Insurers: no recourse to the entire hospital list

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.

The assessment of the federal administrative judges

According to the orientation expressed by the Federal Administrative Court, a hospital list cannot in any way constitute the object of a global or collective challenge. In the grounds written in support of the judgment, the FAC clarified that a list of hospital facilities does not represent a single and indivisible administrative act. On the contrary, it constitutes a coordinated set of distinct service mandates entrusted to individual facilities operating within a canton, namely hospitals, maternity homes and nursing homes. For this reason, the judicial system excludes the possibility of contesting the entire planning framework with a single general appeal. Insurers nevertheless retain the prerogative to act in the appropriate venues, but through different methods compared to what was attempted against the Canton of Schwyz.

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.

Analysis of appeal procedures and operational alternatives

The procedural rules set by the judges in St. Gallen require insurers to change their strategy in examining the health planning measures issued by the Cantons. In detail, the possibility of using judicial instruments to contest cantonal administrative decisions must translate into the appeal of individual specific measures. When a trade association identifies critical issues in the distribution of service mandates, legal action cannot target the general act of the Council of State, but must focus on the individual mandates assigned to well-identified structures, such as specific hospitals, individual maternity homes, or individual nursing homes. This restrictive principle protects the stability of local public health planning, preventing entire lists of regional health structures from being blocked or called into question by a global appeal filed by insurance organizations. To verify how these dynamics reflect on the system and consult regulatory details or the overall impact on costs, it is useful to consult the overview on the cost of living in Switzerland (nav:cost-of-living) to have a clear picture of health and administrative expenses in the country.

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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