Supporting measurement for action: the Austrian approach to decarbonize health care

Austria has a decentralized healthcare system with nearly universal health coverage based on mandatory social health insurance. Responsibilities are shared between the federal government, the nine federal states (Länder), social health insurance funds and healthcare providers. Healthcare services are delivered through a mix of public, non-profit and private organisations, including hospitals, rehabilitation centres, primary care units and outpatient providers. The federal states play a key role in hospital planning and ownership, resulting in a very diverse healthcare landscape. 

The Gesundheit Österreich GmbH (GÖG), Austria’s national public health institute, supports evidence-based health policy, health system planning and health promotion initiatives. Within GÖG, the Department for Climate Neutrality and Sustainable Transformation is responsible for programmes and initiatives at the interface of climate action and health promotion, supporting healthcare facilities in reducing greenhouse gas emissions and advancing sustainability. The activities of the department are commissioned by the Austrian Ministry of Labour, Social Affairs, Health, Care and Consumer Protection, and funded by the Health Promotion Agenda.

Austria's climate goal of achieving climate neutrality by 2040 will be anchored in law through a new climate law (the draft of which is undergoing review in the fall of 2026). A study based on data from 2014 shows that the sector is responsible for approximately 6.7% of Austria's national carbon footprint. At the same time, healthcare systems are increasingly affected by the impacts of climate change, creating a dual responsibility to both mitigate emissions and strengthen resilience. 

To support the transition also in the health care sector, the Austrian National Public Health Institute (GÖG) developed the Strategy for a Climate-Neutral Healthcare System, which was published in 2024 and provides a roadmap for integrating climate action into healthcare governance, infrastructure, procurement, mobility and service delivery while ensuring high-quality care. The strategy serves as a key framework for initiatives such as the Climate-Friendly Healthcare Facilities Advisory Service, which was launched by the Austrian National Public Health Institute (GÖG) in August 2022. The initiative supports healthcare facilities in implementing climate protection measures while simultaneously promoting health. By October 2026, more than 630 healthcare facilities have participated in the programme, including hospitals, rehabilitation clinics, long-term care facilities, primary care units, outpatient centres, medical practices and pharmacies. 

 

Although greenhouse gas emissions from the Austrian healthcare sector have already been estimated, the most comprehensive available analysis is based on data from 2014. This assessment found that the healthcare sector accounts for approximately 6.7% of Austria’s national carbon footprint and has since served as an important evidence base for climate action in healthcare. There are currently no up-to-date data on the carbon footprint of the entire Austrian healthcare system. Responsibility for the national greenhouse gas inventories lies with the Ministry for the Environment rather than the Ministry of Health, as healthcare is a cross-cutting sector whose emissions are distributed across multiple economic sectors, such as energy supply, transport, buildings, industry, agriculture, and waste management.

As a result, Austria currently relies on this existing national estimate while simultaneously expanding facility-level emissions measurement through the Climate-Friendly Healthcare Facilities Advisory Service initiative. Within the project, a structured process for collecting and assessing GHG emissions data across a large number of healthcare organisations was established. 

The programme applies a predominantly “bottom-up” methodology. Greenhouse gas emissions are assessed at facility level using activity-based data collected directly from participating healthcare organisations. Standardised templates enable the collection of Scope 1 and Scope 2 emissions data and selected Scope 3 information. Data are subsequently aggregated and analysed centrally by Gesundheit Österreich GmbH (GÖG) to develop benchmarks and derive sector-wide insights. While the programme does not currently represent a comprehensive national carbon footprint assessment, the aggregation of facility-level data provides the basis for a future hybrid approach combining bottom-up measurements with national-level analyses.

Institutional setup

GÖG developed the programme framework, quality standards, data collection templates, reporting templates and a Climate Action Plan methodology. Consulting companies with climate and healthcare expertise were selected through public procurement procedures. The templates completed during the consulting process are submitted to the GÖG by the consulting firms.

Consulting process

The selected consultants work directly with healthcare facilities through:

• interviews with key stakeholders;
• site visits;
• document reviews;
• collection of activity and performance data;
• collection of emissions-related data. 

