!!!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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Institutions which intend to train individuals for the medical
profession are subject to evaluation and will only be recognised if
they meet certain criteria.
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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.
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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.
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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).
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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.
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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.
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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.
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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.
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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.
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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.
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The public health service and the veterinary administration also
supervise and control legal transport and trade in poisons.
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The Ministry of Health regulates natural health resorts, supervising
Spas, health resorts with medicinal springs or mud baths, and climatic
health resorts.
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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.
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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.
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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.
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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
19%%sup th/% century that smallpox vaccination was widely practised.
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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.
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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.
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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.
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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.
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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).
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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
K. C. F. Strobl, Das Gesundheitswesen in
Oesterreich, 1978; C. Haemmerle, Hebammen und Aerzte, Die
Auseinandersetzung zwischen Volks- und Schulmedizin am Beispiel der
Geburtshilfe, master's thesis, Vienna 1986; Kunst des Heilens. Aus der
Geschichte der Medizin und Pharmazie, erxhibition catalogue, Gaming
1991.
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