Hospital List

What is the Hospital List?

The Hospital List is a cantonal decree that determines which hospitals may provide inpatient treatment for the population of that canton at the expense of basic health insurance. A hospital on this list is called a listed hospital. The list is structured by service mandates: a hospital may, for example, have a mandate for general surgery and obstetrics but none for cardiac surgery. For services without a mandate, it is not a listed hospital.

The Hospital List is the result of cantonal hospital planning. Each canton determines the needs of its population and decides which hospitals inside and outside the canton meet those needs. Private hospitals are included in the planning. For highly specialised medicine, the cantons plan jointly for the whole of Switzerland. Besides hospitals, there are also lists for birth centres and nursing homes.

The term clearly belongs to basic health insurance under the Federal Health Insurance Act (KVG). The Hospital List matters for supplementary insurance because supplementary hospital insurance can cover differences that basic health insurance does not pay, for example for treatment outside your canton or in a hospital without a place on the list. Which differences these are is set out in the contract conditions.

The listed hospital should not be confused with the contract hospital. A contract hospital is not on any Hospital List, but it meets the quality requirements and has a contract with health insurers. There, the canton pays nothing and basic health insurance at most its own share.

How it works

If you are treated as an inpatient in a listed hospital, your canton of residence and your health insurer share the remuneration. The hospital bills using flat-rate payments per case under SwissDRG. The canton’s share is at least 55%; each canton sets it no later than 9 months before the start of the year. The health insurer pays the rest. The insurer charges you the deductible and retention fee, and as an adult you pay a hospital contribution of CHF 15 per day, except in the cases provided for by law, such as for children, young adults in education or women during maternity.

The free choice of hospital allows you to choose among the listed hospitals of your canton of residence and those of the canton where the hospital is located, which in practice means throughout Switzerland. For planned treatment in another canton, however, the insurer and your canton of residence pay at most the tariff that applies to this treatment in a listed hospital in your canton of residence. If the chosen hospital is more expensive, a difference remains.

Things are different for medical reasons. A medical reason exists in an emergency or if the necessary service is not offered in any listed hospital in your canton of residence. The insurer and your canton of residence then cover the full remuneration in their respective shares, even in a hospital that is not on your canton’s list. Except in an emergency, this requires approval from your canton of residence.

Legal basis

Art. 39 para. 1 KVG sets out the conditions under which a hospital is authorised. They include adequate medical care, specialist staff and facilities (let. a–c), consistency with cantonal planning for needs-based provision, in which private providers must be included (let. d), and inclusion on the canton’s Hospital List, structured by service mandates in categories (let. e). Under Art. 39 para. 2 and 2bis KVG, the cantons coordinate their planning and plan highly specialised medicine jointly. Art. 39 para. 3 KVG applies the rules accordingly to birth centres and nursing homes.

Free choice is set out in Art. 41 para. 1bis KVG: you can choose among the hospitals on the Hospital List of your canton of residence or of the canton where the hospital is located, and the insurer and your canton of residence pay at most the tariff of a listed hospital in your canton of residence. Art. 41 para. 3 and 3bis KVG govern medical reasons. Art. 49a KVG divides the remuneration between the canton and the insurer; the canton’s share is at least 55% (para. 2ter). Art. 49a para. 4 KVG allows contracts with hospitals without a place on the list. The planning criteria are set out in Art. 58a–58e KVV and the hospital contribution in Art. 104 KVV.

Example: elective treatment in another canton

Thomas is 58, lives in the canton of Zurich and has basic health insurance only. For a planned operation he chooses a listed hospital in the canton of Bern. The amounts are assumptions to show the mechanism; the canton’s share is calculated at the statutory minimum of 55%.

What this means for you

Before a planned operation, it is worth asking: is the hospital on the Hospital List for exactly this service, and specifically on the list of your canton of residence or of the canton where it is located? The hospital can tell you. If it is in another canton, ask your insurer beforehand whether a difference will remain, and clarify whether your supplementary insurance covers it. You can find the contact details in the health insurer profiles.

If you need a hospital outside your canton for medical reasons, apply for approval from your canton of residence before you are admitted. In an emergency, this obligation does not apply. More on treatment outside your canton of residence under out-of-canton treatment.

If you want to switch your basic health insurance, this does not change your choice of hospital: the rules are the same at all insurers. The differences lie in the premium and the insurance model, which you can compare in the premium calculator. If you have chosen a model with a restricted choice, such as a GP model, you must follow your insurer’s referral rules.

Common mistakes

• Believing every hospital is a listed hospital. Hospitals only have mandates for certain services. For other treatment, they are not on the list.
• Overlooking the tariff difference outside your canton. For elective treatment, the insurer and the canton pay at most the tariff of your canton of residence.
• Confusing a listed hospital with a contract hospital. In a contract hospital, the canton’s share is missing; without supplementary insurance, this can become expensive.
• Forgetting the approval. For treatment outside your canton for medical reasons, you need prior approval from your canton of residence, except in an emergency.

We explain how we handle legal bases and examples under How we calculate.