Facts
In this case, the issue was the cost-effectiveness of the treatment provided by a physician who had a broader education and could therefore directly provide many services without having to refer patients to specialists or hospitals. The arbitration tribunal had ordered the physician to reimburse costs because her direct medical costs were above average, even though her induced costs were below average. The physician appealed this decision.Considerations
In this judgment, the Federal Court changed its previous case law and decided that, in principle, an overall assessment of all costs (direct medical costs, medication costs, and induced costs) should be decisive in evaluating the cost-effectiveness of medical treatment. This is because the objective of Art. 56 HIA is not to limit the physician's income, but to ensure the overall cost-effectiveness of the treatment.
The Federal Court stated that it would create false incentives if only the direct medical costs were considered. Physicians who save many indirect costs would then be penalized because they have higher…