Financial Participation of the Canton in the Hospitalization Costs in the Private Ward of a Public Hospital

Facts

S. was hospitalized at the Cantonal Hospital of Geneva from January 5 to 14, 1998, in the private ward. Her health insurer Assura covered the bill of CHF 10,695.70 and requested the Department of Social Action and Health of the Canton of Geneva (DASS) to financially participate in the hospitalization costs, in accordance with the case law of the Federal Insurance Court. The DASS rejected this request, which led Assura to file an appeal with the Administrative Court of the Canton of Geneva, which upheld the appeal and ordered the DASS to financially participate in S.'s hospitalization costs in the private ward. The DASS then appealed against this judgment to the Federal Insurance Court.

Considerations

The Federal Insurance Court considered that Art. 49 para. 1 HIA applies even when an insured person is hospitalized in the private ward of a public or publicly subsidized hospital. According to this provision, the flat rates cover a maximum of 50% of the chargeable costs in the general ward of these hospitals, with the canton having to bear the other part of the costs. This interpretation stems from the concept of "general ward" developed in the case law, which applies functionally and not based on the physical location within the…