Austria: Industrial Relations in the Health Care Sector

  • Observatory: EurWORK
  • Topic:
  • Social dialogue,
  • Collective bargaining,
  • Social partners,
  • Industrial relations,
  • Published on: 14 February 2011

Bernadette Allinger

Disclaimer: This information is made available as a service to the public but has not been edited by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.

The instalment of a national sectoral collective agreement for the whole health care and social care sector can be considered a milestone for the sector, entailing standardised pay, the improvement of working conditions and improved working time regulations for a large group of employees. However, many problems in the sector have not been solved yet. There is a noticeable shortage of (qualified) labour and substantial lack of funding. The problem of undeclared work in the care sector has been tackled with an ordinance on the legislation of foreign care workers and a law on home care; however, organised labour has great objections against it as it stipulates excessively long working hours.

1. Key developments and trends in the health care sector

1.1 Please provide information on key trends in health care policy

Increasing economisation and privatisation tendencies can be observed in the Austrian health care sector. Estimates show that 80% of all care is being provided informally by family members and friends; nonetheless, there is great demand for and lack of qualified and skilled labour and high fluctuation of workers. A few significant policy changes that address shortcomings and problems in the health care sector have occurred within the last five years.

Firstly, an ordinance on the legalisation of foreign care workers was implemented in November 2006. This was necessary due to a large black market of care workers from Central and Eastern European countries. The ordinance rules that care workers are exempted from the general transition period for workers from the new member states on the Austrian labour market (which limits the right for citizens from the new member states to seek in employment in Austria until April 2011) under certain circumstances: care has to be provided in a private household; the person to be cared for needs to receive public funds in the form of a carers’ allowance at a certain level (at least stage three of a seven-stage scale); the person to be cared, a relative thereof or a national care providing agency need to act as the care worker’s employer; and employment is subject to a fulltime employment relationship, which includes mandatory full insurance coverage (health, occupational injuries and pension insurance).

Secondly, a law on home care (Hausbetreuungsgesetz), also known as the ’24 hour-law’ was implemented in July 2007 regulating the provision of care in private households. It stipulates that care workers are allowed to work up to 128 hours in a two-week time period and forms a legal basis for round-the-clock care. In practice, two care workers often share the job between them. The workers can either be self-employed or work as employees (employed by a care providing agency). The law stipulates that the care workers have to live in the household of the person they take care of. The care that is allowed to be provided under this law generally refers to assistance in housekeeping and activities of the daily life and must not fall under the domain of the Health Care and Nursing Act (GuKG). However, in 2008, these often lay care workers’ competencies were extended so that if ordered by physicians or certified nurses/care workers, they can administer medicine and injections. Furthermore, a law granting amnesty for formerly illegally employed care workers in private households and their employers was implemented and enforced in 2007/08, encouraging official registration with the authorities.

Thirdly, in July 2005, an agreement on social care professions (Art. 15a B-VG) was implemented, harmonising the formerly different regional-level regulations and stipulating minimal qualification standards for different types of professions in the sector.

1.2. Please provide information on the views of the major social partner organisations (trade unions and employer organisations) on trends and changes in the care sector.

While the employers’ side appreciates the reorganisation and emergence of new social care professions and the fact that pay within the sectoral collective agreement in the care sector is regulated by the activity/type of work provided and not by the care worker’s qualification, trade unions strongly oppose this for fear of wage dumping.

Furthermore, organised labour has argued against the Law on Homecare, as it includes no qualification standards for care workers. Moreover, the stipulations on working time are unacceptable, state the respective trade unions and the Chamber of Labour (AK). Within a period of two weeks, the working hours have to amount to 48 hours a week minimum; including stand-by duties, the hours may amount of up to 128 hours in a two-week period. Such a two-week working period has to be followed by an equally long break. Another point of criticism on the law refers to the choice of being self-employed. While for employed workers (employed either by the client, a client’s family member or a care providing agency) minimum wages or collective agreements and working time regulations apply, they do not apply to self-employed workers. Besides, organised labour has objections towards the lawfulness of self-employment because, they argue, generally, the relevant criteria for being dependently employed apply to the profession of care workers.

On another issue, in order to tackle the problem of underfunding, private sector trade unions have requested a ‘social billion’, (EUR 1 billion) for the health care sector in order to create 20,000 new jobs to fight the lack of labour in the sector. A petition initiated by the vida and GPA-djp trade unions (more information on trade unions in the sector see 2.2) was signed by more than 22,000 people. The reorganisation of the financing of care is included in the government’s work programme, to be implemented in 2011.