Data collection

A standardized GHG inventory table is used to collect relevant data from healthcare facilities and provides an estimate of a greenhouse gas inventory based on Scope 1 and 2 emissions, as well as a Scope 3 screening for the healthcare facility.

During the consultation process, data from the previous year are collected. The Greenhouse Gas Protocol (GHG Protocol) forms the basis for structuring and categorizing the collection of GHG emissions in this table. Emissions are estimated using activity data and predefined emission factors. Scope 3 data collection currently represents a screening approach and does not yet cover all 15 GHG Protocol Scope 3 categories.

The following data is collected:

• Performance data (e.g. days of care, bed-days, standardized beds, etc.)
• Scope 1 emissions (e.g. fuels used on-site; owned vehicle fleets; anaesthetic gases; refrigerants)
• Scope 2 emissions (e.g. electricity; district heating; district cooling)
• Scope 3 screening, such as purchased goods and services; business travel; employee commuting; waste management; selected upstream activities. 

Due to the complexity and resource requirements associated with Scope 3 accounting, the programme currently applies a phased screening approach. Data availability varies considerably across organisations; therefore, the assessment focuses on the most material and readily accessible categories. The long-term objective is to progressively broaden Scope 3 coverage and improve data quality, enabling more comprehensive supply-chain emissions assessments.

Climate action planning

Based on the emissions assessment and identified improvement opportunities, each participating organisation develops an individual Climate Action Plan containing 

• measures in all relevant fields of action;
• estimated emissions reduction potential;
• implementation timelines;
• responsible persons;
• expected health co-benefits. 

Review and evaluation 

The collected data is reviewed, validated and aggregated by GÖG to support the development of benchmarks and the analysis of the collected data regarding energy, resource, and cost-saving potentials for healthcare facilities, social insurance institutions, and the public sector. 

 

Several lessons emerged from the implementation process:

• Healthcare facilities are highly motivated to contribute to climate action but require technical support and structured guidance. 
• Standardised templates greatly improve consistency and comparability of emissions data. 
• Combining emissions measurement with practical climate action planning increases engagement and implementation. 
• Ongoing coaching and follow-up support by experts are important for identifying available datasets as well as relevant measures. 
• Linking climate mitigation measures with health co-benefits helps motivate participation and leadership buy-in. 

Challenges

Key challenges included:

• Collection of high-quality and complete emissions data across diverse facility types because of:
  • Limited availability of Scope 3 data and difficulties obtaining supply-chain information. 
  • Limited technical expertise within healthcare organisations regarding GHG accounting. 
  • Limited resources and staff capacity for climate reporting and implementation activities. 
• Ensuring comparability across the aggregated data from participating facilities resulting from the ongoing improvement and refinement of data collection methods throughout the project.

Success factors

Important success factors included:

• Dedicated resources and central coordination. 
• Use of standardised data collection and reporting templates. 
• Involvement of specialised consultants with expertise in both healthcare and climate action. 
• Provision of practical Climate Action Plans rather than emissions inventories alone. 
• Continuous quality assurance and validation of submitted data. 
• Integration of health promotion benefits into climate action planning. 
• Development of benchmarks that will allow participating organisations to learn from collected data. 

Based on the Austrian experience, the following recommendations may be useful for other countries with a decentralized health care system:

1. Start with a pragmatic Scope 1 and Scope 2 assessment and gradually expand Scope 3 coverage to build data systems that can evolve towards more comprehensive Scope 3 accounting and sustainability reporting requirements. 
2. Develop standardised templates, methodologies and reporting formats from the outset.
3. Set up the project so that you receive the data from the institutions, allowing you to review, consolidate and analyse it.
4. Combine emissions measurement with implementation-focused Climate Action Plans. 
5. Establish strong quality assurance and data validation processes. 
6. Provide expert support and coaching. 
7. Highlight health co-benefits alongside climate benefits to increase stakeholder engagement. 

 

For more information, please contact the Department for Climate Neutrality and Sustainable Transformation at the Gesundheit Österreich GmbH (GÖG) at klimaneutrales.gesundheitswesen@goeg.at