Generalists and Specialists in Primary Ambulatory Medical Care

Abstract

The health services system of the Federal Republic of Germany (F.R.G.) is characterized by the following aspects: the ambulatory medical care sector and the hospital sector are strictly separated, with the physician reimbursement schemes in two sectors being different. Physicians in ambulatory care are paid on a fee for service basis, almost all Germans carry health insurance, most of them a compulsory one. Health insurance is comprehensive with very few exceptions, patients, with the exception of the privately insured, do not pay for physicians’ services directly. Rather, physicians charge their services on vouchers provided by the patients, which in turn are refunded by the physicians’ organizations. The latter receive the funds from the health insurance funds, the entry into the ambulatory health care system is not strictly via the general practitioner. Thus, also specialists may be first-contact physicians.