Decision on the Jurisdiction of the Cantonal Arbitration Tribunal in Disputes over the Remuneration of an Out-of-Canton Inpatient Treatment

Facts

A., a patient residing outside the Canton of Zurich, was treated in the general ward of the obstetrics clinic of the University Hospital Zurich from June 3 to June 27, 2005. The University Hospital billed Helsana Insurances AG in the amount of CHF 35,456.70 for this treatment. A. and Helsana then filed a claim with the Arbitration Tribunal for Social Insurance Disputes of the Canton of Zurich with the aim of determining the applicable tariff for this treatment. The Canton of Zurich disputed the jurisdiction of the Arbitration Tribunal.

Considerations

The Federal Supreme Court has decided that the Arbitration Tribunal is not competent in this case. Neither A. as the patient nor Helsana as the health insurer are involved in this proceeding in their capacity as participants in the mandatory health insurance. Rather, it is about the remuneration of an out-of-canton treatment, which is not to be covered by the basic insurance, but possibly by a supplementary insurance. Such disputes do not fall within the jurisdiction of the Arbitration Tribunal under Art. 89 KVG, but are either of a private law nature or belong to the domain of ordinary administrative law.

Even if the tariff principles of the KVG could be materially…