Federal Administrative Court, Decision C-6306/2019 from 15 December 2021

24. Januar 2022 – Presently, the Court had to assess whether the Department of Public Health of the Canton of Zug (DPHZ) did rightfully reject appellant’s request for an authorisation to practise medicine at the expense of the compulsory health insurance (CHI). The Court established that the Swiss legislator had included the possibility to restrict the number of such authorisations according to existing needs. According to the Ordinance on the restriction of the authorisation of service providers to operate at the expense of the compulsory health care insurance, doctors may (only) be admitted to practice at the expense of the CHI if the maximum number in the corresponding canton and in the corresponding speciality pursuant to Annex 1 of the Ordinance is not reached. In the present case, the Court had to examine whether the appellant had fulfilled the requirements for an exemption. It was disputed whether the appellant had been practicing medicine at the expense of the CHI before art. 55a of the Federal Health Insurance Act (HIA) came into force respectively the temporary reintroduction of the need-based authorisation in 2018. In the affirmative, the appellant would benefit from the exemption and be allowed to practice medicine at the expense of the CHI. However, the Court held that the fact that the appellant was admitted to practice at the expense of the CHI in other Cantons did not mean that prima facie the requirement was met. On the contrary, the effects of such a cantonal authorisation were exclusively limited to each respective Canton. Since the appellant has not been authorised to practice at the expense of the CHI in the Canton of Zug before the entry into force of art. 55a HIA, the requirements for an exemption were not met in the case at hand. Moreover, the appellant failed to prove that there was a deficiency of practitioners in the Canton of Zug.

Therefore, the Court dismissed the appeal.

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