century onwards as acting a barbers, surgeons and natural healers. They dressed wounds, bled patients and administered ointments and salves and were organised in regional guilds. From the 15th century, there were a few "Puechaerzte", university-trained physicians, in some of the major cities. In the 16th century the Lower Austrian Estates appointed a regional physician and several area physicians, particularly to give medical assistance to noblemen and the higher clergy. Folk medicine was widely practised by healers, mostly women, who were often at risk of being persecuted Witch-hunting. Diseases and epidemics ( Plague) made public health measures an urgent necessity in the 17th and 18th centuries. By closing frontiers or quarantining affected areas (cordon sanitaire) authorities sought to prevent the spread of epidemics. In some cases, a "master of sanitation" (magister sanitatis) was appointed.

Public health care made considerable progress at the time of Enlightenment. In 1770 Maria Theresia promulgated the Sanitaetshauptnormativ (amended in 1773), an instruction addressed to all physicians practising their art in the hereditary lands which was largely inspired by the Empress's physician-in-ordinary, Gerhard van Swieten. Medical officers were appointed in each district, a distinction was made between surgeons and Bader (whose trade was officially abolished in 1773), the requirement to have every corpse examined by a physician was introduced, and public health was made subject to governmental authorities. Surgeons had to take an examination at a domestic university, and committees of surgeons were set up in each district or region to ensure complete coverage.

From the reign of Joseph II onwards considerable advances were made in public health policy, including the foundation of the Josephinum, which was mainly dedicated to the training of army surgeons; on the French model, hospitals were established in the major cities (including the Allgemeines Krankenhaus - General Hospital -in Vienna). Medicine and surgery were declared artes liberales in 1874. A distinction was made between two categories of physicians: those who had passed an academic examination "in wound healing and obstetrics" and others who had undergone a two-year university training in surgery (in Linz, 1778-1808). In 1830 Lower Austria had 519 surgeons and 63 university-trained physicians. The training of midwives was also improved. Under Maria Theresia the Smallpox Vaccination was introduced; since the population-at-large for the most part still adhered to folk medicine, it was only in the course of the 19th century that smallpox vaccination was widely practised.

From 1856 onwards hospitals were also founded in smaller towns, and by the end of the First World War hospitals had been founded in almost all district capitals, and many had been enlarged by the construction of new buildings.

A new phase was ushered in by the Reichssanitaetsgesetz of 1870. It stipulated that only physicians trained in a five-year university course were to be admitted to practice. The title "Doctor of General Medicine" was introduced in 1872, and the "diplomas of surgery" (Wundarztdiplome) were abolished in 1873. At the same time, the state-controlled health-care administration (subject to the Ministry of the Interior) was complemented by public health councils in the individual regions and districts. From 1888 onwards, smaller municipalities jointly established public health communities whose medical officers were at the same time general practitioners.

Medical science made great strides in Austria in the 19th century. Teachers at Vienna University included such personalities as C. von Rokitansky, J. Skoda, I. P. Semmelweis, T. Billroth and J. Hyrtl, who were responsible for the great reputation of the Vienna School of Medicine.

From 1886 district insurance institutions were established to replace the Bruderladen, journeymen's sickness funds and local self-help organisations; by the middle of the 20th century most people had been provided with health insurance cover. In the early years of the 20th century great advances were made in fighting wide-spread diseases such as tuberculosis, in hospital equipment, the specialisation of physicians and the use of medical technology.

Legislation on the establishment of medical associations with compulsory membership was passed in 1891, a step that was of decisive importance for the medical profession. Since the time of the First Republic these associations have negotiated contracts with the public health insurance institutions (J. Tandler).

After 1938 considerable changes were made when the profession was controlled by the National Socialist Reichsaerztekammer and given a more distinctly regional organisation. In 1949 the Austrian Physicians Law was enacted; it regulated matters of professional training and medical fees and reconfirmed the functions of the medical associations. Since that time, the health care system has been consistently up to its present standard.

Literature#