Healthcare Act - Purpose and Subject Matter

1. This law aims to protect, promote, and restore health, as well as to ensure medical and nursing care for the population while respecting the personal rights of all individuals.

2. It regulates health-related activities of natural and legal persons under private and public law.

2bis. It establishes the principles for the planning and ensuring of the population's care by hospitals and similar health institutions.

3. Unless special provisions exist, it applies to the entire health sector of the canton and the municipalities.

1. Each individual is responsible for their own health to the extent of their abilities and possibilities. Public health services support self-responsibility.

1. The canton and municipalities together create the conditions for adequate and cost-conscious medical and nursing care for the population.

2. In fulfilling their tasks, they take into account the health of the population and support the creation of living conditions that are conducive to health.

3. ...

1. The Canton

a) Ensures outpatient and inpatient healthcare services, including emergency services, unless municipalities are responsible;

abis) * finances, in particular, inpatient medical care as well as acute and transitional care;

ater) * may financially contribute to the costs of outpatient emergency services;

b) is responsible for health promotion and prevention;

c) promotes cooperation between public and private institutions within the canton and the region and coordinates activities in the field of healthcare;

d) regulates the rights of patients;

e) supervises healthcare professionals;

f) establishes the rights and duties of healthcare professionals;

g) oversees healthcare institutions;

h) * ...

hbis) * plans and regulates, according to federal guidelines, the services of hospitals and similar institutions providing inpatient medical and nursing care.

i) * promotes education, training, and further education in the area of extramural healthcare and supports cantonal umbrella organizations. The details are regulated by ordinance;

j) supervises the pharmaceutical sector;

k) performs public health police duties;

l) coordinates and supervises the school medical and school dental services.

2. It may issue directives to ensure the provision of services and set quality standards within the scope of its duties; in doing so, it collaborates with professional associations.

3. It generally finances and supports only activities and institutions that align with the goals of healthcare planning.

1. The municipalities fulfill the tasks assigned to them by legislation in the field of healthcare, in particular

a) Ensuring the provision of nursing homes and retirement homes;

b) Ensuring the provision of outpatient medical and healthcare services;

c) Monitoring general hygiene;

d) Organization and execution of school medical and dental services;

e) Funeral services.

2. They independently choose the organization for fulfilling their tasks in the healthcare sector.

3. They can solve the tasks themselves, merge, create joint bodies, or assign tasks to third parties.

4. The municipalities regulate the financing of nursing homes, outpatient medical and healthcare services, and funeral services within the framework of the guidelines of superior law.

1. The Cantonal Council

a) approves the health report;

b)-c) * ...

d) * acknowledges the hospital planning and nursing home planning;

e) * authorizes in the budget or through special resolutions, subject to the financial powers of the eligible voters, credits for the services, operations, or investments of hospitals and similar healthcare institutions that provide hospital and nursing services;

f) * takes note of the reports from hospitals and similar healthcare institutions in the accountability report, as far as they provide agreed services;

g) * has overall supervision of healthcare provision, health promotion, and prevention.

1. The Governing Council

a) Exercises supervision over the healthcare system;

b) Issues regulations and concludes agreements within its constitutional competencies;

c) Decides on healthcare planning and healthcare reporting;

cbis) Determines the planning of hospitals and nursing homes, as well as the hospital list and nursing home list;

d) Issues service mandates to hospitals and similar healthcare institutions and regulates their financing;

e) Elects the Health Council and the Ethics Council;

f) ...

g) Appoints official physicians;

h) May issue organizational and quality regulations or declare relevant association guidelines binding within the duties of the canton;

i) Sets the cantonal share for compensating inpatient services and services in acute and transitional care applicable to the canton residents in accordance with the Federal Health Insurance Act;

j) Determines the requirements for the financing of outpatient medical and healthcare services.

1. The Department of Health and Social Affairs enforces the law.

2. In the field of healthcare, it fulfills all tasks that are not explicitly assigned to another body, in particular

a) the enforcement of international agreements, federal law, and inter-cantonal agreements;

b) the preparation of healthcare planning for the government council and cantonal council;

c) the coordination of all activities in the field of healthcare;

d) the supervision of hospitals and similar institutions;

e) the oversight and advisory in the areas of nursing homes, elderly care facilities, and outpatient medical and healthcare services;

ebis) the supervision of healthcare professionals and other health service institutions;

f) the designation of practices and hospitals authorized to perform abortions under the Swiss Criminal Code.

