Facts
S., born in 1967, was examined at the Clinic for Orthopedic Surgery at the Inselspital Bern in March 1998 due to left inguinal pain. The investigation revealed residual hip dysplasia, for which a periacetabular osteotomy was proposed. The director of the clinic requested the cantonal physician of the canton of residence, St. Gallen, to approve the costs for this procedure. The cantonal physician's office rejected the request, as according to an orthopedist at the Cantonal Hospital St. Gallen, the planned operation could also be performed there.
S. filed an appeal with the cantonal insurance court, which dismissed the appeal. Subsequently, S. filed an administrative court appeal, requesting the court decision and the objection decision to be overturned and the canton of St. Gallen to be obligated to pay the costs of the periacetabular osteotomy performed at the Inselspital Bern.
Considerations
The Federal Supreme Court states that according to Art. 41 Paras. 2 and 3 of the KVG (Federal Health Insurance Act), insured persons can choose a different service provider than the one in their canton of residence for medical reasons. The decisive factor is whether the required services are offered in the canton of residence or in an out-of-canton hospital listed on its hospital list.
In the present case, it is unclear whether the modified form of the triple osteotomy according to Tönnis applied at the Cantonal Hospital St. Gallen is medically…