The European Centre for Social Welfare Policy and Research supports the Sustainable Development Goals
Health insurance in Austria is a form of mandatory insurance regulated by law. It is tied to gainful employment or the fulfillment of other mandatory insurance requirements; however, health insurance coverage also extends to eligible dependents (derivative coverage) as well as to those who are voluntarily self-insured. Since the turn of the millennium, several policy measures have been implemented to promote the inclusion of individuals in the health insurance system. These include, primarily, the introduction of basic care for foreigners in need of assistance and protection, the extension of coverage following the termination of employment, and the inclusion of BMS recipients (now referred to as social assistance in most federal states) in the health insurance system.
The project – as a follow-up to the earlier studies in 2003 and 2015 – aimed to conduct a quantitative and qualitative reassessement of people in Austria who were not covered by health insurance. The key objectives were to estimate the number of people concerned, to analyse their socio-demographic characteristics, to identify causes for non-coverage and to assess their coping behaviour in the event of illness.
For the quantitative part of the study, we used register data from the umbrella organisation of the health insurance fund and Statistics Austria (data on the resident population, insured persons, cross-border commuters, specific groups such as chamber-related professionals, etc.). For the qualitative part, we conducted a survey on patients in ambulant facilities that also admitted people not covered by health insurance.
Based on administrative data between 9.14 and 9.21 million people in Austria were covered by health insurance at the end of 2024. When compared to the resident population as of January 1, 2025, this means that between 0 and 57,000 people (or 0.0% to 0.6% of the population) had no health insurance coverage (the range is attributable to data uncertainties regarding “in-commuters” and their dependents, as well as to the estimated proportion of dependents among self-employed professionals who are insured exclusively under private law.).
According to administrative data, men (whose insurance coverage rate is about 0.65 percentage points lower than that of women) are more likely to be uninsured. When analyzed by age and gender, the age groups with the highest concentrations of people without health insurance for both genders are, in order, 20–24, 25–29, and 30–34. In these age groups, coverage rates are at least one percentage point below the respective average coverage rate. Furthermore, it is evident that for residents of Vienna, coverage rates for both genders are significantly lower than those in all other federal states combined.
Based on the survey forms (not representative!), further insights can be drawn regarding the sociodemographic characteristics of individuals without health insurance:
• Education: Individuals without health insurance are likely to be primarily those with a low level of formal education, a high proportion of whom have completed no more than compulsory schooling.
• Marital status/household size/housing situation: It can be assumed that people without health insurance are rarely in a relationship. They are also likely to live alone more frequently. Furthermore, it can be assumed that homelessness or a precarious housing situation is relatively common among people without health insurance.
• Citizenship: Austrian citizens are likely to be significantly underrepresented among those without health insurance.
• “Means of subsistence”: There is only minimal participation by those without health insurance in the labor market, and when they do participate, it is exclusively through precarious employment. In the survey forms, “means of subsistence” was most frequently reported as non-employment without entitlement to social benefits, non-employment due to a lack of a residence permit, or undeclared employment.
• Income situation: People without health insurance have very low incomes—if any at all. This applies to both personal and household income.
It also appears that a lack of health insurance is likely a recurring problem for a significant proportion of those clients who have had insurance in Austria at least once. A substantial portion of the periods without insurance likely involve longer stretches of one year or more, particularly among individuals who are not Austrian citizens.
As far as reasons and causes are concerned, generally speaking, the fact that Austrian citizens are uninsured is usually linked to administrative issues, a lack of personal resources, or a lack of information (failure to apply for social benefits, missing deadlines during a proceeding, waiting for a benefit to be granted, lack of support from social workers, etc.). Even after losing a job or having social benefits discontinued—which were also frequently cited as reasons for lack of insurance—individuals should at least be entitled to social assistance if they are presumed to be in need. In addition, there are sometimes exceptional changes in status, such as in the case of Austrians living abroad who return after a prolonged absence.
Non-Austrian citizens without insurance coverage are generally people who are not employed, have not yet lived in Austria for five years, or cannot yet prove permanent residence—and are therefore not eligible for social assistance—and who have not yet acquired the right to AMS benefits. In some cases, these are also individuals staying in Austria for less than three or six months, primarily from EU and other European countries. For EU citizens, job loss and problems with self-insurance are also relevant factors. For asylum seekers, additional issues related to asylum status (no decision, status not yet active, no basic benefits) are cited.
The most frequently cited factor for future enrollment in health insurance—though only a slim majority overall anticipated this—was, relatively independent of sociodemographic background, the start of gainful employment.
For Austrian citizens—and, to a lesser extent, for EU citizens as well—gaining access to social benefits (e.g., AMS benefits, social assistance, family benefits, etc.) and, consequently, health insurance is generally a relatively quick and straightforward process. The necessary step toward inclusion usually involves submitting applications for social benefits, sharing information, or establishing connections with social workers. For EU citizens, obtaining dependent status (through marriage, cohabitation, or the partner taking up employment) also plays a certain role. In contrast, non-working migrants (from outside the EU) who have not lived in Austria long enough (do not have permanent residency) and do not receive social benefits have only a slim chance of integration, as they generally do not qualify for social assistance either. In these cases, according to the respondents, applying for a visa or integration through asylum status or basic social assistance also represents a possibility for integration into the health insurance system.
In the survey forms, the most frequently cited broad reasons for visiting the outpatient clinic were “chronic problem” (46%), followed by “acute problem” (21%) and “emergency treatment” (12%). Among the specific reasons asked about (multiple responses allowed), pain (including headaches, 39%) was cited most frequently, followed by a lack of medication and/or medical aids (20%) and diabetes (16%).
In the sample, 28% sought medical treatment no sooner than three months—and 19% no sooner than one year—after the onset of the first symptoms. In particular, individuals who are not Austrian citizens tend to seek medical treatment relatively late, when the symptoms are already more advanced.
The European Centre for Social Welfare Policy and Research supports the Sustainable Development Goals
