europe: position paper of austrian social insurance

Europe: Position Paper of Austrian Social Insurance

secure.protected.europe

EUROPE: POSITION PAPER OF AUSTRIAN SOCIAL INSURANCE

Preface _________________________________________________________ 03

1. European integration needs social security _______________________ 04

2. Sharpening up competences – united in diversity__________________ 07

3. Cross-border cooperation to ensure sustainable systems___________ 08

4. Cross-border social security through European coordination ________ 10

5. Social sustainability of EU-trade policy ___________________________ 11

6. Access to innovative and affordable healthcare ___________________ 12

7. Actively building Europe _______________________________________ 15

02 EUROPE: POSITION PAPER OF AUSTRIAN SOCIAL INSURANCE

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03EUROPE: POSITION PAPER OF AUSTRIAN SOCIAL INSURANCE

Preface

2018 is a year full of anniversaries. 100 years since Austria became a republic, 70

years ago the Main Association of Austrian Social

Security Institutions was founded, 60 years of Eu-

ropean social security coordination and 50 years

of free movement of workers. In the context of

the Austrian presidency of the Council of the EU

in the second half of 2018, the Austrian Social

Insurance initiated its internal reflection process

and asked itself the question: How do you feel

about Europe? The position paper reflects the

outcome of this exercise.

Europe, as we see it. In the next seven chapters we describe how

European policies affect the development of

the Austrian Social Insurance. On the one hand,

evolution is necessary due to the increasing

cross-border mobility of Austria’s insured: They

study, work and live abroad. On the other hand,

social insurance in Austria, while striving to

deliver excellent care, is increasingly confronted

with European rules, which have to be adhered

to and which can only be changed on the Euro-

pean level.

United in diversity. In Europe, the Austrian social security and health

system is considered as a role model. Main-

taining these high standards requires viewing

social security in its entire European context, as

part of a genuine European social model. The

content of this position paper represents our

guiding principles and compass for Europe in

order to promote social progress in the Europe-

an context.

of Austria’s insured work abroad in Europe each year

70.0001

of Austria’s insured are treated in Europe with the European Health Insurance Card each year

115.0001

182.0001

Austrian pensions are paid each year to beneficiaries residing in Europe each year

1.9001

Austrian accident at work benefits are paid to beneficiaries residing in Europe each year

2020

2015

2010

2005

2000

1995

1990

1985

1980

1975

1970

1965

1960

1955

1950

1958

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s1) Numbers from 2017 for EU/EEC countries


”Social Security is the most reliable foundation

for democracy“. This quote by Johann Böhm,

first president of the Main Association of Aus-

trian Social Security Institutions (Hauptverband

der österreichischen Sozialversicherungsträger,

HVB), is also fully valid within the European

context. According to the European treaties, the

Union’s aim is to promote peace, the Europe-

an values – freedom, democracy, equality, the

rule of law, respect for human rights – and the

well-being of the European peoples. The estab-

lishment and consolidation of the internal market

as well as the continuing economic integration

of the Member States is not an end on its own,

but rather a means to reach the greater social

dimension of the European integration.

In this spirit, the Union

works for a highly com-

petitive social market

economy aiming at

social progress. The

Union combats social

exclusion and dis-

crimination, promotes social justice and social

protection, and contributes to equality between

women and men, solidarity between genera-

tions, and protection of children’s rights. In its

policies, the Union upholds the social market

economy and respects the objective of attaining

high employment levels in combination with so-

cial security, fighting social exclusion and a high

level of health protection for the people within

the Union. The Union is a community of values,

guaranteeing fundamental rights for us all. It

respects the right to access to social protection

and benefits related to motherhood, fatherhood,

sickness, accidents at work, long-term care, as

well as loss of employment. Everyone has the

right of access to adequate healthcare.

For a social Europe that protectsAustrian social insurance is committed to a

Union in which a social Europe is at the heart

of a democratic, solidarity-based and culturally

diverse society that prospers. This includes the

social objectives within the European treaties,

the social rights within the Charter of Funda-

mental Rights of the European Union and the

social and healthcare principles included in the

European Pillar of Social Rights. Together with

the existing social achievements in the area of

free movement, living- and working conditions,

the equality of men and women, health and

safety at work and the access to social pro-

tection, those objectives and principles lay the

foundation for a Union which is committed to

the overall welfare of its citizens.

