The context for supply and demand of public online services in Austria

The basic structures and functions of Austria's public administration are determined by her constitution as a federal republic consisting of nine "Länder" (states). Each "Land" has its own constitution, parliament and government and executes a significant part of public administration independently or by way of delegation. The "Länder" administrations are divided into districts ("Bezirke") to which a number of tasks are devolved. District offices are headed by the district commissioner who is responsible to the governor of the Land. Finally, local government is in the hands of a directly-elected local council and the mayor ("Bürgermeister"). In larger communities the mayor is assisted by a local authority.

Austria has been a member of the EU since 1995. While indigenous minorities are small in number (1.5% of total population and including Croatians, Slovenes, Hungarians, Czechs, Slovaks and Roma), immigration since after the second world war brought Turks, Bosnians, Serbians, Croatians (and others) to the country, which together now make up 10% of the population.

Key figures about Austria[1]

	Austria	Ø EU15	Ø EU25
Old age dependency ratio	22.8	25.5	24.5
Population density	95.8	119.8	116.3
GDP per head	120.9	108.6	100.0
GDP Growth - 5 year average	1.62%	1.85%	1.92%
Unemployment rate	4.8%	8.1%	9.0%
Inequality index	24	30	29

Austria has a well-developed market economy, a high standard of living, low inequality and low unemployment compared to the EU15 average. Social partnership plays an important role for modernising work organisation, improving labour legislation and ensuring satisfactory wage developments. The Austrian economy is closely tied to other EU economies, especially Germany's. Membership in the EU has drawn an influx of foreign investors attracted by Austria's access to the single European market and proximity to the new EU economies. Since 2001, growth has been slow. To meet increased competition from the New Member States and beyond, the Austrian government currently tries to modernise the country's regulatory framework. Participation in the labour market is considered too low, which is problematic given that population is ageing fast. Ageing is also putting much stress on Austria's ability to finance its health and pension systems.

Information Society indicators[2]

	Austria	Ø EU15	Ø EU25
Households with Internet access	45%	45%	42%
Broadband penetration	8.7%	7.6%	6.5%
ICT expenditure as percentage of GDP	3.2%	3.2%	2.6%
Digital Divide Index	63.0	53.0	50.1

Austria is well placed concerning the relative development of the Information Society. While Internet uptake is roughly at the same level as the EU15 average, broadband penetration has advanced faster than in most other Member States: 9 percent of the population have access to high-speed Internet in their homes. Similar to the Nordic countries and the Netherlands, the digital divide is considerably below the EU average, which suggests broad participation in the Information Society regardless of gender, age or educational attainment.

Austria's performance on the UN Telecom Index[3]

eHealth in Austria[4]

Recent years have seen a wealth of health-related information becoming available on the Internet from Austrian sources, and catering for Austrian citizens. There is no single online portal which dominates the market, such as in other countries where the government has taken the initiative to set up a major access gateway to online health services. However, many organisations of the Austrian public healthcare sector have become active in the area.

The Federal Ministry for Health and Women's Issues provides on its official homepage a link collection on particular health issues (e.g. on AIDS, cancer, diverse self-help groups etc.) and lists several associations dealing with a wide range of health issues. This homepage is a good starting point for people who look for general and particular information on health issues. Some of the institutions indicated at the Ministry's homepage (e.g. "medlink.at - the medical Internet address book") deliver further and more detailed information and search engines for health portals, doctors, hospitals, databases etc.

Private websites and online portals have been able to attract many more users. The most well-known is Netdoktor.at, an extensive online resource providing comprehensive and well-structured health information. Moreover, the site lets users search for doctors, pharmacies, hospitals, self-help groups and providers of insurance. Online discussion platforms provide the option to discuss various issues with other users and experts. In early 2004 (the latest time for which data is available) Netdoktor.at had about 275,000 visitors. "surfMED" is another online portal with similar content and interactive features. The portal co-operates with about 300 medical experts in order to deliver well-founded and trustworthy health information. SurfMED's intention is to provide medical information in a language and structure so that it can be understood by the broadest public. Interactive and personalised information are deployed to this end.

Key figures about the Austrian health system[5]

	Austria	Ø EU15	Ø EU25
Percentage satisfied with own health	89.0%	82.5%	79.8%
Prevalence of long-term illness	17.0%	13.8%	20.0%
Doctors per 100,000 inhabitants	338	233	251
Health expenditure as percentage of GDP	7.0%	7.4%	7.3%

With regard to online transactions, the online service of the Association of Austrian Social Insurance Institutions is of interest. The association's portal not only provides general health information, but also offers a wide range of forms, either for downloading and printing or for online submission. In the latter case though, have to be captioned with a digital signature. This particularly applies to those cases which necessitate a personal signature (e.g. pension applications). Since there are 25 public insurance companies, the range of online forms varies. For example, the Vienna Health Insurance Fund provides forms for employers, general health issues (e.g. refund of expenses for particular treatments), psychotherapy, insurance coverage and child allowance.

