Facts
H., residing in T. (Canton of Schwyz), was treated as an inpatient at the Y Clinic (Canton of Zurich) on January 9 and 10, 1996. His health insurance company, Helvetia, covered the costs of CHF 2,048.60 for the treatment and stay in the semi-private ward. Helvetia requested the Canton of Schwyz to reimburse the difference of CHF 476.-- between the costs for out-of-canton patients and the rates for canton residents. The Cantonal Office for Health and Social Affairs rejected the request, whereupon Helvetia filed a complaint with the Government Council of the Canton of Schwyz. The Administrative Court of the Canton of Schwyz upheld the complaint and obliged the Canton of Schwyz to pay the difference of CHF 476.-- to Helsana Insurances AG (legal successor of Helvetia). The Canton of Schwyz filed an administrative court appeal against this decision with the Federal Insurance Court.
Considerations
The Federal Insurance Court states that disputes over the interpretation and application of Art. 41 para. 3 of the Federal Health Insurance Act (KVG) are of a social insurance nature and therefore to be assessed by the Federal Insurance Court as the court of last instance. The obligation of the canton of residence to pay the difference under Art. 41 para. 3 KVG is intended to balance the burden and enhance coordination between the cantons, with the canton of residence contributing to the financing of the out-of-canton hospital. The court concludes that the obligation to pay the difference exists in principle even if the insured person is accommodated in the semi-private or…