Child Health Care Services in Austria
2016; Elsevier BV; Volume: 177; Linguagem: Inglês
10.1016/j.jpeds.2016.04.039
ISSN1097-6833
AutoresReinhold Kerbl, Georg Ziniel, Petra Winkler, Claudia Habl, Rudolf Püspök, Franz Waldhauser,
Tópico(s)Adolescent and Pediatric Healthcare
ResumoWe describe child health care in Austria, a small country in Central Europe with a population of about 9 million inhabitants of whom approximately 1.7 million are children and adolescents under the age of 20 years. For children and adolescents, few health care indicators are available. Pediatric and adolescent health provision, such as overall health provision, follows a complex system with responsibilities shared by the Ministry of Health, 19 social insurance funds, provinces, and other key players. Several institutions are affiliated with or cooperate with the Ministry of Health to assure quality control. The Austrian public health care system is financed through a combination of income-based social insurance payments and taxes. Pediatric primary health care in Austria involves the services of general pediatricians and general practitioners. Secondary care is mostly provided by the 43 children's hospitals; tertiary care is (particularly) provided in 4 state university hospitals and 1 private university hospital. The training program of residents takes 6 years and is completed by a final examination. Every year, this training program is completed by about 60 residents. We describe child health care in Austria, a small country in Central Europe with a population of about 9 million inhabitants of whom approximately 1.7 million are children and adolescents under the age of 20 years. For children and adolescents, few health care indicators are available. Pediatric and adolescent health provision, such as overall health provision, follows a complex system with responsibilities shared by the Ministry of Health, 19 social insurance funds, provinces, and other key players. Several institutions are affiliated with or cooperate with the Ministry of Health to assure quality control. The Austrian public health care system is financed through a combination of income-based social insurance payments and taxes. Pediatric primary health care in Austria involves the services of general pediatricians and general practitioners. Secondary care is mostly provided by the 43 children's hospitals; tertiary care is (particularly) provided in 4 state university hospitals and 1 private university hospital. The training program of residents takes 6 years and is completed by a final examination. Every year, this training program is completed by about 60 residents. Austria is a small landlocked country with a size of 83 855 km2 located in Central Europe. It has approximately twice the size of neighboring Switzerland (41 285 km2) and is similar in size to Bavaria (70 533 km2), a neighboring German (federal) state. The western and central part of the country is covered by the Alps, which are surrounded by a hilly to flat landscape in Austria's north, west, and south.1Wikipedia Encyclopedia, Geography of Austria. http://en.wikipedia.org/wiki/Geography_of_Austria. Accessed March 15, 2015.Google Scholar The Alps can create specific logistical challenges in primary health care (PHC) and accessibility to stationary health facilities. Austria is divided into 9 provinces, some of them with a very long tradition of local governance. At present, these provinces have a high degree of independence concerning administrative affairs, which is particularly reflected in hospital care. In its present geographic and political structure, Austria dates back to 1918 when the Austrian-Hungarian monarchy collapsed in the aftermath of the First World War. At that time, the state of Austria was established as a democratic federal republic encompassing most of the German-speaking areas of the previous monarchy. Historically, culturally, and economically, the country is closely connected to the other German speaking countries in Central Europe (ie, Germany and German-speaking Switzerland). Thus, many health care institutions in the aforementioned countries developed similarly. Even though Austria also