In this respect, the objectives of the European

Union are aligned with the values of Austrian

Social Insurance. We see ourselves as a driver

of social progress within a society that seeks

prosperity, fairness and social participation for

all. We represent a modern system of social

security based on solidarity that covers the

needs of every member of society in a com-

prehensive way. Starting with the principles

of fairness, transparency, effectiveness and

efficiency, we desire a long, self-determined life

with good health under secured circumstances

for all people. Everyone can be confident that

the high-quality care provided through social

insurance is guaranteed in a sustainable way for

themselves, their children and grandchildren.

1. European integration needs social security

Austrian social insurance is committed to a Union in which a social Europe is at the

heart of a democratic, solidarity-based and culturally diverse society that prospers.


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2. Sharpening up competences – united in diversity

The responsibility for the organisation, definition

and financing structure of the national social

insurance and health systems lies with the

Member States. The diversity of national social

insurance systems is a result of historical devel-

opments as well as the different social policy

traditions and priorities. Fundamental questions

like access to social security, financing (via taxes

or social security contributions), the nature and

scope of benefits, as well as the administra-

tive structure, are directly related to societal

decisions and calibrated with respect to other

regulatory areas on a national level.

The Austrian social insurance system is based

on the principles of compulsory insurance,

solidarity, benefits in kind, and independent

administration. Every move towards European

harmonisation without considering national spe-

cificities risks derailing well-functioning systems.

Taking into account the principle of subsidiarity,

systemic issues and fundamental questions of

Austrian social security and healthcare should be

dealt with where they arise.

Preserving solidarityThe area of conflict between national compe-

tences in social security and healthcare and

the ongoing economic integration have led to

increased aspirations of

Union policies. National

social and health-

care policies have to

respect the economic

freedoms. The Euro-

pean Court of Justice’s jurisprudence regarding

restrictions of free movement resulted in a situ-

ation of appropriated competences by the Union

that conflicts with the principle of subsidiarity.

It must be highlighted that the single market is

not an end in itself. The special situation and

protection of a solidarity-based social insurance

and healthcare system

have to be respected

in the framework of

European economic

law (single market

rules, competition regulations, public procure-

ment law, and state aid regulations). Otherwise,

economic integration could undermine corner-

stones of Austrian social insurance (compulsory

insurance, the solidarity principle, benefits in

kind, and independent administration). Attempts

to reduce the Union to the single market would

destroy numerous well-functioning structures

in a cross-border context. Economic freedoms

without accompanying social and healthcare

measures inevitably lead to a race to the bottom

that is in conflict with the Union’s objectives.

The importance of social and health policy has to

be reflected in the organisational structure of the

European institutions. Thus, social insurance and

healthcare must not become a mere annex to

economic portfolios on the European level.

The special situation and protection of a solidarity-based social insurance and healthcare system have to be respected in the framework of European economic law.

Economic freedoms without accompanying social- and health-political measures will inevitably lead to a race to the bottom.


The European welfare states face common

challenges. New forms of work, demographic

developments like an ageing society, increasing

chronic illness, multiple morbidity, anti-micro-

bial resistance, and the lack of health and care

professionals require continuous adjustments

within the national

systems. The European

Union has an important

role in dealing with

these challenges.

It encourages and fosters cooperation between

national systems and complements the social

and healthcare policies of the Member States.

EU activities in the area of health and social pol-

icies save lives and help to sustain our systems

for future generations.

Tackling challenges togetherFor this purpose, the EU has numerous tools

to systematically assess healthcare policy

developments and to work towards increased

social convergence. Using a basis of common

indicators and measure-

ments, problems can

be analysed and bench-

marks defined. This

includes, on the one

hand, the open method

of coordination as well

as the economic governance mechanism of the

European Semester, which increasingly includes

aspects of health care and social policy. On the

other hand, there are also other, more specific

analyses like the regular “Ageing Reports” of

the European Commission or the OECD report

”Health at a Glance” for the health sector.

In addition, numerous platforms, networks and

committees allow structured and institutional-

ised exchanges between various aspects of the

social and healthcare spectrum. This includes

the Administrative Commission for the Coordi-

nation of Social Security Systems, the Health

Technology Assessment (HTA) network, and the

joint project EUnetHTA for European cooperation

in the area of health-technology assessments,

as well as the eHealth-network, which pro-

motes cooperation in the sector of digital health

services.