2. Industrial relations structures in the sector

2.1 Does the health care sector include any specificities in relation to the freedom of association, the right to collective bargaining and the right to strike?

There are no specificities in the health care sector. However, public-sector employees are covered by special service regulations. Those employed in the private sector are covered by a variety of sectoral, branch and company agreements, especially in the hospital sector. This is different from Austria's standard collective bargaining system which is usually characterised by all-encompassing sectoral agreements.

2.2 Please provide details on the structure of trade union representation in the health care sector. For each trade union provide:

In Austria, four different trade unions are involved in the health care sector, but all of them are broader in scope and also comprise workers in sectors other than health care. The respective unions are the Union of Salaried Employees, Graphical Workers and Journalists (GPA-djp), the Union of Public Services (GÖD), the vida trade union (VIDA) (union for blue collar workers in the areas transport; social, personal services and health care; private services) and the Union for Municipal Employees and the small Arts, Media, Sports and Liberal Professions (GdG-KMSfB).

Membership in the trade unions is voluntary. The following data are provided by the respective trade union representatives in June 2010.

Union of Salaried Employees, Graphical Workers and Journalists (GPA-djp)

The GPA-djp includes all of Austria’s private-sector white-collar workers, along with retirees, apprentices, students and unemployed persons. Furthermore, its domain includes blue-collar and white-collar workers in the graphical and paper-processing industries. Morever, GPA-djp represents journalists and formally self-employed persons who do not employ workers and who are economically dependent on one main client and whose working situation resembles that of a salaried employee. Over all of its domains, the union has about 260,000 members (of which 180,000 are active members) and is the largest trade union in Austria. It comprises white-collar workers in the private sector which are generally certified nurses and skilled care workers. The numbers of members in the sector is not available.

Union of Public Services (GÖD)

The GÖD represents the whole public sector of the country, with the exception of the municipal level and former authorities or state-owned companies that have been transformed into private law companies or privatised. It comprises about 230,000 members in total and is the second largest of the nine Austrian trade unions. In the area health care and social services, GÖD comprises 48,000 members. Professions covered are nurses and care workers who work for public entreprises like public hospitals or care institutions.

VIDA trade union

The vida trade union comprises three sections. The ‘transport section’ organises and represents workers of all transport systems (railway, road transport, water transport, air traffic), the ‘social, personal and health services section’ encompasses workers in the areas of nursing, medical activities, social services and wellness. The ‘private services section’ organises blue-collar workers in occupations in tourism, commerce, cleaning, maintenance and private security services. Vida has 151,712 active members and comprises 6929 blue-collar workers who are employed in the health care and social services private sector. They are generally unskilled or lowly skilled care workers. However, with the installment of the sectoral collective agreement, home care assistants (HeimhelferInnen) have changed from blue-collar to white-collar workers, encompassing a change in trade union representation from vida to GPA-djp.

Union for Municipal Employees and the small Arts, Media, Sports and Liberal Professions ( GdG-KMSfB)

The GdG-KMSfB represents Austria’s public employees at the local level – that is, cities and municipalities – along with employees of public utilities run by the local state. It organises employees in governmental services in a narrow sense, along with employees in consumer oriented services such as public health services, public transport, refuse collection, water, gas and power supply, social services, education and care services, and undertaker services. Furthermore, GdG-KMSfB represents employees in the small arts, media, sports and liberal professions, that is employed or self-employed persons in artistic, journalistic, programming, technical, commercial, administrative or pedagogical professions in the areas art, media, education and sports. GdG-KMSfB’s members amount to 155,000 persons in total and the union comprises 21,000 members who work as nurses and skilled and unskilled care workers. Its members work for municipal or city-run health care and care institutions.

Both the GPA-djp and vida trade unions are involved in collective bargaining at the sectoral and company level as they represent private sector employees. As mentioned above, the public sector is excluded from formal collective bargaining in Austria. Instead, employment conditions are fixed by law. The GÖD and GdG-KMSfB negotiate public service regulations (Dienstrecht) and pay regulations (Besoldungsrecht) in annual intervals. Negotiating partners are the respective governments (federal and provincial) for the GÖD and the GdG-KMSfB (local government, municipal level).

All of the four trade unions report that they are involved in bi- and tripartite social dialogue at all levels.