has a long historical connection to its eastern neighbors, medical institutions developed quite differently, mainly because of the communist governments in Eastern Europe during the second half of the last century. In 2012, 1.7 million children and adolescents under the age of 20 years lived in Austria, representing about 20% of the whole population, with a declining trend. The proportion of children less than 15 years of age is approximately 14%, which is less than in most other European countries. Since 1990, the total population has increased by 0.4% per year, whereas the number of children up to 14 years of age has decreased by 0.4% per year (Table I).Table ISociodemographic key indicators199019952000200520102012SourceTotal population∗Annual growth rate of total population (1990-2012): 0.43% per year.7 644 8187 943 4898 002 1868 201 3598 375 2908 408 121Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Population 0-14 y†Annual growth rate of population aged 0-14 years (1990-2012): -0.41% per year.1 340 3041 471 0561 371 7501 323 0331 244 8701 224 134Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Population 15-24 y1 169 6001 016 935954 6511 010 2701 022 2301 017 852Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Population over 65 y1 139 8411 196 8741 233 6671 307 9451 475 9211 496 357Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Population density 1§Population density 1: inhabitants per km2 area of permanent settlement.236245247253258259Eurostat, ST.AT¶ST.AT: http://www.statistik.at/web_de/klassifikationen/regionale_gliederungen/dauersiedlungsraum/index.html.3Population density 2Population density 2: inhabitants per km2.91959598100100Eurostat, ST.AT¶ST.AT: http://www.statistik.at/web_de/klassifikationen/regionale_gliederungen/dauersiedlungsraum/index.html.3Average number of children per family (under age 15 y)1.611.621.611.601.601.60ST.ATST.AT: Statistik Austria (2013): Familien- und Haushaltsstatistik 2012. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Wien.4Average age of women at first childbirth25.027.726.427.328.228.7Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Fertility rate1.461.361.411.441.441.44Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Birth rate (births per 1000 inhabitants)11.811.29.89.59.49.4Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Death rate (deaths per 1000 inhabitants)10.910.29.69.29.29.4Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Age dependency ratios Population 0-14 y:15-64 y26.026.625.423.822.021.5Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2 Population (0-14 y +>65 y):15-64 y48.049.048.347.248.147.8Eurostat‡Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Distribution of population (rural/urban): share of children living in communities up to 20 000 inhabitants696868ST.ATST.AT: Statistik Austria (2013): Familien- und Haushaltsstatistik 2012. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Wien.4,ST.AT: Statistik Austria (2006): Familien- und Haushaltsstatistik 2005. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Wien.5Proportion of single parent households19.219.620.421.220.920.3ST.ATST.AT: Statistik Austria (2013): Familien- und Haushaltsstatistik 2012. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Wien.4Proportion (%) of single parent households: single parent households: all households with children.∗ Annual growth rate of total population (1990-2012): 0.43% per year.† Annual growth rate of population aged 0-14 years (1990-2012): -0.41% per year.‡ Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Eurostat, European Data Statistics. http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database. Accessed March 15, 2015.Google Scholar§ Population density 1: inhabitants per km2 area of permanent settlement.¶ ST.AT: http://www.statistik.at/web_de/klassifikationen/regionale_gliederungen/dauersiedlungsraum/index.html.3Statistik Austria, Dauersiedlungsraum. http://www.statistik.at/web_de/klassifikationen/regionale_gliederungen/dauersiedlungsraum/index.html. Accessed March 15, 2015.Google Scholar∗∗ Population density 2: inhabitants per km2.†† ST.AT: Statistik Austria (2013): Familien- und Haushaltsstatistik 2012. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Wien.4Statistik Austria. Familien-und Haushaltsstatistik 2012. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Wien: Statistik Austria; 2013. http://www.ecoplus.at/sites/default/files/Demographisches-Jahrbuch-2012(1).pdf. Accessed March 15, 2015.Google Scholar‡‡ ST.AT: Statistik Austria (2006): Familien- und Haushaltsstatistik 2005. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Wien.5Statistik AustriaFamilien-und Haushaltsstatistik 2005. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Statistik Austria, Wien2006Google Scholar Open table in a new tab Proportion (%) of single parent households: single parent households: all households with children. About 68% of all children in Austria live in rural areas (ie, communities up to 20 000 inhabitants), 14% live in cities with 20 000-300 000 inhabitants, and 18% live in the capital city of Vienna. Age dependency percentages (indicated as the sum of children 65 years of age vs the "working age group" of 15-64 years of age) remained constant over the past 20 years and were around 48%. This can be explained by the declining population rate of children vs a simultaneous increase in the population rate of the elderly. In 2012, the fertility rate (average number of children per woman) was 1.44, having experienced an increase from a historically low level of 1.33 in 2001. The Austrian fertility rate is below the average of the European Union (EU) countries. About 80 000 children are born per year, which represents a birth rate of approximately 9.4 children per 1000 inhabitants. The average age of women at the birth of their first baby is increasing continuously. In 2012, the mean age at birth of her first baby was 28.7 years and the mean age at birth of any baby was 30.3 years. Furthermore, 2.6% of all children had mothers younger than 20 years of age. The rate of teenage pregnancies has been decreasing (2.6% in 2012, 4.4% in 1995). Of all households with children under the age of 15 years, 14.2% are single parent households. This rate has remained stable since 1990. This also means that in 2012, 13.7% of all children under the age of 15 years did not live with both parents. At about 1.6 children per family, the average size of families with children under the age of 15 years has been stable over the past 20 years. Economic key indicators are listed in Table II.Table IIEconomic key indicators199019952000200520102012SourceGDP136 135176 183213 196253 009294 208317 213Statistik Austria∗Statistik Austria.6,7GDP per capita17 80822 18026 64230 85035 08637 526Statistik Austria∗Statistik Austria.6,7Public expenditure (% GDP)NANA52.13%NA52.6%†2009.50.7%‡2011.OECD§OECD http://www.oecd-ilibrary.org/governance/government-at-a-glance-2013/general-government-expenditures-as-a-percentage-of-gdp-2001-2009-and-2011_gov_glance-2013-graph48-en.8Unemployment (number and % of total labor force)165 795 (5.4%)215 716 (6.6%)194 314 (5.8%)252 654 (7.3%)250 782 (6.9%)260 643 (7.0%)AMS¶AMS (Arbeitsmarktservice).9Youth unemployment rate (15- to 24-y-olds)6.310.38.88.7EurostatEurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Poverty ratePoverty rate: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_peps01&lang=de.10 (total population)16.816.618.5EurostatEurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Poverty ratePoverty rate: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_peps01&lang=de.10 (children less than 16 y)18.519.321.7EurostatEurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Inequality measure: Gini coefficientGini coefficient: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_di12&lang=de.1126.226.127.6EurostatEurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2GDP, gross domestic product; NA, not available; OECD, Organization for Economic Cooperation and Development.∗ Statistik Austria.6Statistik AustriaGesundheitsausgaben in Österreich nach System of Health Accounts.http://www.statistik.at/web_de/static/gesundheitsausgaben_in_oesterreich_laut_system_of_health_accounts_oecd_199_019701.xlsxDate: 2014Google Scholar, 7Statistik AustriaStatistik des Bevölkerungsstandes gemäß §9 Abs.9 FAG 2008.http://www.statistik.at/web_de/statistiken/bevoelkerung/volkszaehlungen_registerzaehlungen_abgestimmte_erwerbsstatistik/bevoelkerungsstand/index.htmlDate: 2014Google Scholar† 2009.