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Country Study: Federal Republic of Austria

CPT Scott J. Stokoe

HCA 5312, Issues in International Health

06 February 2004

Austria

Nestled in the center of central Europe lies the Republic of Austria. It was created in 1918 after the collapse of the Austro-Hungarian Empire. In 1938, it fell under German control and became part of the Third Reich. Despite its liberation from Germany in 1945, Austria continued to experience internal change until 1955 when it officially became free and independent (U.S. Department of State, 2004). In spite of Austria’s size and location, it is well known for its world contributions in music, physics, psychology, and philosophy. Some of the well-known names associated with Austria are: Wolfgang Amadeus Mozart, Johann Strauss (senior and junior), Kurt Goedel, and Sigmund Freud (Wikipedia, 2004).

Peer Nations in the Region

Austria is a landlocked country, which is broken down into nine states: Voralberg, Tyrol, Salzburg, Carinthia, Styria, Upper Austria, Lower Austria, Burgenland, and Vienna. The capital city is located in Vienna. Austria shares its northern borders with Germany and Czech, its eastern borders with Slovakia and Hungary, its southern borders with Italy and Slovenia, and its western borders with Switzerland and Liechtenstein. Comparably, it is smaller than the U.S. state of Maine, measuring 83,858 square kilometers (1,120 square kilometers are water and 82,738 square kilometers are land). The western region of the country holds the remarkably beautiful and world-renowned Alps mountain region, while the eastern and northern regions remain generally flat with occasional sloping terrain. The climate is temperate with snow found in the mountain regions and rain in the lowlands. The winters are often cold and the summers cool (CIA World Factbook, 2003).

Demographics

With an annual growth rate of 0.22%, Austria’s current population is estimated at 8,032,926. Historical ties with its surrounding neighbors resulted in its current ethnic mix of German, non-national, and naturalized citizens. The non-national mix includes migrants from Croatia, Slovenia, Hungary, Czech, Slovakia, and Roma. Austria still experiences small annual migration, which measures 2.44 migrants per 1000 people (CIA World Factbook, 2003). The ethnic mix also introduced a number of religions. Roman Catholic is the primary religion, followed by Muslim and other, then Protestant. There is also a small number with an undeclared religious preference. The primary language spoken throughout the country in German; however, other languages spoken within the country include French, Slovenian, Czech, Polish, Greek, Farsi, Turkish, and Arabic (Country Watch, 2004).

Immigrants and Refugees

Austria has been challenged with a growing number of refugees seeking asylum. In 2000, they received 18,284 requests for asylum, in 2001, 30,135, and by October 2002 they had received 29,817 requests (UN Refugee Agency, 2003). The final tally for 2003 was 30,240 requests (UN Refugee Agency, 1998). The number of refuges seeking asylum almost doubled in 1998 because of the war in Kosovo. Since then, it has been primarily the Kosovars that have caused the increase in asylum requests. Other groups seeking a new life in Austria include the Armenians, Azerbaijanis, Georgians, Turks, Macedonians, and Yugoslavs (UN Refugee Agency, 2003).

Energy Resources

The country’s primary natural resources are iron ore, oil, timber, magnesite, lead, coal, lignite, copper, and hydropower. Of the primary natural resources, hydropower provides 67.2% of the country’s electricity (CIA World Factbook, 2003). In 2002, energy production reached 66 terawatt hours and was sufficient to support its hydroelectric consumption of 39.3 terawatt hours. Austria’s primary energy consumption, however, was generated from oil, in which 30,660,000 gallons per day were produced and 11,298,000 gallons per day were consumed. Following oil, in succession of energy consumption, was hydroelectricity, natural gas, and coal (BP, 2003).

Labor within Austria is split between services, industry and crafts, and agriculture and forestry, all of which support the country’s import and export businesses. Imports to Germany, Italy, the United States, and France generate $138 billion and exports to the same (replacing France with Switzerland) generate $145.7 billion annually. The major export and import products are relatively similar and include machinery, transport equipment, consumer goods, travel services, insurance, and financial services. Austria’s internal industries provide additional export products, like food, chemicals, lumber and wood processing, paper and cardboard, and communication equipment (CIA World Factbook, 2003; Index of Economic Freedom, 2004). Year-round tourism brings 15 million visitors annually and greatly contributes to the country’s financial strength. Despite high production costs, internal agriculture provides roughly 80% of the domestic food requirements (Country Watch, 2004).