3. In the area of inpatient care by hospitals and similar health service institutions, the department is additionally responsible for

a) preparing the hospital and nursing home planning as well as the hospital and nursing home list according to the Federal Health Insurance Act for the government council;

b) issuing service contracts to hospitals and similar health service institutions to the extent that the government council assigns this task to the department;

c) regularly reviewing how hospitals and similar institutions provide the agreed services and reporting to the government council;

d) checking the safety and effectiveness of inpatient medical care and nursing;

e) monitoring compliance with the regulations regarding controlling by service providers;

f) determining the applicable reference tariff for out-of-canton treatments pursuant to Article 41, paragraph 1bis of the Federal Health Insurance Act.

4. Through service agreements, the Department of Health and Social Affairs may delegate enforcement tasks to public or private service providers. Further details are regulated by ordinance.

1. The Health Council advises the Department of Health and Social Affairs on matters related to healthcare and provides opinions on health policy issues.

2. It must be consulted on significant projects of the Department of Health and Social Affairs. These include, in particular, draft laws and regulations, health planning, and the health report, as well as measures for health promotion and prevention.

3. The Health Council consists of a maximum of eleven members. The various sectors of healthcare should be represented within it in a balanced manner. The chair is held by the head of the department.

4. The Health Council may involve additional experts.

1. The Ethics Council addresses the matters assigned to it by this law and the regulations enacted based on it. It may also independently address ethical issues within the healthcare sector and provide opinions to the Government Council.

2. In particular

a) * it advises patients, their relatives, as well as healthcare professionals, especially in connection with life-prolonging measures and coercive measures,

b) * it provides opinions when there are doubts about the scope of an advance healthcare directive,

c) * ...

3. It consists of a maximum of seven members.

4. The population, healthcare professionals, and representatives of healthcare institutions should be adequately represented.

5. The Ethics Council may consult additional experts.

1. The responsibilities under the Federal Human Research Act and the Federal Stem Cell Research Act are assigned to the Ethics Committee of Eastern Switzerland. The cantonal government shall regulate the details.

1. The Executive Council plans health policy and reports to the Cantonal Council every four years.

2. The Health Report

a) Formulates the objectives of health policy;

b) Contains the principles for health promotion and the prevention of diseases and accidents;

c) Coordinates the activities of various sectors within the health service;

d) Evaluates the quality and effectiveness of the services provided with regard to health needs and health policy objectives.

3. The Executive Council coordinates hospital and nursing home planning according to Art. 52b with health planning and the Health Report.

1. The Department of Health and Social Affairs collects the data and other information necessary for the creation and evaluation of health planning.

2. Health professionals and healthcare institutions are required to cooperate in the collection of data and other information in accordance with paragraph 1.

1. The canton and municipalities support measures to maintain and improve the health status of the population, early detection of risk factors, and the prevention of diseases and addictions.

2. They initiate and participate in projects, actions, and campaigns that contribute to the development of health-related competencies among the population.

3. They provide support and advice to individuals and groups, and promote the education, further training, and continuing education of persons involved in health promotion and disease prevention.

4. They strive to create health-promoting living conditions.

1. The Canton

a) Promotes sexual self-determination and self-responsibility, particularly among adolescents and young adults, and supports family planning measures;

b) supports projects and measures to promote mental health and prevent mental illnesses;

c) supports age- and gender-specific health promotion and prevention measures;

d) implements measures for the prevention of communicable diseases in general.

2. The municipalities ensure the counseling of parents of infants and young children.

1. The canton supports projects by public and private organizations for the prevention of alcohol and tobacco misuse as well as other forms of substance addiction. It operates one or more counseling centers.

2. Advertising for alcoholic beverages, tobacco products, and smoking goods with tobacco substitutes, as well as other harmful substances, is prohibited on public land and in its visible areas, in public buildings, and at sports facilities. Exceptions are regulated by the government council.