‡ 2011.§ OECD http://www.oecd-ilibrary.org/governance/government-at-a-glance-2013/general-government-expenditures-as-a-percentage-of-gdp-2001-2009-and-2011_gov_glance-2013-graph48-en.8OECDiLibrary, Government at a Glance 2013. http://www.oecd-ilibrary.org/governance/government-at-a-glance-2013/general-government-expenditures-as-a-percentage-of-gdp-2001-2009-and-2011_gov_glance-2013-graph48-en. Accessed March 15, 2015.Google Scholar¶ AMS (Arbeitsmarktservice).9AMSArbeitsmarktlage seit 1946.http://www.ams.at/_docs/001_aml46-13.xlsDate: 2014Google Scholar∗∗ Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database.2Eurostat, European Data Statistics. http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database. Accessed March 15, 2015.Google Scholar†† Poverty rate: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_peps01&lang=de.10Eurostat, European Data Statistics. http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_peps01&lang=de. Accessed March 15, 2015.Google Scholar‡‡ Gini coefficient: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_di12&lang=de.11Eurostat, European Data Statistics. http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_di12&lang=de. Accessed March 15, 2015.Google Scholar Open table in a new tab GDP, gross domestic product; NA, not available; OECD, Organization for Economic Cooperation and Development. For almost 100 years, Austria has had a federal democratic government system, which was disrupted during the 1930s and 1940s and was re-established after the Second World War. At present, it is well accepted by its population. The directly elected president (head of the entire state, Bundespräsident) has representative responsibilities and limited political power. Representatives for the parliament are elected by the population, who votes for a specific party. According to a ranking list within each party and corresponding to population size of provinces, representatives are then "assigned for" the parliament. The parliament and the president appoint the prime minister (Bundeskanzler) and the government (Bundesregierung). Within the provinces, representatives are elected by the population for the provincial parliament (Landtag). These representatives appoint the province president (Landeshauptmann) and the province government (Landesregierung). In addition to the separation of legislative and executive power between parliament and government, power is also shared between the state and Austria's 9 provinces according to subsidiary principles. This fact is relevant for child health care because many responsibilities regarding health care and preventive measures (eg, vaccination programs) remain in the hands of the 9 provinces. This structure is frequently considered a possible source for the lack of cooperation in health issues and as a cause for delays in steps to a health reform. During most of the last 70 years, Austria has been governed by a coalition of 2 political parties (ie, The Social Democratic Party [a social democratic party] and The People's Party [a Christian conservative party]). Occasionally, these parties have ruled singularly or in coalition with The Freedom Party (a right-wing party). During the last 30 years, The Green Party (an environmental party) has become a stable player in Austrian politics, with some 10% of votes. Presently, The Green Party or The Freedom Party are coalition partners in several province governments. In 1956, the state of Austria declared its military neutrality and until now holds no membership in any military coalition. Instead, the declared aim of Austria's foreign policy is to participate in international organizations.12Bundesministerium für Europa, Integration und Äußeres (BMEIA). http://www.bmeia.gv.at. Accessed March 15, 2015.Google Scholar In accordance with this intention, Austria is presently a member of 72 such organizations,13Index Mundi, Austria International organization participation. http://www.indexmundi.com/austria/international_organization_participation.html. Accessed