[Competition between office-based physicians and hospitals--general legal conditions]

Before December 31, 2002 hospital options were limited to demand-oriented individual authorisations and ambulatory emergency care, so there was no competition against private practice physicians. For the first time the Healthcare Reform Act (GSG) provided hospitals with the opportunity to offer ambulatory services from January 1, 2003 in individual areas of care (pre- and post inpatient treatments according to Sect. 116a SGB and ambulatory surgical interventions according to Sect. 115b SGB V). Following numerous reform acts the spectrum for hospitals has been considerably extended today, particularly by establishing medical service centres (MVZ) and the authorisation to provide certain ambulatory services according to Sect. 116b para. 2-6 SGB V after special approval. Conversely, an amendment of Sect. 20 para. 2 Aerzte-ZV from January 1, 2007 enabled office-based physicians to be employed in a hospital and provide inpatient care so that today we may speak--at least in important sections--of a competitive situation on different levels.