How are health care services organized and financed?
Physicians: General practitioners (GPs) and specialists in ambulatory care who get reimbursed by SHI are by
law mandatory members of regional associations that negotiate contracts with the sickness funds. Regional
Physicians’ Associations are responsible for coordinating care requirements within their region, and act as
financial intermediaries to the sickness funds and the physicians in ambulatory care. However, ambulatory
physicians typically work in their own private practices—around 60 percent in solo practice and 25 percent in
dual practices. Most physicians employ doctors’ assistants, while other nonphysicians (e.g., physiotherapists)
have their own premises. In 2012, of the 141,038 practicing SHI-accredited physicians in ambulatory care, 49
percent were practicing as family physicians and 51 percent as specialists. Since 2004, specialized medical care
provided by hospital specialists in outpatient care has been introduced. It includes treatment of severe progressive
forms of disease and of rare diseases, as well as highly specialized procedures. Details of this and qualifications
requirements are defined by the Federal Joint Committee.
Individuals have free choice among GPs, specialists, and, if referred to inpatient care, hospitals. Registration
with a primary care physician is not required and GPs have no formal gatekeeping function. However, since