March 15, 2015.Google Scholar and among others, hosts the International Atomic Energy Agency, United Nations Industrial Development Organization, United Nations Office at Vienna, Organization for Security and Cooperation in Europe, and European Monitoring Center on Racism and Xenophobia. However, membership in the EU (since 1995) is its most important membership. At present, Austria is one of the EU net contributors and one of the wealthiest members of the community with a gross domestic product of 34 000 € per capita in 2013.14Eurostat, European Data Statistics. http://ec.europa.eu/eurostat/tgm/table.do?tab=table&init=1&language=en&pcode=tsdec100&plugin=1. Accessed June 28, 2016Google Scholar In the 2013 academic ranking of 500 world universities (Shanghai Ranking), the Medical School of Vienna holds positions between 201 and 300, and the Graz Medical School and the Innsbruck Medical School hold positions between 401 and 500, respectively.15Academic Ranking of World Universities. http://www.shanghairanking.com/ARWU2013.html. Accessed March 15, 2015.Google Scholar These medical schools are the most important providers of tertiary health care. In the 2012 Corruption Perception Index of Transparency International,16Transparency International. http://www.transparency.org/cpi2013/results. Accessed March 15, 2015.Google Scholar Austria scored 69 and ranked 26th of 175 assessed countries worldwide (position 1 = country with least evidence for corruption). In 2012, median life expectancy in Austria was 80.2 years (women 83.3 years and men 78.3 years), which corresponds to an increase of about 4 years in comparison with life expectancy in 1990.17Statistik Austria, Lebenserwartung,. http://www.statistik.at/web_de/statistiken/gesundheit/gesundheitszustand/lebenserwartung_in_gesundheit/. Accessed March 15, 2015.Google Scholar Life expectancy in Austria is slightly above the EU-27 average.18Eurostat Statistics Explained. http://ec.europa.eu/eurostat/statistics-explained/index.php/Glossary:EU_enlargements. Accessed March 15, 2015.Google Scholar However, healthy life expectancy is only around 60 years of age, depending on the calculation method. Over the past 20 years infant mortality has fallen considerably (Table III). Whereas in the early 1990s when approximately 8 of 1000 newborns died within the first year, only 3.2 died in 2012,22Statistik Austria, Sterbefälle. http://www.statistik.at/web_de/statistiken/bevoelkerung/sterbefaelle/023633.html. Accessed March 15, 2015.Google Scholar about one-half of whom died within the first week. Infant mortality in Austria corresponds to the EU-15 average, but is below the EU-27 average. There are, however, problems regarding high preterm birth rates (8.4% in 2012) and a high proportion of infants with low birth weight (around 7% below 2500 g and around 1% below 1500 g). Both indicators are above the EU-15 average.18Eurostat Statistics Explained. http://ec.europa.eu/eurostat/statistics-explained/index.php/Glossary:EU_enlargements. Accessed March 15, 2015.Google Scholar Furthermore, the rate of deliveries by cesarean in Austria is, compared with many other European countries, very high (about 30% of births with an increasing trend).Table IIIKey indicators for child health and well-being status199019952000200520102012SourceLife expectancy at birth (y)75.776.778.179.280.080.4ST.AT∗ST.AT Statistik Austria Todesursachenstatistik19 and calculations from Gesundheit Österreich GmbH/ÖBIG.4Perinatal mortality rate (per 1000 live births)6.96.96.75.95.95.1ST.AT†ST.AT Statistik Austria (2013) Jahrbuch der Gesundheitsstatistik (2012).20Neonatal mortality rate (per 1000 live births)4.53.43.32.92.72.3ST.AT†ST.AT Statistik Austria (2013) Jahrbuch der Gesundheitsstatistik (2012).20Postneonatal mortality rate (per 1000 live births)3.32.01.61.21.20.9ST.AT†ST.AT Statistik Austria (2013) Jahrbuch der Gesundheitsstatistik (2012).20Maternal mortality rate (per 100 000 live births)6.61.12.63.81.31.3ST.AT†ST.AT Statistik Austria (2013) Jahrbuch der Gesundheitsstatistik (2012).20Infant mortality rate (per 1000 live births)7.85.44.84.23.93.2ST.AT†ST.AT Statistik Austria (2013) Jahrbuch der