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Federal Supreme Court, Decision 9C_493/2018 of 14 October 2019

7. November 2019 – In a recent decision, the Federal Supreme Court held that the Canton of Zurich may not refuse its pro rata remuneration for voluntary extra-cantonal treatment covered by mandatory health care insurance on the basis of the quantity restriction stated for the clinic in question in the hospital list of the Canton of Graubünden of July 2012. The Federal Supreme Court thus upheld its jurisprudence of recent years (Decisions 9C_151/2016, 9C_153/2016, 9C_155/2016 and 9C_507/2016). The hospital list of the Canton of Graubünden clearly states that the quantity restriction laid down in this list solely relates to the inpatient treatment of residents of the Canton of Graubünden. The different effects that the quantity restriction has on patients from within and from outside the Canton are objectively justified and do not violate art. 8 of the Swiss Federal Constitution (SR 101). In a comparable earlier decision (BGE 138 II 398), the Federal Supreme Court already stated that the legislator was aware that there is a certain contradiction between hospital planning pursuant to art. 39 of the Health Care Insurance Act (Bundesgesetz über die Krankenversicherung (KVG); SR 832.10) and the free choice of hospital pursuant to art. 41 para. 1bis KVG. The Court held that it is mainly a political question to what extent voluntary extra-cantonal treatment, which was intended to promote inter-cantonal competition, is reasonable. For the full decision, see here.