In the event of inpatient hospital treatment, the insured person has in principle the free choice of hospital. The canton and the health insurer bear the cost of hospital treatment. The insured contributes to the costs of the treatment.
Choice of hospital
To cover the inpatient hospital treatment needs of their resident population, the cantons are required to carry out hospital planning. On this basis, they establish a list of hospitals which contains the necessary institutions (listed hospitals) to ensure the planned supply. A canton may include on its list both hospitals located on its territory and hospitals from other cantons.
Hospitals not listed in the list of hospitals of a canton, but which have concluded an agreement with the health insurer on the remuneration of the services provided under the compulsory health insurance (conventioned hospitals).
The FOPH publishes information on hospitals to help patients choose their hospital. This information mainly takes the form of quality indicators and key figures .
The insured participates in the costs of the services from which he receives. In the case of inpatient hospital treatment, the co-payment includes the deductible chosen by the insured person, the copayment and a contribution per day to hospital accommodation costs. The insured receives the corresponding statement from the health insurer.
Remuneration for inpatient hospital treatment (including stay and care) is paid for by the health insurer and the canton of residence of the insured person according to a fixed financing key. The part of the canton of residence in the remuneration amounts to at least 55%; the share of the health insurer amounts to a maximum of 45%. The hospital generally issues two invoices for the inpatient services provided: an invoice addressed to the canton (at least 55% of the total amount) and an invoice addressed to the health insurer (maximum 45% of the total amount). The insured person receives a copy of the invoice addressed to the health insurer and paid by the latter (third-party payment system).
Depending on the situation (choice of hospital and treatment followed), the insured or his complementary insurance may have to cover additional costs.
The following situations do not incur any additional costs:
For medical reasons, the insured person is treated in a hospital that is not on the list of his canton of residence because no hospital listed in his canton of residence can provide the necessary services. The canton of residence must nevertheless provide a guarantee of cost coverage beforehand;
The insured must expect additional costs if he chooses a listed hospital or a contracted hospital which is not on the list of hospitals in his canton of residence when none of the medical reasons mentioned above justifies it. (emergency cases and cases where no hospital listed in the canton of residence can provide the necessary services).
In the event of inpatient treatment in a listed hospital not appearing on the list of the canton of residence, the health insurer and the canton of residence bear their respective share of the remuneration up to the amount of the tariff applicable for this treatment in a listed hospital in the canton of residence. If the tariff applied by the listed hospital not appearing on the list of the canton of residence is higher than the tariff of a listed hospital of the canton of residence (refer to the reference tariffs for hospitalizations outside the canton ), the difference is the responsibility of the insured or his complementary insurance.
In the case of approved hospitals, the share of the canton falls, and the health insurer remunerates a maximum of 45% of the hospital treatment. The rest of the remuneration is the responsibility of the insured or his complementary insurance