Gesundheitsstatistik (2012).200-5 y mortality rate (per 100 000)191.5138.1109.899.393.475.7ST.AT∗ST.AT Statistik Austria Todesursachenstatistik19 and calculations from Gesundheit Österreich GmbH/ÖBIG.40-14 y mortality rate (per 100 000)73.854.543.338.335.331.3ST.AT∗ST.AT Statistik Austria Todesursachenstatistik19 and calculations from Gesundheit Österreich GmbH/ÖBIG.4Main causes of child death (% communicable, noncommunicable, external)NANANANANANANAMain causes of DALYs in childhoodNANANANANANANAMain causes of morbidity (asthma, diabetes, epilepsy, neuropsychiatric, injuries)NANANANANANANAMain risk factors for ill health Daily smoking 15-y-olds (%)19.4HBSC, Ramelow Daily smoking 17-y-olds (%)32.6HBSC, Ramelow Drinking alcohol at least once a wk 15-y-olds (%)19.7HBSC, Ramelow Drinking alcohol at least once a wk 17-y-olds (%)38.4HBSC, Ramelow Eating fruit and vegetables daily, 11- to 15-y-olds (%)44.4HBSC, Ramelow Number of days with 1 h physical activity per d within the last wk, 11- to 15-y-olds4.42HBSC, Ramelow Early leavers from education and training (18- to 24-y-olds)9.18.37.6Eurostat Children (less than 16 y) at risk of poverty or social exclusion18.519.321.7Eurostat Adolescent pregnancy and birth rates (under 20 y)4.44.23.93.22.6ST.AT†ST.AT Statistik Austria (2013) Jahrbuch der Gesundheitsstatistik (2012).20 Immunization rates for measles60.060.074.776.076.0WHO‡WHO http://data.euro.who.int/hfadb/.21HBSC, Health Behaviour in School-aged Children Study; NA, data not available; DALY, disability-adjusted life year; WHO, World Health Organization.∗ ST.AT Statistik Austria Todesursachenstatistik19Statitsik Austria, Todesursachen. http://www.statistik.at/web_de/statistiken/gesundheit/todesursachen/todesursachen_im_ueberblick/. Accessed March 15, 2015.Google Scholar and calculations from Gesundheit Österreich GmbH/ÖBIG.4Statistik Austria. Familien-und Haushaltsstatistik 2012. Ergebnisse der Mikrozensus-Arbeitskräfteerhebung. Wien: Statistik Austria; 2013. http://www.ecoplus.at/sites/default/files/Demographisches-Jahrbuch-2012(1).pdf. Accessed March 15, 2015.Google Scholar† ST.AT Statistik Austria (2013) Jahrbuch der Gesundheitsstatistik (2012).20Statistik AustriaJahrbuch der Gesundheitsstatistik 2012.2013Google Scholar‡ WHO http://data.euro.who.int/hfadb/.21World Health Organisation (WHO), Regional Office for Europe. http://data.euro.who.int/hfadb/. Accessed March 15, 2015.Google Scholar Open table in a new tab HBSC, Health Behaviour in School-aged Children Study; NA, data not available; DALY, disability-adjusted life year; WHO, World Health Organization. The maternal mortality rate also has decreased over the past decades.19Statitsik Austria, Todesursachen. http://www.statistik.at/web_de/statistiken/gesundheit/todesursachen/todesursachen_im_ueberblick/. Accessed March 15, 2015.Google Scholar Whereas in 1990 when 6.6 women died per 100 000 births, in 2012 only 1.3 women died per 100 000 births (Table III). Since 2002, the maternal mortality has been 1 to 3 women per year countrywide. The mortality rate for 0- to 14-year-old children also has decreased considerably over recent years. Although 74 deaths per 100 000 were registered in 1990, only 35 deaths per 100 000 were reported in 2012. In 2012, apart from causes of death originating in the perinatal period (33%) and congenital malformations (26%), the main causes of death of children up to the age of 14 years were "external" causes (11%) and cancer (8%).19Statitsik Austria, Todesursachen. http://www.statistik.at/web_de/statistiken/gesundheit/todesursachen/todesursachen_im_ueberblick/. Accessed March 15, 2015.Google Scholar The main reasons for hospital treatment of 0- to 14-year-olds in 2012 were diseases of the respiratory system (18%), injuries (14%), infectious diseases (8%), and diseases originating in the perinatal period (8%).23Statistik Austria, Spitalsaufenthalte. http://www.statistik.at/web_de/statistiken/gesundheit/stationaere_aufenthalte/spitalsentlassungen_nach_ausgewaehlten_diagnosen/index.html. Accessed March 15, 2015.Google Scholar Data related to diseases treated in outpatient settings or outside of hospitals are not systematically documented in Austria, and therefore