Hospital Act (SpiG) - Purpose (SPIG)

1. This law governs the provision of high-quality, appropriate, and economically sustainable medical care for the residents of the canton in hospitals and birthing centers both within and outside the canton.

2. The canton pursues this purpose by

a) issuing service mandates to hospitals and birthing centers within and outside the canton based on the hospital planning;

b) operating a cantonal hospital with multiple locations alone or with other carriers.

1. This law applies to all hospitals and maternity homes that are listed on the hospital list of the Canton of Solothurn (hospital list).

2. Subject to legally binding decisions based on the Intercantonal Agreement on Highly Specialized Medicine (IVHSM) of March 14, 2008.

1. The department prepares a hospital plan based on the principles of § 1 to serve as a foundation for hospital care, which is documented in an appropriate report. It also considers the service offerings in other cantons.

1bis. The government council approves the hospital planning report.

2. Based on the hospital planning, the government council issues the hospital list, divided according to groups of services, for the areas of acute care, psychiatry, and rehabilitation for hospitals within and outside the canton, that are authorized under the Federal Law on Health Insurance (KVG) of March 18, 1994.

3. The hospital list is published.

4. The government council periodically reviews the hospital planning and the hospital list and makes necessary adjustments after consulting with the affected parties, as needed.

1. The basis for the inclusion of hospitals and birth centers on the hospital list is the quantitative need according to the healthcare planning.

1bis The inclusion of a hospital or a birth center requires the fulfillment of the criteria according to Article 39 paragraph 2ter KVG, particularly concerning quality and cost-effectiveness.

2. The government council regulates the prerequisites for the inclusion of a hospital or a birth center on the hospital list as well as the further details of hospital planning in an ordinance. In doing so, it particularly takes into account

a) the cost-effectiveness of service provision, considering, among other things, the efficiency of service delivery, the utilization of synergies, the promotion of outpatient care, and the concentration of services;

abis) the quality of service provision, ensuring, among other things, the necessary quality, minimum case numbers, and low case numbers are considered;

ater) an adequate coverage of medical care and the service relevance of hospitals and birth centers;

b) patient accessibility to treatment within a reasonable period;

c) the readiness and ability to fulfill the service mandate;

d) an appropriate participation in emergency services;

e) the willingness to admit patients in accordance with § 5;

f) ...

g) compliance with specific requirements for accounting and financial control;

h) the willingness of hospitals without binding collective labor agreements to comply at least with the working conditions as per the cantonal collective labor agreement (GAV) of October 25, 2004.

3. The government council assigns a service mandate to each facility listed on the hospital list. The service mandate may be limited in time and subject to conditions.

3bis A facility listed on the hospital list must promptly inform the department of any changes in the relevant conditions.

4. The service mandate may be limited, not renewed, or partially or entirely withdrawn,

a) if the services are not provided according to the service mandate;

b) if the prerequisites for inclusion on the hospital list are no longer fulfilled or are only partially fulfilled;

c) if the conditions of the service mandate are not met.

1. The canton ensures the provision of emergency medical rescue services.

2. The government council or the cantonal hospital designated by it may conclude service agreements with rescue organizations. § 3ter applies mutatis mutandis.

3. The canton operates an alarm center. The government council may appoint a third party to operate the alarm center.

4. The coordination of the rescue service is conducted via the operations control center of the alarm center.

1. Hospitals listed on the hospital list with an intra-cantonal location are obligated to appropriately participate in the training and further education of non-university healthcare professions. The government council may decide that the execution of the training and further education obligation may be fully or partially suspended for the years 2024 and 2025, or that deviations from the legal requirements concerning the training and further education obligation are allowed in certain areas.

2. The scope of the training and further education obligation is determined, in particular, considering the size and the service offerings of the institution, as well as in relation to the demand.

2a. Those providing services in the area of training and further education for non-university healthcare professions must develop a training concept. This concept

a) specifically outlines the framework within which training and further education occur, the objectives and focus areas of the training and further education, as well as the number of available training and further education places;

b) indicates any deviations from the scope of the training and further education obligation as established in paragraph 2.

3. Where possible, appropriate training and further education places should be offered to individuals with health impairments. In this regard, hospitals aim to closely collaborate with the competent disability insurance offices.

4. The government council regulates the details in a regulation and may declare guidelines from professional organizations or industry associations as binding.

1. The Promotion of Education Relating to the Nursing Curriculum at a Higher Technical School (HF) and the Bachelor's Degree Program in Nursing at a University of Applied Sciences (FH) is governed by the Introductory Act to the Federal Act on the Promotion of Education in the Field of Nursing (EG Education Promotion Act Nursing) dated May 15, 2024.