The interrelationship between the trade unions in the health care sector:

  • Specify whether there are differences between public and private operators in terms of trade union representation

As mentioned above, there are different unions for private and public sector employees. The demarcations are strict and binding so that generally, no overlaps occur. In the private sector, the vida’s domain consists of blue-collar workers and the GPA-djp members are white-collar employees.

  • Are there rivalries and competition between trade unions in the sector? What is the relationship between more traditional organisations and emerging professional associations of health care workers?

As mentioned above, the demarcations between the four unions' domains in the health care sector are clear and binding. The trade unions deny any rivalries or competition for members. On the contrary, in order to secure an efficient and high-quality representation of the unions in the sector, a trade union working group for health care professions (ARGE/FGV Gesundheitsberufe) is coordinating the work of the different trade unions (which all belong to the Austrian Trade Union Federation ÖGB) in the sector.

  • Have there been major reorganisations/splits/mergers of trade unions in the sector within the past five years?

In 2006, the former Union of Railway Employees (GdE), the blue-collar Commerce and Transport Union (HTV) and the blue-collar Hotels, Catering and Personal Services Union (HGPD) merged to form the vida trade union. Vida now organises and represents employees in such diverse occupations like truck and engine drivers, waiters and nurses. In 2007, the formerly separate unions GPA and DJP merged to form GPA-djp, and GdG and KMSfB merged to form the GdG-KMSfB.

The series of merger activities within the ÖGB was necessary due to continued membership loss and financial instability.

2.3 Please provide information on the structure of employer organisations in the health care sector. For each employer organisation provide:

There are many different employer associations in the health care sector which makes the field very fragmented and unclear. Thus, in this section, all employer organisations that operate on a national level in the hospital sector and all national-level employer organisations in the private health care and care sector which have the capacity to conclude collective agreements will be considered. Employer organisations with the capacity to conclude collective agreements, but operating on a regional level only (Land level) are mentioned below, but not described in detail.

The employer organisations that are taken into account here are the Austrian Association of Public and Social Enterprises (VÖWG), the Association of Health Companies FVG, (a subunit of the Federal Economic Chamber WKO), the Association of Private Hospitals in Austria (VPÖ), the Association of Interest Representation of Catholic Hospitals and Old People’s and Nursing Homes (VIO), the Professional Association of Employers for Health Care and Social Workers (BAGS), the Association of Interest Representation of Charitable Facilities of the Catholic Church Austria (also known as Caritas), the Employers’ Association of Deaconry Austria (also known as Diakonie).

Further employers’ organisations or interest organisations that are involved in collective bargaining at a regional level are the Association of Styrian Residential and Caring Homes for the Elderly, the Lower Austrian branch of the federally operating association Hilfswerk, the Styrian Umbrella Association for outpatient Elderly Care and Home Assistance Graz and the Employers’ Association of Social and Health Care Institutions in Vorarlberg.

All of the employer organisations are limited to the health care and/or care sector with the exception of the VÖWG and the FVG.

The VÖWG organises and represents enterprises and organisations with public participation and/or public ownership. Moreover, its domain comprises enterprises providing services of general interest, irrespective of their legal ownership or status (AT0609019I). The VÖWG has about 100-110 member companies which include not only individual companies, but also groups and networks or associations of entreprises, such as regional hospital associations consisting of several hospitals, but only counting one VÖWG member. The number of employees is not available. In the health care sector, VÖWG comprises four large hospital associations (Krankenanstaltenverbände) which run several dozen hospitals.

The FVG represents private hospitals, outpatient departments and sanatoria, as well as private old people's homes, nursing institutions and different kinds of health resorts (baths). All together, FVG comprises about 2000 member companies. In the health care sector FVG comprises 1174 member companies.The number of employees is not available.

The VPÖ organises and represents all hospitals and nursing institutions that are not owned or managed by the federal state, regional governments or the local state. It comprises about 130 member companies. The number of employees is not available.

The VIO represents hospitals, old-people’s homes and nursing institutions run by the distinct units of the Catholic Church. It has about 18 member companies (exact figure is not available). The number of employees is not available.

The BAGS is a voluntary employers’ organisation in the health care and care sector including care for the disabled, children and youth welfare and labour market policy services and has 261 members. In total, some 80.000 employees fall under the scope of the BAGS collective agreement (members and extension order of the collective agreement).

The Caritas is a social aid organisation run by the Catholic Church which employs over 9,000 workers and has about 25,000 voluntary staff members. More specifically, the Caritas employs about 4,600 workers in its 43 senior citizens’ and residential homes

The Diakonie is a charity run by the Protestant Church. Its domain includes work with the disabled, children and youth, aid for refugees and care of the sick, those in need of care and the elderly. It employs 5,750 staff members in 34 member organisations.