are limited. In 2007, the incidence of diabetes for 0- to 14-year-olds was 18 per 100 000 for type 1 and 0.3 per 100 000 for type 2.24Griebler R. Geißler W. Winkler P. Zivilisationskrankheit Diabetes: Ausprägungen–Lösungsansätze–Herausforderungen. Österreichischer Diabetesbericht 2013. Bundesministerium für Gesundheit, Wien2013http://www.bmg.gv.at/cms/home/attachments/5/8/2/CH1079/CMS1382427010786/diabetesbericht_20131021.pdfGoogle Scholar A regional analysis has documented problems relating to the musculoskeletal system for one-third of all school children.25aks Arbeitskreis für Vorsorge- und Sozialmedizin. Schulstatistik gesamt 2011/2012. http://www.aks.or.at/. Accessed March 15, 2015.Google Scholar The prevalence of atopic diseases is increasing, and regional data show that about 20% of the 8- to 22-year-olds suffer from allergies.26Podolsky A. Gesundheits- und Fitnessstudie NÖ SchülerInnen. Institut für Präventiv-und Angewandte Sportmedizin, Landesklinikum Krems2011Google Scholar According to the Health Behavior in School-Aged Children Study,27Health Behaviour in School-aged Children (HBSC). http://www.hbsc.org/. Accessed March 15, 2015.Google Scholar about 15% of all school-aged children in Austria are overweight; this rate has increased over the past 20 years. About 19% of 15-year-olds and 33% of 17-year-olds smoke daily (Table III). Smoking rates for 15-year-olds increased between 1994 and 2002, and decreased after 2002. About 25% of 11- to 17-year-olds regularly drink alcohol at least once a week. Both smoking and drinking rates are above the European average.28Ramelow D. Griebler R. Hofmann F. Unterweger K. Mager U. Felder-Puig R. et al.Gesundheit und Gesundheitsverhalten von österreichischen Schülern und Schülerinnen. BMG and BMUKK, Wien2011Google Scholar In Austria, about 22% of children under the age of 16 years live at risk of poverty or social exclusion (with increasing trend).29Statistik Austria, Soziales. http://www.statistik.at/web_de/statistiken/soziales/armut_und_soziale_eingliederung/. Accessed March 15, 2015.Google Scholar This is clearly below the European average of EU-28 and EU-15 countries.18Eurostat Statistics Explained. http://ec.europa.eu/eurostat/statistics-explained/index.php/Glossary:EU_enlargements. Accessed March 15, 2015.Google Scholar The rate of early dropouts of education and vocational training (7.6% in 2012) is below the European average. Aside from national action plans in 200430Österreichischer Gesundheitsplan für Kinder. Bundesministerium für Gesundheit und Frauen (BMGF) Wien; 2014.Google Scholar and 201131Bundesministerium für Gesundheit, Kinder-und Jugendgesundheitsstrategie. http://www.bmg.gv.at/home/Schwerpunkte/Kinder_und_Jugendgesundheit/Kinder_und_Jugendgesundheitsstrategie/. Accessed March 15, 2015.Google Scholar to specifically promote child health, child health care services in Austria are part of the overall health care system and, thus, closely linked to the system as a whole. As shown in Figure 1, health care services are based on a complex and complicated system of national planning, which is adjusted by regional modifications and provisions.32Kerbl R. Das Gesundheitssystem für Kinder in Österreich - Strukturen und positive Seiten.in: Kerbl R. Thun-Hohenstein L. Damm L. Waldhauser F. Kinder und Jugendliche im besten Gesundheitssystem der Welt, 4.Jahrestagung Politische Kindermedizin. Springer, Wien, New York2011: 21-37Crossref Google Scholar, 33Waldhauser F. Das Gesundheitssystem für Kinder in Österreich – die Schwächen.in: Kerbl R. Thun-Hohenstein L. Damm L. Waldhauser F. Kinder und Jugendliche im besten Gesundheitssystem der Welt, 4.Jahrestagung Politische Kindermedizin. Springer, Wien, New York2011: 39-52Crossref Google Scholar Furthermore, responsibilities for different fields (eg, PHC, hospital care, rehabilitation, preventive measures) are divided among several institutions. Because of the federal system, the 9 provinces have a major influence on all health care system decisions; the same holds true for the (overall) 19 social insurance funds.32Kerbl R. Das Gesundheitssystem für Kinder in Österreich - S
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