**1. The Government Council may delegate the execution and the associated decision-making authority for determining and reviewing the training and continuing education obligations, as well as for determining compensation payments, to professional organizations or industry associations. It enters into a performance agreement with them, which governs the obligations and reporting.**

**2. Appeals against decisions made by professional organizations or industry associations pursuant to paragraph 1 can be lodged with the Department within 10 days.**

**3. If a hospital does not fulfill the established training and continuing education performance, it must make a compensation payment to the dedicated compensation fund for the bonus-malus balance, managed by the Department or by the entity entrusted with the execution of the training and continuing education obligations pursuant to paragraph 1.**

**4. The amount of the compensation payment shall not exceed 300 percent of the average costs of the unmet training or continuing education. The Government Council may stipulate in a regulation that the obligation to make a compensation payment lapses if the difference between the established and provided training and continuing education performance does not exceed a tolerance value of 10 percent.**

**5. If a hospital exceeds the established training and continuing education performance, it receives a contribution from the compensation fund.**

**6. Surpluses in the compensation fund can be used to finance measures and projects in favor of non-university health professions in the canton of Solothurn.**

1. The department may conclude performance agreements with the hospitals and maternity homes listed on the hospital list.

2. The performance agreements specify the conditions and requirements of the service mandate according to § 3bis paragraphs 2 and 3.

3. ...

1. As part of their service mandates and capacities, hospitals and maternity homes are obliged to ensure readiness for admission for all insured persons residing in the Canton of Solothurn (obligation to admit).

2. ...

3. Every person must be admitted in the event of an emergency.

1. The department shall decide on applications for guarantees and contributions in accordance with Article 41 paragraph 3 of the KVG in favor of insured persons who, for medical reasons, must be hospitalized in a hospital or maternity home not listed on the hospital list.

2. ...

1. The Government Council establishes the cantonal share applicable to all residents of the canton in accordance with Article 49a of the Health Insurance Act (KVG).

2. The Government Council determines the listed hospitals for which the tariffs are decisive for proportional compensation by the canton when insured persons are hospitalized in a hospital not listed on the hospital list of the canton of location for non-medical reasons (reference tariffs).

1. The department may establish a catalog of examinations and treatments for which outpatient care is generally more effective, appropriate, or economical than inpatient care.

2. If a catalog has been established pursuant to paragraph 1, the canton’s contribution pursuant to § 5quater paragraph 1 will only be provided if inpatient care is necessary for special reasons. Special reasons include, in particular

a) The presence of a particularly severe illness or a severe accompanying illness;

b) A demonstrated need for special treatment or care;

c) The presence of special social circumstances.

3. The hospital documents the special reasons and provides the documentation to the department. The department may exempt hospitals from the documentation obligation for certain examinations and treatments or impose restrictions on this obligation.

4. The department may at any time conduct a comprehensive review of the patient documentation.

1. The department may process all patient-related and operational data necessary for

a) hospital planning, including the creation of the hospital list, awarding of service mandates, and conclusion of service agreements;

b) verifying compliance with the legal requirements for the issuance of the service mandate and the conditions and obligations associated with the service agreement;

c) reviewing quality and performance costs within the scope of comparisons;

d) invoice control in connection with reference and location tariffs;

e) examining the canton’s share according to Art. 49a paragraph 1 KVG;

f) exercising the canton’s right of recourse according to Article 79a KVG.

2. Patient-related data, in particular, such as name, age, gender, place of residence, AHV number, as well as the type and scope of medical services received, must be anonymized by the hospitals beforehand, unless they are used by the department for invoice control, examination of the canton’s share, or coding review.

3. Operational data, particularly information about additional fees, staff numbers, and case-related cost accounting, may be processed without anonymization.

4. Hospitals and birthing centers are required to provide the relevant data to the department free of charge within a specified, reasonable period.

5. The department may publish operational data of hospitals and birthing centers in non-anonymized form, provided they are of public interest, while maintaining trade secrets. Patient-related data may only be published in anonymized form. No conclusions about natural persons must be possible.

1. The canton obtains the funds necessary to finance its contributions to hospitals from general tax revenues, particularly from the proceeds of the state tax.

1. The cantonal hospital independently fulfills the tasks assigned to it.

2. The canton transfers the necessary competencies and resources to the hospital for this purpose. It finances the hospital based on performance.

3. The cantonal hospital assumes responsibility for the outcomes of the tasks assigned to it. It operates its business considering the principles of economic efficiency, coordination of service offerings, transparency, and comparability with other service providers, as well as quality assurance.

1. The canton operates the cantonal hospital in the form of a joint-stock company pursuant to Article 620 paragraph 3 of the Swiss Code of Obligations, with a charitable purpose in the sense of federal tax legislation (charitable joint-stock company).

2. The government council regulates the remuneration of the members of the board of directors.

1. The Olten Cantonal Hospital, the Solothurn Citizens' Hospital, the Grenchen Hospital, the Dornach Hospital, the Solothurn Heights Clinic Allerheiligenberg, and the psychiatric services of the Canton of Solothurn are incorporated into a nonprofit joint-stock company under the name "Solothurn Hospitals."