These processes and structures allow the fruit-

ful exchange with other healthcare systems, the

use of synergies in the areas of health promo-

tion and prevention as well as an innovative and

people-centred development of the Austrian

structures. They are testimony that social insur-

ance and healthcare are not limited to the single

market aspects, but essential for delivering on

the objectives of European integration. Austrian

social insurance appreciates the added value of

European social and health policy and is commit-

ted to actively contributing Austrian expertise in

the respective European committees.

3. Cross-border cooperation to ensure sustainable systems

EU activities in the area of health and social policies save lives and help to sustain

our systems for future generations.

Austrian social insurance appreciates the added value of European social and health policy and is committed to actively contri-

buting Austrian expertise in the respective European committees.


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4. Cross-border social security through European coordination

Free movement of persons within the European

Union is inconceivable without the coordination

of social insurance and healthcare systems.

For more than 60 years, Europe has provided

the legal framework en-

abling patient mobility

and guaranteeing that

free movement will

neither result in loss of

benefits, nor in situations of double insurance.

The most visible success story of European

social law is the European Health Insurance

Card. With this card insured persons are granted

unbureaucratic access to medical care in other

European countries.

The cross-border mutual recognition and

aggregation of insurance periods guarantees

mobile persons their acquired rights in the field

of pensions or benefits in the area of accidents

at work. The main institutional player at the

European Union level is the Administrative

Commission for the Coordination of Social

Security Systems. In this commission, experts

from 32 different countries have been working

for decades on the continued and cooperative

implementation of European social security law.

Improved administrative cooperation through electronic exchangeThe success and acceptance of this legal

framework requires a high degree of cross-bor-

der collaboration between the European social

security institutions. Special attention is given

to the implementation of electronic exchange

of social security information, a conciliation

procedure for disputes between member states

as well as a fair burden-sharing of cross-border

medical treatments and improved recognition of

the European Health Insurance Card.

Combating fraud in social securityFollowing the increased mobility of employed

and self-employed persons, European so-

cial insurance systems are confronted with

cross-border phenomena aiming at evading

social security contributions as well as unduly

receiving benefits.

Such behaviour is contrary to the European

legal framework, distorts competition between

companies and results in situations of social

dumping. For geographic reasons, Austrian so-

cial insurance in particular has to deal with these

phenomena. Committed and united European

action is required to combat undeclared work,

social fraud and bogus self-employment in a

cross-border context.

The European Health Insurance Card guarantees unbureaucratic access to

medical care in other countries.


5. Social sustainability of EU-trade policy

The European Union constantly negotiates

free-trade agreements that are binding for its

Member States. Taking into account the serious

doubts and questions regarding the potential

impact of European free-trade agreements in

the Member States in general, there has to be

a stronger focus on the impact on the social

insurance and healthcare systems. Free-trade

agreements must not infringe upon the compe-

tences of Member States to define and organise

their own social protection infrastructure. The

European Union has to guarantee that free-trade

agreements do not undermine existing health

and social standards and that commitments in

the areas of intellectual property, competition law,

as well as public procurement do not constitute

obligations beyond the level of European law.

The particular societal role of social and health

services as well as social insurance has to be ex-

plicitly acknowledged within the European Union

and its external commercial policy. Therefore, a

clear commitment is necessary to ensure that

social security and healthcare systems are not

subjected to global competition and that there

will be no pressure to privatise social and health-

care services. Just as public investments in in-

frastructure enable businesses to transport their

goods smoothly, social insurance guarantees

a not-for-profit social infrastructure that helps

people to deal with economic and health risks,

guaranteeing a stable society even in times of

crisis or disaster. A stable and secure society is,

in turn, a strong foundation for economic activity

and prosperity.

Moreover, the association agreements between

the European Union and third countries include

comprehensive provisions for the coordination of

social security systems with a significant impact

on the insured persons

and social security

administrations. In the

future, the inclusion of

those provisions should

be discussed in coop-

eration with the Administrative Commission for

the Coordination of Social Security Systems, in

order to conduct a sound analysis and impact

assessment.

The European Union has to guarantee that free-trade and association agreements do not undermine existing health and social standards.


