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There is no upper limit for the carrying out of the compulsory health care insurance costs of hospital treatment, as long as this complies with the statutory requirements. This was decided by the Federal court in the case of health insurance, Sympany.
The health insurance wanted to take over the 1.08 million Swiss francs, which was a hospital of the Canton of Basel-Stadt in the invoice, only around 300'000 Swiss francs. Vivao Sympany took the view, in this specific case, you could invoke the jurisdiction of the Federal court. This meant, there is an upper limit for the use of financial resources.
Everyday life
been As it was when you treated a 71-year-old patient of a remaining life expectancy of 14.8 years out. However, this was in the everyday life is severely limited.
Due to the so-called QALY-method, this follows a value of 2.96. This will be multiplied by 100'000 Swiss francs, this is an amount of 296'000 Swiss francs.
No method
The Federal court, in one on Tuesday published judgement makes it clear that it had never established such an absolute upper limit to the expense of the compulsory health care insurance. Also it determines the QALY-method, never as authoritative.
In the present case, the Patient 2014 was entered due to a knee operation in hospital. After the surgery, he suffered a heart attack, kidney failure and many other life-threatening complications. In total, he spent 421 days in the hospital. The treatments cost around 2.4 million, of which the insurance should take 45 per cent.
insurance pay
writes The Federal court that the health insurance had not objected to the cost-effectiveness of the respective treatments. Rather, they have limited to take the amount of the lump sum in question. The files do not show that the treatments have been economically and not to pay therefore, of the insurance.
Rather, an unrestricted obligation under the health insurance law would insist, as long as individual measures of hospital treatment meet the conditions of the effectiveness, appropriateness and cost-effectiveness, more in the considerations of the Federal Supreme court.
the aim of the act was it just to ensure in the case of a stationary treatment is a perpetual obligation for the health insurance. (Judgment 9C_744/2018 from 01.04.2019) (ms/sda)
Created: 23.04.2019, 13:58 PM
