First court ruling on the new right of appeal by associations in relation to hospital lists

Since 1 January 2024, the Federal Health Insurance Act grants health insurance associations the right to appeal against cantonal decisions concerning hospital lists. prio.swiss, an association that emerged from the associations curafutura and santésuisse, lodged an appeal with the Federal Administrative Court (FAC)
against the entire hospital list regarding the field of acute somatic care 2025 of the Canton of Schwyz.

Inadmissible appeal
In a landmark judgment, the FAC establishes that its case law since landmark judgment DFAC 2012/9 also applies to the new provisions in Article 53(1bis) of the Health Insurance Act. Accordingly, a hospital list qualifies primarily as a bundle of individual performance mandates. A canton thereby awards performance mandates to hospitals, birth centers and nursing homes for various medical services for its insured persons. These are grouped together in a hospital list. The law does not provide a hospital list as such to be challenged, but only the individual performance mandates. This principle also applies to appeals lodged by health insurance associations.

In the case at hand, the association prio.swiss challenged the hospital list regarding acute somatic care 2025 of the Canton of Schwyz as a whole and not merely individual performance mandates. The appeal is found to be inadmissible, and the FAC declines to consider it.

This judgment is final and may not be appealed to the Federal Supreme Court.