2. ...

2bis. The Cantonal Council makes the final decision regarding the transfer of ownership of the real estate to the joint-stock company.

2ter. ...

3. The Canton is the sole shareholder at the time of the joint-stock company's establishment.

4. The execution of the conversion lies with the Cantonal Government. It resolves the founding statutes of the joint-stock company. These must be approved by the Cantonal Council before the establishment of the company.

5. The Cantonal Government appoints the members and the president or chairperson of the first board of directors as well as the first statutory auditing body after the establishment.

1. The canton must hold at least 67 percent of the share capital and the voting rights of the corporation.

2. The government council exercises all shareholder rights accruing to the canton. It informs the cantonal council about the statutory annual financial statements and the annual report. It informs the cantonal council about the sale of shares.

1. The performance agreement between the joint-stock company and the canton is a contract under public law.

2. For the remuneration of services not covered by social insurance, public law applies. The tariff provisions of Solothurner Spitäler AG apply to these services.

3. The legal relationships with the personnel are governed by the State Personnel Act. The associations of hospital personnel may conclude a collective labor agreement with the joint-stock company based on the State Personnel Act or the Code of Obligations.

1. The Liability of the Corporation and Its Personnel is governed by the Act on the Liability of the State, Municipalities, Public-Law Entities and Institutions, and the Responsibility of Authorities, Officials, and Public Employees and Workers (Liability Act) of June 26, 1966.

1. In proceedings before the State Chancellery and the Administrative Court, procedural and court costs may be imposed and party compensations awarded, for which § 76bis and § 77 sentence 1 of the law on legal protection in administrative matters (Administrative Procedure Act) of November 15, 1970 are applicable mutatis mutandis, and the fee schedule (GT) of March 8, 2016 is decisive. As a rule, no party compensation is awarded to the corporation.

2. Otherwise, the procedure is governed by the Administrative Procedure Act of November 15, 1970. This also applies to access to official documents in pending and concluded liability proceedings.

1. The claim for damages from medical state liability must be submitted to the corporation in writing and with justification. The corporation may conduct settlement negotiations. If no agreement is reached within 3 months of submitting the claim for damages, the claim may be submitted to the State Chancellery in writing and with justification.

2. The State Chancellery shall issue a decision on the claim for damages. An appeal against this decision can be filed with the Administrative Court within 10 days.

3. In processing the claim for damages, the State Chancellery is independent and solely committed to the law.

1. The corporation shall assume the employment relationships existing at the time of its establishment at the hospitals mentioned in § 16 paragraph 1.

2. No later than three years after the law comes into force, the governing council shall regulate, upon the request of the corporation, the occupational pension plans for all personnel. Before doing so, it shall consult with the representatives of the employee associations and the previous insurance carriers.

1. If existing public hospitals cannot be provisionally converted into a corporation as per § 16 upon the law's enactment because the competent bodies have not yet made the corresponding decisions or these decisions are not yet legally binding, the Cantonal Council shall decide to what extent these hospitals will receive contributions from the canton until they are converted into a corporation. The decision of the Cantonal Council is not subject to a referendum.

1. If existing public hospitals cannot definitively be converted into a public limited company because the relevant authorities have rejected the conversion or because a decision on the conversion has been annulled by the competent authorities or courts, the entitlement to contributions pursuant to § 21 lapses once the relevant decision becomes legally binding.

2. If the real estate of public hospitals, which cannot be converted into a public limited company, does not fall under the ownership of the canton, the owners owe the canton the residual value of investments financed by the canton at the time the entitlement to contributions under this law lapses. A statutory mortgage right pursuant to Article 836 of the Civil Code exists in the amount of this debt. The government council shall determine the details of the valuation.

1. The new law applies to all proceedings for medical state liability pending at the State Chancellery at the time of the entry into force of §§ 19bis-19quater, with the exception of the preliminary proceedings pursuant to § 19ter paragraph 1. If the forfeiture under the previous law has already occurred, it shall remain applicable.

1. Sections 3quinquies paragraph 1 sentences 2 and 3septies shall apply until the expiration of the EC Training Assistance Act for Nursing.

1. Hospital Proposition IV from May 26, 1963, and Hospital Proposition VI from June 23, 1974, are repealed.

2. The commitment credits approved under the previous law and charged to the Hospital Construction Special Financing Fund, as well as the corresponding resolutions, remain valid. The expenditure shall be charged to the general state account upon the law's entry into force.

3. The existing balance of the Hospital Construction Special Financing Fund at the time the law comes into force shall be credited to the general state account with effect on the result, while a negative fund balance shall be charged against the state account.

1. The amendments have been incorporated into the respective decrees.

1. This law shall come into force on January 1, 2006.

2. The government council shall elect the bodies of the corporation even before the law comes into force and shall consult them in its decisions regarding the establishment of the corporation.

3. The necessary funds shall be included in the 2005 budget at the expense of the hospital construction fund.