Only membership of FVG is compulsory for all private hospitals, outpatient departments, sanatoria, and old people’s and nursing homes.

Involvement in collective bargaining

The VÖWG is excluded from the right to conclude collective agreements. Both VPÖ and VIO conclude collective agreements at the sectoral level. The FVG is involved in collective bargaining at company level. The BAGS is involved in collective bargaining at sectoral level. Both the Caritas and Diakonie conclude collective agreements at a sectoral level (churches and religious communities and their facilities).

Involvement in social dialogue

In Austria, employer consultation is based on a practice of permanent, but informal social partner involvement. While the trade unions declare that they are part of the bipartite and tripartite social dialogue at all levels, this holds only partly true for the employers' organisations.

The interrelationship between the employer organisations in the health care sector:

  • Specify whether there are employer organisations specific for public and private operators in the health care sector

The VÖGW comprises members from the public sector, the FVG, VPÖ, VIO, BAGS, Caritas and Diakonie from the private sector.

  • Are there rivalries and competition between employer organisations in the sector?

According to BAGS, there are rivalries and competition as there are many different collective agreements that stipulate different regulations regarding pay, working time, etc. for essentially the same employee groups and the same occupations. According to FVG, there is some competition between this association and VPÖ concerning the right to conclude collective agreements.

  • Have there been any major reorganisations/splits/mergers of employer organisations in the sector within the past five years?


2.4 Please provide information on the structure of collective bargaining in the health care sector (covering nurses and care workers). Please explain whether the structure is different for public and private providers.

At what level are collective agreements in the health care sector concluded (multi-employer / single employer bargaining)?

Nurses and care workers in the public sector are covered by special service regulations unilaterally determined by the responsible authorities, in particular at Land level, rather than collective agreements. In the private sector, there is a multitude of collective agreements at different levels (company level, regional level, sectoral level). Company specific collective agreements are, however, not concluded by individual employers, but rather by employer associations or clerical organisations on behalf of them. Experts are divided over whether these agreements should be classified as multi-employer or single-employer agreements (see AT0802019Q).

The sectoral agreement concluded between the BAGS employer organisation and the GPA-djp and vida on behalf of the employees represents the only sector-wide collective agreement covering the whole health care and care sector including work with the disabled, children and youth welfare and the provision of labour market policy services.

Estimate the coverage rate of collective bargaining in terms of a) companies and b) employees.

The coverage rate lies at an estimated 90-100%, according to the social partner organisations in the sector.

Is there a practice of extending multi-employer agreements to employers who are not affiliated to the signatory employer associations?

There are two collective agreements in the sector that are to be extended by order: The BAGS collective agreement, a sectoral agreement which came in place in 2004, is by extension order (Satzungserklärung) to be extended to employers not affiliated with the association. The regional collective agreement AGV-KV by the Employers' Association for Social and Health Organisations Vorarlberg (AGV) is also to be extended by order.

In case of sectoral collective bargaining, are there derogation practices and opt-out rules from collective agreements and to what extend have these been used?

According to BAGS, there are rivalries and competition because the Labour Constitution Act (ArbVG) stipulates that membership of a voluntary interest organisation has priority over organisations with a mandatory membership for collective bargaining. This sometimes leads to the practice of becoming member of such a voluntary organisation in order to use their collective agreement in case it is more favourable to the employer.

2.5 Is there a forum for social dialogue dealing with matters of the health care sector? (Bi-partite and/or tripartite social dialogue; national, regional or local level?)

In Austria, there is a practice of informal and permanent social partner involvement at all levels. BAGS states that it is only involved with lobbying activities.

2.6 Elaborate on the incidence of industrial action in past five years within the health care sector. (The nature of industrial action, number of employees involved, number of working days lost, reasons for conflict, outcomes)

Austria has traditionally had very low strike rates with no days lost since 2005. There have been some works meetings, protests, demonstrations and threats of strikes in the health care sector in the past five years.

3. Contribution of collective bargaining and social dialogue to addressing the challenges facing the health care sector

As shown in chapter 1.1, several laws were introduced in order to tackle the challenges and problems the health care sector was facing. It can be said with some caution that these laws had a bigger impact on the changes in the health care sector within the last five years than collective bargaining and social dialogue.