High prices for new health technologies are

destabilising publicly financed health systems

and threaten to exclude patients from necessary

treatments in many countries. Recently, the

affordability question, in the past only discussed

in context with emerging economies and devel-

oping countries, has reached the best and most

comprehensive health systems in the centre of

Europe.

Re-thinking the European regulatory frameworkIn order for Austrian Social Insurance to maintain

its excellent system of health coverage for the

whole population, it is necessary to critically re-

think and modernize the European legal frame-

work governing the whole process of health

technology development. This includes research

and innovation funding in the EU, intellectual

property rights, transparency of clinical trials,

marketing authorisation of products, as well as

pricing and reimburse-

ment mechanisms for

medicines and medical

devices. The EU needs

new concepts to incen-

tivise research to make

sure that innovative technologies are developed,

in particular, in therapeutic fields where there

is an actual unmet medical need and thus truly

serves the public interest.

With regards to marketing authorization and

health technology assessment (HTA) of new

medicines and medical devices, updated

instruments are needed in order to properly

distinguish real technological advances from

pseudo-innovation. When reforming the regula-

tory framework in the health technology sector,

policy makers need to ensure that the decision-

making responsibility remains coupled with

financial responsibility to achieve optimal health

outcomes for society. Austrian social security

advocates more transparency of pharmaceutical

development costs and the enhanced cross-bor-

der cooperation of European health systems

in the procurement of health technologies.

Through our engagement at the European level

and in cooperation with our partners in Brus-

sels, we are working towards modernising the

legal framework and strengthening international

partnerships to advocate the interests of the

Austrian insured with a strong voice.

6. Access to innovative and affordable healthcare

The existing legal framework governing research funding and health technology

development in the EU must be critically re-assessed and modernised.


The HVB is the umbrella organisation of the

Austrian social health-, accident- and pension

insurance institutions. The HVB represents the

interests of the social security institutions and

the insured persons in all matters of common

concern and advocates strategic issues of Aus-

trian social insurance. One of its key competenc-

es is representing the Austrian social security

system in dealing with institutions from other

countries.

International single point of contact in AustriaThe HVB is the international liaison body re-

garding cross-border social security for national

and foreign insured persons, social insurance

institutions and public authorities, and acts as an

access point for cross-border electronic ex-

change of social security information.

Proactive representation on the European levelRepresenting the Austrian social security

system requires close attention to the deci-

sion-making process of the European Union.

Therefore, the HVB is actively involved in the

Administrative Commission for the Coordination

of Social Security Systems as well as numerous

of its subcommittees (Technical Commission,

Audit Board, Conciliation Panel).

In 2015, the HVB decided to establish a perma-

nent European representation at the centre of

the European Union in Brussels. This European

representation communicates, promotes and

defends the core values of the Austrian social

insurance and healthcare system as well as the

financial interests of the insured persons in close

interaction with European decision makers.

It closely monitors relevant European devel-

opments that could affect the Austrian social

security system directly or indirectly and acts

as a connecting factor for stakeholders from the

European and Austrian context.

In order to foster advocacy on the European lev-

el, the HVB is a member of the European Social

Insurance Platform (ESIP). ESIP brings together

more than 50 statutory

social insurance asso-

ciations from all over

Europe. In addition, the

representatives from

Austrian social insurance participate in numer-

ous other European and international networks.

Raising awareness for the European dimensionWe support and promote general awareness

of the European Union and its significance for

social health, accident and pension insurance as

well as the healthcare

system in Austria. For

that reason, the HVB

integrated specialised

training modules in the

schedule of the Acad-

emy of Austrian Social

Insurance. Furthermore, a specialised second-

ment program enables employees of Austrian

social insurance to work for a couple of months

at our European representation in Brussels to

gain hands-on experience and knowledge about

European decision-making.

7. Actively building Europe

Representing the Austrian social security system requires close attention to the deci-sion-making process of the European Union.

We support and promote general awareness of the European Union and its significance for the social health-, accident- and pension insurance as well as the healthcare system in Austria.


Imprint

Main Association

of Austrian Social Security Institutions

Haidingergasse 1 | 1030 Wien www.sozialversicherung.at

Production | Public Relations HVB

GraphicDesign | Heinzle & Partner, Markus Mair

Pictures | Fotolia

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europe: position paper of austrian social insurance

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