following the introduction of reference pricing if a patient chooses a product whose retail price exceeds the reference price heshe needs to pay the share above the reference price due to shortages and long waiting times in some municipalities primary care providers do not always function as gatekeepers and patients sometime seek specialist and emergency care directly even if these visits may often be unnecessary this is partly related to the fact that accountability is assigned separately to providers delivering primary care specialist care and longterm care and funding mechanisms with multiple sources do not embed adequate incentives to strengthen care coordination among providers finland invested substantially in ehealth