29 June 2026

In its judgment, the Federal Supreme Court (the Court) dismissed, to the extent it was admissible, the appeal of a Spitex organisation (an organisation providing outpatient nursing care) against a resolution of the Cantonal Government of Glarus (Regierungsrat des Kantons Glarus) of 25 November 2025, confirming that the cantonal residual financing contribution of CHF 8.80 per hour for basic nursing care provided by employed family caregivers complied with federal law. In dispute was whether this contribution, set in art. 31 para. 3a of the Glarus Care and Support Ordinance (Pflege- und Betreuungsverordnung des Kantons Glarus, PBV/GL), was too low to allow cost-covering and economical provision of services and thus incompatible with art. 25a para. 5 of the Health Insurance Act (Bundesgesetz über die Krankenversicherung, KVG).

The appellant was an admitted service provider that had basic nursing care within the meaning of art. 7 para. 2 let. c of the Ordinance on Healthcare Benefits (Krankenpflege-Leistungsverordnung, KLV) carried out by relatives of persons in need of care whom it employed as caregivers. Under the contested provision, the residual financing contribution for such care was set generally at CHF 8.80 per hour (tariff of CHF 61.40 per hour), whereas for other basic nursing care the contribution ranged from CHF 53.20 to CHF 86.26 per hour. The appellant argued that this amount did not permit economical service provision, exceeded the government's discretion, and was incompatible with art. 25a para. 5 KVG.

On the merits, the Court recalled its case law that cantons enjoy wide discretion in regulating residual financing, and may set maximum amounts, tariffs, or flat rates to contain costs, provided these do not prevent coverage of the costs of economical service provision. As the profit-oriented Spitex organisations concerned had not submitted cost and performance accounts despite being requested to do so, the canton was unable to determine a tariff based on actual costs. Instead, it combined three methods: a "bottom-up" calculation based on an appropriate wage for caregivers, a "top-down" calculation skimming off the profits of profit-oriented providers, and an inter-cantonal comparison. The combination produced an average residual financing contribution of CHF 8.80 per hour.

The Court found none of these methods, nor the resulting amount, to be contrary to federal law. It noted in particular that the caregivers concerned had in 2024 been paid gross wages roughly equal to those of qualified health professionals with a federal certificate, which was problematic in view of the recruitment of specialist staff, and that the wide range of residual financing contributions did not, in itself, establish a violation of federal law, since factors such as supply obligations, infrastructure, and flexibility justified cost differences. The contribution also withstood comparison with other cantons, such as Appenzell Innerrhoden (CHF 8.20 per hour) and Valais (CHF 8.05 per hour).

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