A decision-making tree of a patient’s pathway through the system of health care provision is depicted in Fig. 5.1. An interesting feature is that urgent cases can access health services directly, even an uninsured person has access in the case of urgency. Since the law defines “urgent care” rather vaguely, there is room for misuse.
If a service is not covered by SHI or the provider is not contracted, an individual may still receive reimbursement but only if the health insurance company gives prior authorization.