Insurers: no recourse to the entire hospital list (cross-border guide)

Context

In brief

• Appeal dismissed by the Federal Administrative Court
• Insurers cannot challenge the entire hospital list
• It is only possible to appeal individual planning decisions
• The court's decision is final and without appeal

Key facts

• Appellant body: Association of Swiss Health Insurers (prio.swiss)
• Court: Federal Administrative Court (FAC) in St. Gallen
• Canton concerned: Canton of Schwyz
• Scope: List of hospitals for acute somatic care
• Outcome: Appeal dismissed

Health insurers do not have the legal standing to file an appeal against a canton's hospital list in its entirety. In a published ruling, the Federal Administrative Court formally dismissed the application filed by the trade association. The legal dispute originated from the appeal submitted by the Association of Swiss Health Insurers (prio.swiss) to the Federal Administrative Court (FAC) in St. Gallen. The subject of the dispute concerned the list of hospitals for acute somatic care drawn up by the State Council of the Canton of Schwyz. Based on what emerged in the legal claims, the insurers sought the complete annulment of the hospital list. The claim put forward aimed to obtain the referral of the entire act to the Schwyz executive, so that the latter could proceed with the drafting of a new comprehensive hospital planning for the cantonal territory. However, the judges based in St. Gallen examined the issue and established an opposite principle, rejecting the request for total annulment.

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Operational details

The practical implications arising from the ruling of the Federal Administrative Tribunal outline a well-defined framework regarding the relations between trade associations in the insurance sector and cantonal governments on health matters. The decision establishes a clear line of demarcation on the methods for controlling regional hospital planning. Industry operators cannot undertake massive legal action to overturn the entire acute somatic care planning network decided by a cantonal executive. On the contrary, the protection of the economic and managerial interests of health insurers must necessarily take place through targeted and punctual challenges.

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Key points

The ruling issued by the Federal Administrative Court is final and binding on all the institutional actors involved. The judges of St. Gallen have expressly stressed that the decision is not susceptible to further encumbrance and cannot in any way be appealed before the Federal Court of Lausanne. This means that the judicial process for the global challenge of the cantonal hospital lists is definitively interrupted at the TAF level, confirming the restrictive orientation adopted regarding the right of appeal of trade associations.

Procedure and limits for trade associations

For operators in the sector and trade associations that intend to monitor or challenge the health planning acts issued by the cantonal governments, the way forward requires a detailed and targeted analysis of the individual administrative measures. No collective action or general blocking of regional lists is allowed. The correct procedure requires isolating the individual decisions relating to the service mandates assigned to the individual health institutions in order to be able to initiate a specific judicial dispute. Each dispute must therefore be limited to the individual mandate, respecting the limits established by federal jurisprudence. To deepen the management of expenses related to the health system and mandatory coverage, you can scoprire i dettagli sulla LAMal e le casse malati.

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Source: swissinfo.ch