832.10
CH-TG
CH-TG
§ 56 Krankenversicherungsverordnung (TG KVV) - Referenztarife
Spitalplanung und Spitalfinanzierung - Spitalplanung
§ 56 TG KVV · Referenztarife
1. Die Referenztarife werden für die Akutsomatik, die Psychiatrie und die Rehabilitation einzeln festgelegt.
2. Die Referenztarife orientieren sich an den mit den Patientenströmen gewichteten Tarifen der relevanten kantonalen Listenspitäler. Als relevant gilt ein Spital dann, wenn der kantonale Bedarf mehrheitlich durch dieses Spital erbracht wird. In der Regel sind dies die kantonalen Listenspitäler mit Standort im Kanton.
3. Die Referenztarife werden auf der Homepage des Amtes für Gesundheit publiziert.
Gerichtsentscheide zu dieser Bestimmung (328)
BGE 151 V 284 (Art. 56 Abs. 1 KVG)
Cost-effectiveness review of physicians in compulsory health insurance: tolerance margin in two-stage screening, composition of comparison group by specialist title, handling of practice-specific services, and repayment calculation based on overall versus direct cost index.
Underlying obligation of economical treatment, relevant to the substantive dispute.
BGE 150 V 178 (Art. 56 Abs. 1 KVG)
Billing audit reimbursement based on extrapolating a non-representative random sample of MRI tariff positions violates statistical validity requirements.
Cited in the dispositive as part of the substantive basis for the reimbursement claim.
200 2018 9 · be (Art. 56 Abs. 1 KVG)
Insured vs. Health Insurer: Coverage for Hospitalized Varicose Vein Surgery vs. Economical Outpatient Alternative
Cited regarding the principle that service providers must limit their services to what is necessary.
200 2018 9 · be (Art. 56 Abs. 2 Satz 1 KVG)
Insured vs. Health Insurer: Coverage for Hospitalized Varicose Vein Surgery vs. Economical Outpatient Alternative
Cited regarding the refusal of reimbursement for services exceeding necessary limits.
A/2134/2025 · ge (art. 56 al. 3bis LAMal)
Insurance Payment Claim Settlement and Case Dismissal
The parties agreed to attempt to negotiate an agreement based on this article in the event of obtaining discounts.
A/547/2023 · ge (art. 56 LAMal)
Insurer v. Medical Practitioner: Restitution for Improperly Billed Treatment Codes
Used as the legal basis for the insurer's claim for restitution of unduly paid sums.
A/2137/2020 · ge (art. 56 LAMal)
Insurers' Overbilling Claim Barred by Procedural Defect; Individualized Review Ordered
This provision establishes the principle of economic benefit which was allegedly violated and forms the substantive basis of the dispute.
A/2278/2021 · ge (art. 56 LAMal)
Insurers v. Physician: Failure to Conduct Mandatory Individual Case Review
The court finds that the principle of economy in medical practice, as per this article, was violated because the required individual case review was omitted.
A/2737/2023 · ge (art. 56 al. 1 de la loi fédérale sur l'assurance-maladie du 18 mars 1994 (LAMal - RS 832.10))
Health Insurers v. Medical Practitioner: Premature Overbilling Claim Due to Incomplete Statutory Review
The core issue of the case concerns the application of the principle of economy in medical services under this article, which is directly addressed by the order to conduct a proper analysis.
A/3464/2020 · ge (art. 56 al. 2 LAMal)
Insurer v. Clinic: Restitution Claim Based on Accreditation Status
This provision was central to the applicant's main claim for restitution, although the claim was ultimately rejected based on good faith (Art. 13.11).
730.16.229 · bl (Art. 56 Abs. 2 KVG)
Health Insurers v. Physician: Recovery of Uneconomical Treatment Costs
Cited as the legal basis for the recovery of remuneration that was unduly paid to the service provider.
A/2449/2018 · ge (art. 56 al. 1 LAMal)
Insurance Companies v. Psychiatrist (Statistical Billing Dispute)
Cited as the core legal basis for determining if the provider's practice was contrary to the principle of economy.
A/2449/2018 · ge (art. 56 al. 1 et 2 LAMal)
Insurance Companies v. Psychiatrist (Statistical Billing Dispute)
Cited again when discussing the scope of the reimbursement obligation based on the principle of economy.
A/2449/2018 · ge (art. 56 al. 2 LAMal)
Insurance Companies v. Psychiatrist (Statistical Billing Dispute)
Cited in relation to the reimbursement obligation stemming from non-economic services.
A/2603/2019 · ge (art. 56 al. 1 LAMal)
Health Insurers v. Physician Overbilling and Obstruction
Establishes the principle that healthcare providers must limit their services to what is necessary and in the best interest of insured individuals.