With regard to the online sale of medicaments, "e-rating.at" (a private consumer advice and market research company) analysed in September 2004 the Internet performance of Austrian pharmacies. The study found that only 163 out of more than 1,000 pharmacies had a web site. 46 of them offered the option to conduct online orders and only 10 of them met the requirements of the Austrian eCommerce Law. Three pharmacies provided a SSL-connection for a secure data transfer and five websites fulfilled the Austrian data protection rules.

Online communication between patients and general practitioners, health clinics or specialist doctors is the exception rather than the rule in Austria. Mainly, the Internet is being used to prepare visits to doctors, for which purpose sophisticated online directories are available, such as www.arztverzeichnis.at which lists all Austrian physicians together with their specialisation, opening hours, additional qualifications, contracted health insurance companies. Links are included in cases where practitioners have websites of their own. Some doctors provide extensive information on their personal homepages.

General Practitioners with Websites[6]

The Austrian Ministry for Health and Women's Issues estimates that about 80% of the Austrian physicians use ICT equipment for their daily data procedures. However, the percentage of those who use ICTs for interaction with their patients, including consultations, is very low. A small number of doctors offer the option to make online appointments.

No evidence is available on the extent of Internet use for the reception of test results or prescription renewals. Currently, several pilot projects on online exchange of medical test results in Vienna and in other Austrian provinces are being carried out.

Online consultation is provided by some health portals (e.g. "Netdoktor.at") which offer the option to discuss health issues online with medical experts. This does not reach so far as to amount to online diagnosis, though.

An other alternative to traditional face-to-face consultation, quite popular in some European countries, is telephone consultation. Basically, most Austrian physicians offer the option for telephone consultation. However, there is no data available on the extent and nature of private telephone consultation. The overall extent is likely to be small because of the problem of liability: Telephone consultations do not correspond to the Austrian "medical culture", and are not regulated to the same extent than traditional patient-doctor interaction. The Austrian medical system is mainly based on direct interaction between the doctor and the patient and involves face-to-face communication.

There is no regulation which would hinder (or encourage) telephone-based medical consultations in Austria. The same applies to online medical consultations.

Overall, most Austrian eHealth services are still in pilot stage, apart from basic provision of health information and simple administrative transaction services. In addition, for those few very ambitious eHealth services which are already available on the market, take-up rate are still low.

The Austrian Government's eHealth strategy has recently revolved around a major initiative of far-reaching implications for the whole sector, which is the introduction of the so-called "e-card" in 2005. This card will be the key to the health insurance system. The intention behind it is to simplify life for all actors involved: patients, doctors, insurance companies, hospitals and all other healthcare providers. It will be distributed to all persons who are entitled to benefits from the public health insurance system, which means the large majority of Austrian citizens.

Satisfaction with National Healthcare System[7]

The e-card gives full access to medical treatment and health-related services, while doing away with the need for paper documents, in the process reducing bureaucracy but also enabling higher levels of privacy than before. The e-card is a smart card which will substitute for any type of health insurance vouchers. Moreover, the device is prepared for acting as a personal identification through electronic signature, which means it can also be used as a citizen card for applications which go far beyond health services alone. By means of an electronic signature it will be possible to sign electronic documents to handle transactions with public authorities round the clock at home. The smart card itself is not a carrier of application data, but contains the necessary data and keys for the identification and control of access authorizations. Only administrative data of the cardholder are stored on the e-card, for instance name, insurance number, data of birth, etc.

On the reverse side of the e-card the European Health Insurance Card (EHIC) will be implemented. It will substitute for the international health insurance voucher for the claim of medical treatment during temporary visits in EU Member States of the European Union, the European Economic Area and Switzerland.

Additionally, the e-card is prepared for electronic signature. This means that - after purchase of an adequate certificate - the e-card can also be used as citizen card. In the start-up period the e-card only will substitute the health insurance voucher. Further extensions are planned and partly are already under preparation, including the integration into the system of hospitals and pharmacies which will enable ePrescribing.

User orientation in eHealth services

According to most experts the national strategy in Austria does not put much stress of user orientation explicitly. Nevertheless, most components pursue the objective of facilitating patients to obtain online the information they need, and making it easier for them to access high-quality services. In general, Austrian citizens tend to be comparatively content with the national health care system. They benefit from a number of features which are uncommon in many other EU countries. For example, Austrians can choose their physicians or specialists by themselves rather than needing a referral from an agency or another doctor. This means that Austrians can always obtain a second opinion on a certain diagnosis if they wish so.

With regard to eHealth services, the provision of extended online information on health issues is a first step to open up administrative structures and to improve the information level of the public. Thus, information on opening hours of ambulances, hospitals and physicians, and access to a full range of self-help groups that are using the Internet as communication platform, are considered as basic eHealth services. Moreover, the current Austrian Government envisages a nation-wide "health reform" which shall partly come into power in 2005 and which also sets the first steps for the introduction of a "patient online file". This shall ease the handling of patient data, avoid double examinations (which currently often happen because of lack of coordination between doctors, and which can and cause high expenditures and risks to personal health such as in the case of X-ray examinations). Both, patients and medical doctors shall benefit from such an "online file" because of more efficiency and less bureaucratic barriers.

