Private vs. statutory health insurance: an overview

Medication blister

Good health insurance is important for health protection. © Roberto Sorin,

In Austria, citizens are faced with the choice between two fundamentally different types of health insurance: statutory health insurance (GKV) and private health insurance (PKV). This decision not only affects how one accesses medical services, but can also have financial and long-term health implications.

Basic principles and entry requirements

Statutory health insurance is based on the principle of solidarity. This means that the contribution amount is based on income and not on the individual health risk.

In contrast, the Private health insurance according to the equivalence principle. This means that the contributions are calculated based on the individual risk and the selected scope of services.

Scope of services and options

A key difference between GKV and PKV lies in the scope of services and the possibility of customizing them. While statutory health insurance offers a standardized catalog of benefits that benefits all insured persons, those with private insurance can put together their insurance coverage tailored to their needs. This includes, among other things, the free choice of doctor, single rooms in the hospital and reimbursement for alternative healing methods.

This flexibility in the selection of services enables privately insured people to adapt their insurance coverage to their individual needs and ideas. For example, you can include additional services such as dental treatment, preventive examinations or daily sick pay in your contract. This gives you the opportunity to put together tailor-made insurance cover that optimally meets your personal requirements.

Contribution structure and cost reimbursement

In the GKV, the contributions are income-dependent and are borne equally by the employee and the employer. With private health insurance, on the other hand, the contribution depends on the age of entry, the state of health when the contract is concluded and the tariff selected. While those with statutory health insurance usually bill directly via the electronic health card, those with private insurance first receive an invoice that they pay themselves and then submit to their insurance company for reimbursement.

There are also differences between statutory and private health insurance when it comes to reimbursement. It should be noted that those with private insurance often have to bear part of the costs themselves, as tariffs with deductibles are common. In statutory health insurance, however, the costs are covered by the health insurance company as long as they are services that are included in the GKV’s catalog of services.

Female doctor with smartphone in her hands
Digitalization simplifies appointment scheduling, access to files and more. © National Cancer Institute

Digitalization in the healthcare system: GKV vs. PKV

The Digitalization in healthcare is advancing and increasingly influencing how medical services are offered and used. Both statutory and private health insurance companies are integrating digital solutions to improve access to health services and simplify administration. From electronic patient records to apps for scheduling appointments or telemedicine – the options are diverse. Private health insurance companies often offer innovative digital offers more quickly because they can react more flexibly to market changes and have a more individual service portfolio.

This can be a crucial factor for policyholders who place particular value on advanced medical care and convenience. While statutory health insurance companies often take longer to introduce and offer digital innovations due to their structures, private health insurance companies have the advantage of being able to respond more quickly to the needs of their insured persons.

These offerings range from virtual consultations to innovative health apps and digital health coaching, which enable contemporary and modern patient care. In this way, private health insurers not only make it easier for their customers to access medical services, but also help ensure that these can be used more efficiently and in line with needs.

Which insurance is worthwhile for whom?

The choice between statutory health insurance and private health insurance depends on the professional situation, income, state of health and personal preferences regarding medical care. In general, it can be said that private health insurance can offer financial advantages, especially for young, healthy people with above-average incomes.

May 22, 2024

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