Population Pyramid

On the Human Development Index (HDI), which measures a country’s quality of life, Austria ranked 16th out of 175 countries. When broken down further, 16th reveals that Austria had significant achievements in the three main areas of human development: longevity, knowledge, and education (Country Watch, 2004). For population, Austria is ranked 88th out of 227 countries (Nationmaster, 2003) and has median age (or probably better know as the baby boomers) of 39.2 years (2002). The population pyramid predicts that this age group will remain the largest group in 2025, causing the age group of 80 and older to double. Future predictions also indicate that Austria’s population growth will be 0% between 2010 and 2020. A negative population growth rate is expected to follow this decade (U.S. Census Bureau, 2004). Current population challenges, such as Austria’s current birth rate, death rate, and fertility rate may be the early indicators that point to the future population changes. With 9.43 births and 9.69 deaths per 1000 people, Austria exchanges one birth for one death. The fertility rate is also relatively low at 1.41 children per woman (CIA World Factbook, 2003).

Health Status

As noted by the World Health Organization’s ranking of nine, Austria is known worldwide for maintaining a high health status (www.geographic.org, 2004, International Network for Health Policy and Reform, 2003). Facilities and housing standards allow 100% of the population to use improved water sources and adequate sanitation facilities. Though not a measure of actual health status, self-perceptions of health status are relatively high (UNICEF, n.d.). On a scale of very good to very bad, 74.3% viewed their health status above the median of fair (34.3% very good and 40.4% good). Health status restricts the daily activities of only 5% of the total population (World Health Organization, 2003). To counter disease, the government provides 100% financing for vaccines. However, despite government financing, not everyone receives vaccines. For example, only 90% of the population received a vaccination for measles and 83% for polio3 (Hofmarcher & Rack, 2001; UNICEF, n.d.). The running incidence rate of tuberculosis is 15 per 100,000 people (World Bank, 2000).

The average life expectancy in Austria is 78.17 years, with only a 10.6% chance of not reaching the age of 60. With 15.5% of the population 65 years and older, and future projections for growth, Austria is on the verge of facing the same health care challenges as other developed countries throughout the world. On the opposite end of the spectrum, Austria’s infant mortality rate is extremely low at 4.33 deaths per 1000 (CIA World Factbook, 2003).

Morbidity / Mortality

Austria’s life expectancy is challenged by two main causes of death: cancer and cardiac disease. The combined effect of these two illnesses accounted for 76.1% of all deaths in 2001. Unchanged for roughly 25 years, every fourth death in men and every fifth death in women are attributed to cancer (World Health Organization, 1998). It is estimated that cancer takes 139.2 lives per 100,000 people (Nationmaster, 2003). The Austrian lifestyle is important note because it is a product of long-standing cultural traditions and beliefs. With drinking and smoking as a cultural norm, the incidence of stomach cancer, in particular, is important to address. Although declining, it still causes of 9.2 deaths per year (World Health Organization, 1998). In addition to cancer and cardiac disease, circulatory disease is the cause 255.7 deaths per 100,00 people (Nationmaster, 2003).

HIV/AIDS

The adult prevalence rate of HIV/AIDS is extremely low in Austria at 0.2%. Estimates from 2001 indicate that only 9,900 are living with the disease and there were less than 100 disease related deaths (CIA World Factbook, 2003). In 2001, the primary mode of transmission was almost equally split with 15 cases by heterosexual contact, 12 cases from injecting drug use, and 11 cases from homosexual/bisexual males (UNAIDS and WHO, 2002). The reason for the low prevalence rate is difficult to ascertain from the literature; however, a few theories could be posited. The leading theory begins with an amendment to Austria’s Social Security Act in 1992. This amendment made health promotion a mandatory requirement for the state sickness funds. A year later, the Ministry of Health joined with the Ministry of education to work on health promotion in schools. One of the nationwide programs set in motion by the Ministry of Health was concentrated on AIDS (World Health Organization, 2003).