There are a number of factors which act as barriers to the delivery of user-oriented eHealth services. It appears that the federal structure of the Austrian state is not always of advantage for the implementation of innovations in health services. Given that most of the decision-making is done by the regional governments, all decisions related to investments and technological systems are taken on a sub-federal level. This makes it more complicated to develop and establish a national eHealth strategy and causes additional costs. However, in order to make full use of eHealth services, federal and regional actors have to co-operate more closely.

Uptake is likely to be held back by concerns about the quality of the information provided online. In 2002, the Austrian Chamber of Labour undertook an evaluation on usability and quality of content offered in 13 online health portals. The assessment involved user-relevant aspects, the findability of the portals and the quality and completeness of information related to three selected diseases. It made use of a list of quality criteria which had been produced before by a number of experts in the field. Shockingly, only three health portals met all criteria (namely netdoktor.at, surfmed.at and medwell24.at). According to the PR department of the Austrian Chamber of Labour, there has been no further assessment undertaken since 2002. It is likely that some of the other health portals have improved their Internet performance in the meantime. Still, the findings of the evaluation clearly point out why users behave very reasonably if they question the quality of much of the health-provided data which is available online.

On the positive side, experts point out four factors that favour implementation of eHealth services in Austria: Firstly, Austrian health institutions (hospitals, ambulances) and the Austrian physicians are well equipped with ICT. This provides a good background for the implementation of eHealth services. Secondly, introduction of the "e-card" will open up manifold options for introducing advanced, user-oriented eHealth services in the near future. Thirdly, awareness of the importance of data protection and the need for sensitive handling of personal data are well established among all key players. Since cases of data misuse, once made public by the press, can cause a huge backlash for uptake, the fact that data privacy protection is taken seriously is reassuring. Fourthly, regional governments have expressed their preference for the Federal Ministry for Health and Women's Issues to take a stronger role in coordinating co-operation between the "Länder", the municipalities and the Federal Ministry in the field of eHealth, which means that implementation procedures may well be streamlined and best practice in user orientation transmitted faster throughout the country's healthcare system.

Internet Use for Searching Health Information[8]

In the short to medium-term future new applications of ICTs in medical treatment are expected to play an every more important role. An example is the combination of diagnostic technologies with ICTs to transmit medical measurement data between different actors in the health system. Consideration of user needs will have 0to be a condition sine qua non since all evidence suggests that acceptance by users is of utmost importance for applications in sensitive life areas such as health. One of the most decisive factors in this context appears to be that patients are provided with trustworthy, easily accessible and user-friendly eHealth services.

eUser - the Project

The eUser study is funded by the European Commission's IST (Information Society Technology) programme. eUser is a major research and support project which has set out to provide solid evidence as to users' real needs regarding eGovernment, eHealth and eLearning offers, as well as providing data about their attitudes and the uptake levels of current public online services. The project supports the IST programme to achieve its key objectives of putting the user and his/her needs at the centre of IST developments. It provides empirical information on key public eServices domains -eGovernment, eHealth, eLearning - identified as priorities by the European Council, and assesses the demand/supply match in these fields.

The eUser Approach

To achieve its objectives, eUser addresses both generic user-related issues and domain-specific topics, and develops a globally accessible repository of evidence-based knowledge, methods and best practice examples. It pursues an extensive programme of active knowledge translation, transfer and dissemination supported by sophisticated online knowledge dissemination tools. The knowledge base will consolidate both existing knowledge and approaches, and novel data generated by the project through representative population surveys (demand side) in old and new Member States, and through comparative analyses of readiness to address user aspects of public eServices in each Member State (supply side).

The project is designed in two phases. Phase I - the preparatory phase - has developed a conceptual framework that systematically identifies and cross-references user issues and service characteristics in relation to online public services. An EU-wide population survey regarding the needs, experiences and requirements of both current and potential users of online public services has been carried out in early 2005. Concerning the supply side, information from national public sector environments has been collected, about the degree to which the European public sector pays sufficient attention to user-orientation of online services. Good practice examples regarding user-appropriate online public service provisions are being identified and described.

All these results build the basis and provide content for the eUser interactive online knowledge base and support service which is being set up as an online observatory on user issues. This constitutes the basis for active support services on user-centred topics which are being made available inside and outside the IST programme.

eUser Country Briefs

This document has been prepared by the eUser consortium based on information provided by a National Correspondent (Roman Winkler, Institute of Technology Assessment at the Austrian Academy of Sciences, Vienna) as well as secondary data sources such as Eurostat and other Commission Services.

25 eUser eHealth Country Briefs are available in a common format, one for each member of the enlarged European Union. You can access and download these documents in PDF format (for free) from our website

Notes About the Data Sources Used in This Document