As Art. 49 KVG prohibits the assumption of costs for public services (including research), health insurances increasingly refuse to cover costs of cancer treatment once such treatment takes place in the context of a study. This may affect study-specific costs or even non-study-specific (all) costs.

To clarify this issue, SAKK mandated Prof. Pascal Coullery (BFH) to provide his legal opinion on the interpretation of the concept of research under Article 49 (3) KVG or Article 7 (2) VKL: Does in-patient treatment, by being provided within the framework of a clinical study, lose its compulsory character as a whole, that is to say also with regard to individual elements of the treatment complex whose compulsory character is undisputed?

The expert opinion concluded, that a compulsory benefit retains its compulsory benefit character even in the context of a clinical study conducted in a hospital inpatient environment. An insurer's refusal to remunerate such a compulsory benefit because it is provided in a research context thus violates the Health Insurance Act and is therefore contrary to federal law. Any other conclusion would then also be incompatible with the equality of rights enshrined in Article 8 of the Federal Constitution.

The article from November 11, 2019 in Jusletter can be found here.