National Health Services System and Structure

Austria’s health care is delivered under a national heath care program. Social insurance and government contributions, both federal and state, support the medical infrastructure throughout the nine states. Individuals are primarily insured through state social insurance funds, employer based insurance, or special programs that cover civil servants, farmers, craftsmen, or liberal professions. The required tax payments into the social insurance program are dependent on individual gross income. Social insurance, which finances roughly half of Austria’s total health spending, includes health insurance, pension insurance, and work accident insurance. Private insurance is also an option, but it is mainly purchased as supplemental insurance to cover nicer, more comfortable room and services (Hofmarcher & Rack, 2001). Providing health care under a national health care system has led to 99% of the population possessing some sort of insurance. The federal government maintains oversight and responsibility for legislation, formulation of health policy, technical supervision of health services and training, and supervision of the country’s health insurance system (World Health Organization, 1998).

Health insurance funds contract with general practitioners (GP) and form networks in which patients can select doctors. Both GPs and specialists provide primary health care services through outpatient centers provided by the social insurance agencies and local hospitals (World Health Organization, 1998). In April 2001, Austria experienced a 0.6% decline in hospitals bringing the final count to 310 (Statistics Austria, 2004). A potential reason for this decline is the requirements necessary to start up a hospital. Before a private or public hospital can be set up, the provincial government must grant approval and licensure. According to Austria’s Hospitals Act, public hospitals “must be accessible to all patients, charge the same prices for equivalent services, and may set aside no more than 20% of beds for patients with supplementary private insurance.” Medical treatment is required to be the same regardless if a patient has supplementary private or general insurance (World Health Organization, 1998). With 310 hospitals, Austria’s current “bed to patient ratio” is 8.8 hospital beds per 1000 people (Nationmaster, 2003).

Healthcare Providers

Due to the dearth of updated literature on healthcare providers in Austria, the following information is reflects the provider status as of 2001. An interesting fact written by Statistics Austria states that “compared to 10 years ago… one hospital doctor had to cater for the medical needs of 6.1 hospital beds, on average, and there was one nurse for every 1.4 hospital beds.” Increased medical training and improvements in health have changed this fact and one hospital doctor is now responsible for 4 beds, while one nurse is responsible for 1 bed. Of the 35,812 practicing doctors in 2001, 31% were GPs, 42% specialists, 10% dentists, and 16% trainees (Statistics Austria, 2004).

Doctors within Austria are required to join the Austrian Medical Association. As their primary professional representative, the organization (or regional organizations) is responsible for providing input toward doctor training, awarding of contracts with health insurance funds, and administering the doctor registry. Other professional organizations exist throughout the country, but these are mainly organized into voluntary associations (Hofmarcher & Rack, 2001).

Costs and Financing of Healthcare

The most accurate and up to date information regarding health care expenditures is stated in the 2004 version of Statistics Austria. As this reference is primarily written in German, its finance figures have been converted from euros at a $1.25 exchange rate (FOREX, 2004). In 2002, Austria allocated 7.7% of its gross domestic product (GDP) or $21 billion towards health care expenditures. This is a 5.5% increase from 2001. The majority of health care expenditures was in public health and reached $14 billion (5.4% of the 7.7%). The largest portion of public health spending was on hospital services at $6.5 billion. Closely following hospital services was outpatient services at $4.5 billion, medical equipment/products at $2.9 billion, preventive health at $344 million, research and development at $8.8 million, and other at $1.1 million (Statistics Austria, 2004).

Health Reform

Health reform has been underway in Austria for a number of years. Historically, reforms have focused on changes in hospital structures, financing, integrated delivery systems, nursing, social services, and health promotion/prevention. In addition to the changes mentioned in the HIV/AIDS section regarding the Social Security Act, some other health initiatives have been the Tobacco Act (1995), Genetic Engineering Act (1996), Hospital Financing Act (1996), and Medical Devices Act (1997) (World Health Organization, 1998). Some of the most recent policies include the Long Term Care policy (2003), which seeks to reorganize the long-term health care program, and the Pharmaceutical Policy (2003/2004), which seeks to reduce the average cost increase of public pharmaceutical expenditures from 7-9% to 3-4% annually by 2006 (International Network for Health Policy and Reform, 2003). Another important reform involves hospitals improvements. Austria currently exceeds the European average of beds per 1000 people by 2.1. These extra beds cost the federal government almost three billion euros. A reduction of beds and internal improvements will produce large savings for the government (Auswaertiges Amt, 2003).

