Refusal of the canton of residence to cover the treatment costs in a private hospital

Facts

Mr. [M.], domiciled in the canton of Schwyz, was treated on 5 and 6 February 1996 in the general department of the private clinic X in Zurich. The canton of Schwyz refused to cover the difference in costs between the rates of this private clinic and those of a public or subsidized hospital, based on Article 41 para. 3 of the Federal Health Insurance Act (HIA). Mr. [M.] and clinic X appealed against this decision.

Considerations

The Federal Tribunal ruled that the obligation of the canton of residence to cover the difference in costs under Article 41 para. 3 HIA only exists for treatments carried out in a public or publicly subsidized hospital. This obligation does not exist when the insured person goes to a private, non-public or non-subsidized hospital. The Federal Tribunal considered that…