austria's health programs are funded by the sickness insurance fund known as the krankenkasse, which in 2013 took 11.0% of the gdp, which was above the average of the e.u average of 7.8% of gdp. austria's healthcare system is decentralized, and operates with a system similar to united states federalism. each of the nine states and the federal government of austria have legal limitation and roles in their healthcare system. federal ministry of labor and social affairs is the federal aspect, its role is to develop the framework for the services that are offered, and handle the sickness insurance fund known as the krankenkasse, which funds austria's healthcare system. the role of the provinces is to manage and provide the care as needed. the provision of healthcare is ultimately carried out jointly by federal, provincial, and local actors. since austria's health program covers a vast array of social insurance including but not limited to unemployment insurance, family benefits, accident insurance, the overall bureaucracy is vast. while the krankenkasse is the primary fund, austria social protection network actually implemented by 22 smaller funds, 19 of which are purely for sickness and all of which by public law are self-governed in order to insure decentralization. the funds are also differentiated to allow for effective risk pooling, which is why membership is compulsory and citizens are generally unable to select which fund they will belong to.