Utilization of Technology Promoting Health Care

Harris International, best known for “The Harris Poll,” conducted a study between the European Union (EU) and the United States that examined the use of electronic technology in medicine. The study was conducted using an interview survey technique to sample 3,504 general practitioners in the fifteen countries of the EU. Of the five main categories, Austria exceeded the EU in four. With advances in technology and the forward progression of the computer age, 82% of general practitioners (GP) use a computer in their practice. Use of a computer allows 64% of GPs to use the Internet or to connect to a GP network. A connection to one or the other improves physician communication and leads to the use of electronic medical records. An examination of electronic medical records use revealed that 55% of GPs use them. As some studies indicate, the use of the electronic medical records may lead to a reduction in medical errors and improvement in quality of care for the Austrian medical system. Two final areas to note were that 18% of GPs had a website and 2% used a PDA (e.g. palm pilot) in their practice of medicine. Austria was 9% below the EU average of PDA use (Harrison Interactive, 2002).

Politics and Election

Austria’s government is a Federal republic that democratically elects its president and nine state/provincial governors. The majority vote by the Austrian People’s Party reelected Thomas Klestil as president in 1998. He will continue to serve until the new elections in spring 2004. The president is elected for a six-year term and is limited to serving two consecutive terms. The two primary duties executed by the president are to act as the head of state and the commander-in-chief of the armed forces. The president appoints a prime minister to form the government. If successful, the prime minister recommends additional government officials for presidential approval. The federal government maintains control over its nine states, but delegates the responsibility for welfare matters and local administration to the provincial governors. The political parties within Austria consist of the Austrian People’s Party, the Social Democratic Party of Austria, the Freedom Movement, and the Greens (Country Watch, 2004).

The government’s executive, legislative, and judicial authorities are similar to that of the United States. The executive authority is responsible for the development and implementation of Austria’s domestic and foreign policies. The legislative party is broken into two parties, the National Council (Nationalrat) and the Federal Council (Bundesrat). The National council consists of 183 members, who are elected for a maximum of four years, and the Federal Council’s 64 representatives, which are elected by the provincial parliaments and serve for a term of five to six years. Austria’s highest judiciary authorities consist of the Constitutional Court for constitutional matters, the Administrative Court for bureaucratic issues, and the Supreme Judicial Court for civil and criminal cases (Country Watch, 2004).

External Debt

On January 1, 1995, Austria officially became a member of the EU. Its membership brought a number of foreign investors and helped improve its international competitiveness, both of which helped reinforce its reputation as a well-developed market economy (U.S. Department of State, 2004). Averaging a score of 2.1 on a five-point scale (five being the worst), Austria was ranked number 20 by the Index of Economic Freedom. Fiscal burden to of the government and regulation scored the worst at 4.5 and 3.0 (Index of Economic Freedom, 2004).

Estimates from 2001 state that Austria’s revenue reached $53 billion and its expenses reached $54 billion. The country’s continued expenditures added to country’s external debt raising it to $12.1 billion. Drawing the figures down further, revenue per capita was $6487.20, expenditures per capita was $6609.60, and the external debt per capita was $1481.04 (Nationmaster, 2003). Austria’s economic growth rate reached 1.1% in 2002 (CIA World Factbook, 2003).

Corruption

Transparency International ranks the level of corruption in 133 countries. They rate countries on a scale of one to ten, with ten being the best (or highly clean). The score reflects the sentiments of business people, academics, and risk analysts. In 2003, Austria tied with Hong Kong at number fourteen with a Corruption Perception Index of eight on the ten-point scale. Corruption influences from Austria’s eastern neighbors pose the greatest threat (Transparency International, 2003). To curb corruption, Austria’s penal code assesses up to $350 dollars per day for up to 365 or up to seven years imprisonment for bribery crimes (Country Review, 2004).

Telecommunications

Recent changes within Austria have prompted the government to deregulate the telecommunications and power generation industries. Deregulation has allowed larger private and state owned agencies to acquire these new markets. Research indicates that there are no shortages in telecommunication abilities and that the telephone system is highly developed and efficient throughout the country (Country Watch, 2004). In 2001, there were four million main telephone lines, which equated to 48 main lines for every 100 persons. Cellular telephones have expanded communication abilities and have reached the six million mark. Austria’s per capita level for telecommunications is 734.4 cell phones, 744.19 radios, 520.2 televisions, and 452.88 Internet users per 1000 people (Nationmaster, 2003).