3.1 Please indicate whether multi-employer collective bargaining has contributed to address the challenges facing the health care sector since 2005. Has multi-employer collective bargaining introduced specific clauses or instruments to address these challenges? Please illustrate the most important of such clauses or instruments and include a brief assessment of their impact.

The sectoral collective agreement that was negotiated between the BAGS employer organisation and the GPA-djp and vida trade unions in 2004 is the most important collective agreement for the private health care sector in Austria and has made more than 200 works agreements and numerous regional collective agreements obsolete. For the first time, standard pay with an automatic bi-annual remuneration raise and annual adjustments for inflation have been implemented at the sectoral level. Due to the extension order implemented in 2006, over 80,000 employees now fall under this collective agreement. This has decreased the competition among employers and generally improved the employees’ working conditions (reduced weekly working hours, certain limits on working hours with some flexibility for both sides).

In the collective bargaining round for employees in private and church-run hospitals, nursing institutions and elderly people’s homes between VPÖ and VIO on the employers’ side and vida on the trade union side, the topic of belated changes on a fixed work schedule was articulated. As this seems seems to be a frequent practice, vida representatives request more stability of scheduled duty rosters. However, this could not be agreed upon and will be brought up in future collective bargaining rounds.

In 2007, the national social partners concluded an agreement on the introduction of a minimum wage of EUR 1000 (gross) for fulltime work in all sectors by 2009. Where collective agreements apply, this aim has been reached, as in Austria, there is no statutory minimum wage regulation but minimum rates of pay are rather laid down in individual collective agreements. The ÖGB’s aim is to increase the minimum wage to EUR 1300 in a next step. In the private health care and care sector, the minimum wage for aides lies around EUR 100 below that threshold. For workers covered by the BAGS collective agreement, however, the minimum of EUR 1300 has been negotiated in the most recent round of collective bargaining for 2010. This was preceded by protests by 7500 workers in the sector. Wages were increased by 1.5 percentage points thereafter, with a minimum increase of EUR 24.

3.2 Please indicate whether single-employer collective bargaining and social dialogue practices at company level have contributed to addressing the challenges facing the health care sector since 2005. Has single-employer collective bargaining introduced specific clauses or instruments to address these challenges at company level? Please illustrate up to three cases and include your assessment of their impact.

In the public sector, a trade union representative states that single-employer collective bargaining has led to improvements in the area of adult education/training: Within the employment relationship, care workers or nurses’ assistants (PflegehelferInnen) can be trained in order to become a certified nurse. This is a means of human resources development and intended to decrease the shortage of qualified labour in the sector.

3.3 Please indicate whether social dialogue (national, regional, local level – bipartite/tripartite) has contributed to addressing the challenges facing the health care sector since 2005. Has this dialogue introduced specific instruments to address these challenges? Please illustrate the most important of these instruments, specify at which level they have been concluded, who was involved and include your assessment of their impact.

See chapters 3.1 and 3.2. Some problems have been articulated and discussed, but only partly solved by new laws, works agreements and organisation models. However, there are many areas that still need to be improved: Pay in the sector is still about 20 percentage points below average and the pressure on workers is high. Even though training courses on care are being promoted by the public-law Labour Market Service (AMS), the lack of labour in the sector has not yet been tackled sufficiently, which leads to excessive working hours and a lack of planning for employees. Funding shortfalls are an imminent problem in the sector, as well.

The GÖD reports that in the public sector, more family friendly working hours, better and increased training measures, the possibility of part-time work for all professions, the improvement of the workplace and increased employee protection, as well as 'social measures' such as meals for the employees' children, or uniforms / professional clothing could be reached through social dialogue.

4. Commentary

The main problem the sector is facing is the lack of (qualified) labour which will further increase due to the demographic development. Especially the care sector still lacks prestige and pays comparatively low wages. The introduction of the BAGS collective agreement in 2004 and its extension order two years later was a major step towards standardising pay and improving the working conditions for a large group of employees.

However, not enough is being done in order to improve the attractiveness of the sector. Even though education and training in the sector has increased, there is still not enough of it in order to meet the need. On the other hand, lots of new professions and training models have been implemented and in some areas, an increasing academisation of health care professions has taken place; the question of how to deal with this development will need to be tackled more intensely. The main obstacle in collective bargaining and social dialogue is the problem of funding (especially in economically hard times); there are not enough jobs and workers and therefore increased pressure at work. However, improvements have been made with regards to flexibilisation of working time and more family friendly working hours.

Bernadette Allinger, FORBA (Working Life Research Centre)

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