Angebotsstrukturen der ambulanten vertragsärztlichen Versorgung: Deutschland und andere dezentral organisierte Gesundheitssysteme

Background The image of outpatient medical care is physician-centered; little attention is paid to the (potential) influence of health organizations and their characteristics on medical care dimensions. Aim Description of the structures of outpatient medical care stratified by legal forms, comparison with those of other decentralized health systems and discussion of the potential effect of legal form on different dimensions of medical care. Methods The frequencies of solo practice, group practice and Medical Care Centers for both primary and specialist medical care, the average team size of practices and the proportion of interdisciplinary health organizations are described over time based on secondary data sources (mainly provided by the National Association of Statutory Health Insurance Physicians). Results The structures of outpatient medical care are characterized by high fragmentation (2018:>80,000 health organizations), high proportion of small organizations (73% of all health organizations are solo practices), low average team size (1.7 physicians on average) and low proportion of interdisciplinary health organizations (17% of all group practices and Medical Care Centers). Overall, there is little indication that family and specialist care facilities tend to merge with each other. Conclusions The fragmentation of the German health care structure is more pronounced and lasting than in other decentralized health systems. Legal forms and average values do not adequately capture the heterogeneity of organizations in outpatient health care. In order to improve organization of medical care, a broader database including more organizational characteristics would be desirable.