3. It is prohibited to distribute tobacco products and smoking goods with tobacco substitutes to persons under 16 years of age, or to offer them in vending machines.

4. A general smoking ban applies on school premises. Exceptions are regulated by the government council.

1. Smoking is prohibited in enclosed spaces that are accessible to the public, particularly in public administration buildings, hospitals, care homes, educational, cultural, and sports facilities, and in all areas of the hospitality industry.

2. Separate and appropriately designated rooms with adequate ventilation may be provided for smokers.

3. Exceptions are regulated by the governing council.

1. The authorities of public and private schools up to and including secondary level II ensure that students are instructed in the appropriate maintenance of health.

1. Public and private school administrators, as well as those of kindergartens and residential care facilities, are responsible for providing a school medical and dental service. Oversight is provided by the Department of Health and Social Affairs.

2. The school medical and dental service advises parents, authorities, and educators on matters of health education and prevention.

3. Details and cost allocation are regulated by the government council through regulations.

1. Patients within the meaning of this section are individuals who are under care or treatment by healthcare professionals, as well as in public or private healthcare institutions.

1. The Will of the Patients is Decisive. It shall be taken into account within the framework of medical, nursing, and operational possibilities. The same applies to legitimate wishes of relatives and other close persons.

1. Patients are entitled to consultation and examination, treatment and care according to medical principles and, if possible, in their accustomed environment. Their personal freedom and privacy must be respected.

2. Incurable patients and the dying are entitled to appropriate care and alleviation of their suffering.

3. The dying shall be provided with dignified end-of-life care and be allowed a dignified farewell. Hospitals and care homes must ensure that the dying can be accompanied by their relatives.

1. Patients have the right to be informed about their health condition in an appropriate, comprehensible, and situation-adapted manner. The information includes the diagnosis, the nature, purpose, methods, and risks of the relevant diagnostic or therapeutic measures, the consequences of refraining from such measures, and the coverage of costs by insurance.

2. They have the right to access their files and request explanations thereof. Exceptions are data concerning third parties and subject to professional secrecy. Patients can request that their file or a copy thereof be handed over to them or forwarded to another healthcare professional. They may also prohibit the provision of information, access, and sharing with third parties.

3. The right of access also extends to persons who legally represent the patients. This is subject to other instructions from patients who are capable of judgement.

4. If sufficient information could not be provided in an emergency situation, it must be furnished as soon as possible thereafter.

5. Moreover, the processing of patients' data by public health institutions is subject to the Data Protection Act. The processing of data by private health institutions and private healthcare professionals is subject to the Federal Act on Data Protection.

1. Medical and nursing measures may only be carried out if the competent patient – whether of legal age or not – has consented.

2. If the measure does not involve an intervention in the body, implicit consent suffices; interventions are only permissible if the affected person has expressly consented.

3. Before major interventions or those associated with significant risks, the relevant healthcare professional or institution shall obtain a written consent form in which the essential content of the information provided is noted.

4. If the entitled person refuses consent to a proposed measure, they must confirm this in writing upon request.

1. Medical and nursing measures for an incapacitated person may only be undertaken with the consent of the legal representative unless a person authorized to represent has been designated in an advance directive.

2. The following persons are entitled, in the order listed, to grant consent for an incapacitated adult who has no representative according to paragraph 1

a) the spouse, registered partner, or civil partner living in a shared household with the incapacitated person or providing regular and personal assistance to them;

b) the person living in a shared household with the incapacitated person and providing them with regular and personal assistance;

c) descendants, if they provide the incapacitated person with regular and personal assistance;

d) parents, if they provide the incapacitated person with regular and personal assistance;

e) siblings, if they provide the incapacitated person with regular and personal assistance.

3. If multiple persons are authorized to represent, the well-meaning doctor may presume that each is acting in agreement with the others.

4. If an advance directive lacks instructions, the authorized representative shall decide according to the presumed will and the interests of the incapacitated person.

5. In urgent situations, the doctor shall take medical measures according to the presumed will and the interests of the incapacitated person.

6. The doctor shall notify the Child and Adult Protection Authority when

a) there is no authorized representative or a representative does not wish to exercise the authority;

b) it is unclear who is authorized to represent;

c) the authorized representatives have different opinions;

d) the interests of the incapacitated person are endangered or no longer preserved.

