To work as a doctor in Switzerland and be able to invoice services covered by mandatory health insurance (OKP), one needs more than just a federal degree. The Federal Law on Health Insurance (KVG), specifically Articles 36 and 37, governs the professional and administrative licensing requirements at the federal level. In addition, cantonal authorizations are required, such as those in the Canton of Lucerne.
Overview of General Admission Requirements
According to Article 36 KVG, physicians may only provide services covered by the OKP if they:
- hold a Swiss federal diploma or an equivalent foreign diploma recognized in Switzerland,
- have completed the necessary continuing medical education and hold the corresponding specialist title,
- hold a license to practice independently from the relevant canton (e.g., Lucerne), and
- are registered in the cantonal registry of healthcare providers.
For foreign diplomas, confirmation of recognition by MEBEKO is also required so that the degree is recognized as equivalent in Switzerland. In the Canton of Lucerne, this license to practice is issued by the Department of Health and Sport (DIGE). The required form, “Gesuch um Erteilung einer Bewilligung zur fachlich eigenverantwortlichen Berufsausübung und um Zulassung zur Tätigkeit zulasten der OKP” (Application for a License to Practice Independently and for Authorization to Provide Services Covered by Compulsory Health Insurance) is available online at gesundheit.lu.ch/bewilligungen. Once cantonal authorization has been granted, a ZSR number is required for billing health insurers; this number serves as a unique identifier for the service provider.
Admission restrictions under Art. 37 of the Health Insurance Act
Under Article 37 KVG, the federal government may require the cantons to introduce additional conditions for the licensing of physicians. These include, in particular, requirements regarding:
- a minimum period of practice at a recognized Swiss training facility (three years),
- proof of sufficient proficiency in the national language of the canton of practice, and
- participation in a quality assurance system.
These requirements were tightened with the 2022 revision of the KVG to better control the number of licensed physicians and ensure the quality of medical care.
Key Issues and Current Developments
Since the amendment to the KVG on June 19, 2020, two points have become particularly relevant in practice:
Three years of practice at a recognized Swiss training institution
Only those who have worked for at least three years at a Swiss training institution in the requested specialty during the three years prior to submitting the application may be admitted. This rule is intended to ensure that physicians are familiar with the Swiss healthcare system. The Canton of Lucerne strictly applies these provisions as part of its licensing procedures.
General practitioners and Regional Underservice
A key issue in recent years has been ensuring primary care by general practitioners, particularly in rural areas. The growing shortage of family physicians means that many cantons — including Lucerne — can make use of the exceptions provided for in the KVG in cases of underservice. The same applies to the specialties of pediatric and adolescent medicine as well as child and adolescent psychiatry and psychotherapy.
This increased flexibility is intended to prevent entire regions from being left without primary care — a problem that particularly affects smaller municipalities. At the same time, the cantons’ responsibility remains significant: they must ensure that such special licenses are granted in a targeted and transparent manner.
Demand-Based Licensing
Cantons may restrict licensing if regional care provision is already secured. This applies in particular to specialties with excess capacity. The Canton of Lucerne has exercised this authority through its cantonal licensing ordinance and has limited the maximum number of full-time equivalents in the specialty of angiology to 11.5.
Conclusion
For physicians, this means that in addition to a medical degree and board certification, domestic experience, language proficiency, and quality assurance are now also decisive factors for admission under the KVG. Anyone seeking to practice in Lucerne should carefully review the cantonal requirements and submit a complete application—this will help avoid delays and follow-up inquiries.