Military/Armed Forces

Followings its declaration of being free and independent in 1955, the Austrian constitution was drafted with two important laws: 1) Austria declares of her own free will her perpetual neutrality, and 2) …in future times Austria will not join any military alliances and will not permit the establishment of military bases on her territory. World events have prompted Austria to reevaluate its security position, which led to its granting of over-flight rights for the United Nation sanctioned action against Iraq in 1991 and its joining Partnership for Peace with the North Atlantic Treaty Organization (NATO) (U.S. Department of State, 2004). Austria currently holds an observer status in the Western European Union (WEU) and has contemplated becoming a full member of the WEU and NATO (Country Watch, 2004).

Being a landlocked country, Austria maintains both land and air forces. Compared to its neighbors, their military strength is smaller than Germany, Italy, Switzerland and Czech, but is larger than Hungary, Slovakia, and Slovenia (StrategyPage, 2003). In fiscal year 2001-2002, Austria devoted 0.8% of its GDP, or $1.5 billion, on military spending (CIA World Factbook, 2003). Their military active duty strength is roughly 38,000 men, with 800 armored fighting vehicle, and 120 combat aircraft. On a ten-point scale (with 10 being the highest), leadership, equipment, experience, support, and tradition ranked between five and seven. The largest shortfall was in mobility, which ranked number three. On the whole, Austria’s armed forces are ranked number 19 out of the 40 European countries (StrategyPage, 2003).

Military Health Services System

The largest military hospital within the Austrian federal army is an Army hospital located in Vienna. Two additional military hospitals are also available in the cities of Graz and Innsbruck. The Sanitaetsdienst, or medics, support the hospitals and field units by providing first aid, evacuation, and medical treatment (e.g. vaccinations, nutrition, hygiene, and industrial medicine). In addition to military operations, the medics are prepared to work in unison with civilian relief agencies, hospitals, and civil authorities in times of national disasters. Other than stating that each military company had its own medics, there was little literature available that discussed the breakdown of medical units within the Austrian armed forces (Osterreichs Bundesheer, 2004).

Implications for Military Health Services System

Due to the limited information available on the Austrian military health care system and the potential for error, implications were not drawn.

Implications for Military Planners

There are a few important implications military planners should keep in mind when studying the country of Austria. Only 16% of the current population is over the age of 65. This means that in the next 25 years, health care needs, demands, and services will dramatically change and increase. Unless fertility rates increase to at least 2.1 children per woman, the overall population will continue decline throughout the next decade. It is difficult to predict how future events will affect immigration in Europe, but Austria’s overall economic and health status will continue to attract large numbers of immigrants seeking asylum. As asylum is granted and immigrants are accepted, they will arrive with varying health and financial statuses that could positively or negatively affect Austria’s current conditions.

Austria’s relationships with Germany, France, Switzerland, Italy, and the United States provide many opportunities and strengths. Austria’s location in Europe makes it the gateway, link, and central hub for much of the business throughout Europe. This provides them the opportunity to stay abreast of new technology, trade opportunities, partnerships, and continued growth. Good business practices and trade agreements with its import and export partners provide the potential to increase its 1.1% growth rate and reduce its 4.8% unemployment rate. Austria’s central location in Europe and its opportunities for expansion are key elements for military planners to keep in mind.

The literature does not allude to any current security or terrorist threats within Austria, but that does not mean that there is a potential for future growth in this area. Despite the positives associated with its central location, there are also some negatives. The primary negative aspect of Austria’s location is its potential to become a primary travel route or meeting place for terrorists traveling throughout Europe. It is important for the country to maintain a strong security posture. In the future, it is also likely that Austria will become a full member of the Western European Union and NATO. Membership will reinforce its relationships and ties with the world and possibly increase training opportunities and joint military operations.

Lessons Learned for US Health Care System

A comparison between Austria and the United States (see appendix) shows that the two countries are remarkably similar in a number of areas. However, health expenses per GDP are roughly 6% lower in Austria. The primary reason is that Austria’s health care is delivered through a national health care program. Government control and intervention have allowed Austria to control its health care delivery and insure 99% of its citizens. Despite the lack of a nationwide national health program in the United States, lessons can be drawn from the area of health insurance design and coverage. Health insurance costs have risen within the United States and have dramatically increased the number of uninsured. Streamlining how insurance is designed and delivered within the United States will help reduce health care expenditures and the number of insured.

