Inter­pel­la­ti­on Cas­sis (11.3622): Data and pri­va­cy pro­tec­tion in the Swiss DRG flat rate per case system
Done (30.09.2011)

Sub­mit­ted text

In con­nec­tion with the intro­duc­tion of the Swiss DRG flat rate per case system as of Janu­ary 1, 2012, the Fede­ral Data Pro­tec­tion and Infor­ma­ti­on Com­mis­sio­ner (Edöb) empha­si­zed at a media ori­en­ta­ti­on on May 31, 2011, that “the syste­ma­tic trans­mis­si­on of dia­gno­ses and the pro­ce­du­res per­for­med in non-pseud­ony­mi­zed form, as pro­vi­ded for in the Swiss DRG rate struc­tu­re agree­ment, can hard­ly be recon­ci­led with the prin­ci­ple of pro­por­tio­na­li­ty.” The health insu­r­ers, on the other hand, syste­ma­ti­cal­ly demand all medi­cal data with the invoi­cing. The new legal opi­ni­on published on May 31, 2011, on behalf of the H plus hos­pi­tal asso­cia­ti­on and the Asso­cia­ti­on of Swiss Phy­si­ci­ans (FMH) con­clu­ded: “The syste­ma­tic deli­very of all medi­cal data sets with the hos­pi­tal invoice, as deman­ded by the health insu­r­ers, vio­la­tes medi­cal sec­re­cy, inf­rin­ges data and per­so­na­li­ty pro­tec­tion and the prin­ci­ple of pro­por­tio­na­li­ty.” The asso­cia­ti­on of can­to­nal data pro­tec­tion offi­cers Pri­va­tim deman­ded in a media release on Febru­ary 25, 2011: “No dis­clo­sure of medi­cal data in advance”.

I would ask the Fede­ral Coun­cil to ans­wer the fol­lo­wing questions:

1. is it wil­ling to con­sist­ent­ly enforce data and pri­va­cy pro­tec­tion as well as the pre­ser­va­ti­on of phy­si­ci­an and pati­ent con­fi­den­tia­li­ty in the con­text of the intro­duc­tion of Swiss DRG, if neces­sa­ry with a cor­re­spon­ding strict ordinance?

2. will it ensu­re that the FDHA, as part of its over­sight of health insu­r­ers, ensu­res that health insu­r­ers do not request, recei­ve, and retain more data than is strict­ly necessary?

3. will it sup­port the prin­ci­ples of the Edöb regar­ding data deli­very and the cla­ri­fi­ed ide­as on pro­por­tio­na­li­ty and imple­ment the­se requirements?

4. does it see a need for action in the legal foun­da­ti­ons in the KVG and UVG are­as to streng­then data and per­so­na­li­ty pro­tec­tion and to pro­tect medi­cal secrecy?

5. is it pre­pared to coor­di­na­te Edöb’s efforts with the recom­men­da­ti­ons of the can­to­nal data pro­tec­tion com­mis­sio­ners and their asso­cia­ti­on Pri­va­tim, which are aimed in the same direction? 

State­ment of the Fede­ral Council

1 The Fede­ral Coun­cil atta­ches gre­at importance to the pro­tec­tion of insu­red per­sons’ data. As part of the ordi­nan­ce amend­ments on hos­pi­tal finan­cing, the Fede­ral Coun­cil has the­r­e­fo­re alre­a­dy sup­ple­men­ted Artic­le 59 of the Health Insu­rance Ordi­nan­ce (KVV) and sti­pu­la­ted that, on the one hand, the­re must be a clear sepa­ra­ti­on bet­ween the invoice for man­da­to­ry health care insu­rance and that for sup­ple­men­ta­ry insu­rance, i.e. sepa­ra­te invoices must be issued, and that, on the other hand, the dia­gno­sis-rela­ted data must be kept in pseud­ony­mi­zed form and the pseud­ony­mizati­on can only be can­cel­led by the insurer’s medi­cal exami­ner. Sin­ce the agree­ment of July 5, 2011 bet­ween H plus, “Die Spi­tä­ler der Schweiz”, and San­té­su­i­s­se, which should also have regu­la­ted data trans­mis­si­on, did not mate­ria­li­ze, the Fede­ral Coun­cil will exami­ne the ancho­ring of the neces­sa­ry prin­ci­ples by ordinance.

2 With regard to the trans­mis­si­on of data in the con­text of invoi­cing, the Fede­ral Admi­ni­stra­ti­ve Court, in a land­mark ruling of 29 May 2009 (C‑6570/2007) on the inter­pre­ta­ti­on of Artic­les 42 KVG and 59 KVV, sta­ted that the appli­ca­ble pro­vi­si­ons allow for a regu­la­ti­on by coll­ec­ti­ve agree­ment regar­ding the syste­ma­tic trans­mis­si­on of cer­tain medi­cal infor­ma­ti­on, wher­eby the prin­ci­ple of pro­por­tio­na­li­ty must of cour­se be obser­ved. The com­pe­tent Fede­ral Office of Public Health will, within the scope of its com­pe­ten­ces in the super­vi­si­on of health insu­r­ers, ensu­re that the insu­r­ers pro­cess and store the data trans­mit­ted to them in accordance with the law.

3. the frame­work con­di­ti­ons for data trans­mis­si­on in con­nec­tion with invoi­cing are known from the point of view of the Fede­ral Coun­cil – in par­ti­cu­lar in view of the afo­re­men­tio­ned judgment. The Fede­ral Coun­cil will make the neces­sa­ry decis­i­ons within the scope of its com­pe­ten­ces, taking data pro­tec­tion into account. The Fede­ral Data Pro­tec­tion and Infor­ma­ti­on Com­mis­sio­ner is regu­lar­ly invol­ved in such procedures.

4/5 Data and per­so­na­li­ty pro­tec­tion is regu­la­ted in the Fede­ral Data Pro­tec­tion Act (FADP) and also applies in prin­ci­ple to social insu­rance. The Fede­ral Coun­cil the­r­e­fo­re sees no rea­son to pro­po­se addi­tio­nal sta­tu­to­ry regu­la­ti­ons in the KVG or UVG area.