The information age has also brought increased demands to automate the practice of medicine. Studies and literature throughout the medical arena indicate that the use of electronic medical records reduces error and improves quality of care. The Harris Poll indicated that European Union, especially Austria, exceeded the United States in its use of electronic medical records. The World Health Organization has validated Austria’s health care; therefore, the United States could potentially draw experience and ideas from Austria on how to better expand the use of electronic medical records within its own system.

A final note is that both the United States and Austria will soon begin to feel the burden of increased health demands as the baby boomers continue to age. Changes in health demands, health needs, and an increasing mix of acute and chronic diseases will challenge both health systems. A key to overcoming these challenges is continued information exchanges between the two, and the rest of the developed world, to share best practices. Contributions made by both countries on new treatment methods, improved technology, and cost control measures will inevitably improve the status of both health systems.

Conclusions

For a small country nestled in central Europe, Austria continues to stand out as a country with a strong reputation in economics and health. The greatest challenges Austria must face in the future is its shrinking and aging population. An older population with fewer replacements will introduce a number of economic and health challenges for the country. Early action and intervention on Austria’s part will help maintain their world recognized economic and health posture.

References

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BP. (2003). Statistical review of world energy. Retrieved January 22, 2004, from http://www.bp.com/subsection.do?categoryId=95&contentId=2006480

CIA World Factbook. (2003, December 18). Retrieved January 12, 2004, from http://www.odci.gov/coa/publications/factbook/print/au/html

Country Watch. (2004). Austria: 2004 country review. Retrieved January 11, 2004, from http://www.countrywatch.com

FOREX. (2004, February 04). Retrieved February 04, 2004, from http://www.advfn.com/p.php?pid=forex

Harris Interactive. (2002). European physicians especially in Sweden, Netherlands, and Denmark, lead U.S. in use of electronic medical records. Retrieved February 02, 2004, from http://www.harrisinteractive.com

Hofmarcher, M. M., & Rack, H. (2001). Health care systems in transition: Austria. Retrieved January 20, 2004, from http://www.who.int

Index of Economic Freedom. (2004). Austria. Retrieved January 11, 2004, from http://www.cf.heritage.org

International Network for Health Policy and Reform. (2003). Policy survey: Austria". Retrieved January 28, 2003, from http://www.healthpolicymonitor.org

Nationmaster. (2003). Europe: Austria. Retrieved January 23, 2004, from http://www.nationmaster.com

Osterreichs Bundesheer. (2004). Federal Army: current information. Retrieved February 03, 2004, from http://www.bmlv.gv.at

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Transparency International. (2003). Transparency International Corruption Perceptions Index 2003. Retrieved January 15, 2003, from http://www.transparency.org

U.S. Department of State. (2004, January). Background note: Austria. Retrieved January 12, 2004, from http://www.state.gov

UN Refugee Agency. (2002b, November 19). Austria sends back what it calls "economic refugees". Retrieved January 22, 2003, from http://www.unhcr.ch

UN Refugee Agency. (2002a, October 30). Austria "virtually swamped" by asylum-seekers, says paper. Retrieved January 22, 2004, from http://www.unhcr.ch

UNAIDS and WHO. (2002). Epidemiological fact sheets. Retrieved January 28, 2004, from http://www.who.int

UNICEF. (n.d.). At a glance: Austria. Retrieved January 28, 2004, from http://www.unicef.org

U.S Census Bureau. (2004). IDB population pyramids. Retrieved January 11, 2004, from http://www.census.gov/ipc/www/idbpyr.html

Wikipedia. (2004, January 11). Austria. Retrieved January 12, 2004, from http://www.en.wikipedia.org/wiki/austria

World Bank. (2000). Austria. Retrieved January 11, 2004, from http://www.devdata.worldbank.org

World Health Organization. (2003). Vaccines, immunization, and biologicals. Retrieved January 28, 2004, from http://www.who.int

World Health Organization. (1998, January). Highlights on health in Austria. Retrieved January 11, 2004, from http://www.who.int

www.geographic.org. (2004). World health organization’s rankings of world’s health systems. Retrieved January 11, 2004, from http://www.photius.com/rankings/healthranks.html

Appendix

Comparison of the United States and Austria