1. The extension of an intervention beyond the extent to which the patient has consented is permissible if it is urgent and cannot be postponed, and if it occurs in the interest of and with the presumed consent of the person concerned.

1. Any capable person can determine in advance in a living will which medical measures they consent to or do not consent to in the event of their incapacity to make judgments.

2. They can also designate a natural person who, in the event of their incapacity to make judgments, is to discuss the measures with the treating physician and make decisions on their behalf. They can give instructions to this person.

3. The living will must be made in writing, dated, and signed.

4. The living will can be amended or revoked at any time.

1. The physician acts in accordance with the advance directive. This is disregarded if it contravenes legal regulations or if there are reasonable doubts that the advance directive is based on free will or still corresponds to the presumed will of the patient. In case of doubt, the physician may consult the ethics committee.

2. The patient file must document the reasons for not complying with the advance directive.

1. To ensure medical quality, an autopsy may be performed on deceased hospital patients.

2. An autopsy is only permissible if the deceased person or their relatives have explicitly consented to it. The will of the deceased person must always be followed.

3. In the interest of public health, the Department of Health and Social Affairs may order an autopsy against the will of the deceased person and their relatives.

4. The provisions of the Swiss Code of Criminal Procedure remain reserved.

1. The removal of organs, tissues, and cells for transplantation purposes is governed by the Federal Transplantation Act.

2. For persons who are incapacitated or minors, the consent of the Ethics Council must be obtained prior to removal.

1. Healthcare professionals are defined as individuals who provide services (examination, care, therapy) in direct contact with their patients, and whose activities require regulation in the interest of public health.

2. Healthcare professionals also include individuals who conduct examinations and therapies on animals.

3. The governing council shall determine by ordinance which professions are covered by this law and the conditions under which they may be practiced. It shall specify in particular the required certificates of competence and educational programs for professional practice. It may declare regulations of Swiss or cantonal authorities and professional organizations to be universally binding.

1. Health professionals require a license from the Department of Health and Social Services if they practice independently, professionally, or otherwise for remuneration, to

a) Diagnose and treat diseases, injuries, and other pathological disorders of physical and mental health, as well as conduct examinations of patients;

b) Treat diseases and injuries of animals;

c) Render medical services covered by social insurance;

d) Practice midwifery;

e) Conduct procedures to alter fertility and reproductive capability;

f) Manufacture, further process, dispense, or apply medications within the area of cantonal jurisdiction.

2. Anyone working dependently, i.e., under the responsibility and direct supervision of a licensed health professional, does not require a license but may only practice the profession if all other legal requirements are met. The responsible person has an obligation to report to the Department of Health and Social Services.

3. A health professional may only engage in activities for which they have received a license.

1. The professional practice permit is granted subject to federal legal provisions if the respective person

a) meets the professional requirements or has successfully completed the required training or examination depending on the profession,

b) is legally competent,

c) has appropriate premises and facilities,

d) does not have a health issue that is incompatible with professional practice,

e) has obtained sufficient professional liability insurance.

2. Persons who have been denied or revoked a permit in another canton for reasons related to public health authority concerns may not be granted a professional practice permit.

1. The authorization may be subject to a time limit or be associated with conditions and obligations.

2. The authorization expires if the person in question gives up the activity; in the case of a temporary cessation of the activity, it expires after two years.

3. If a healthcare professional permanently or temporarily ceases their activity, they must report this to the Department of Health and Social Affairs.

1. The authorization is to be revoked in whole or in part

a) If the prerequisites are no longer present or if reasons for refusal become known subsequently;

b) Due to serious or repeated breaches of professional duties despite warnings;

c) Due to the abusive exploitation of professional position;

d) Due to repeated abusive billing towards patients or their insurers;

e) Upon the imposition of an administrative penalty for serious or repeated breaches of professional duties, behavior unworthy of the profession, as well as intentional criminal offenses, or serious or repeated violations of health legislation despite warnings, including, for healthcare professionals who treat animals, against animal protection and animal disease legislation.

1. The Department of Health and Social Affairs regulates the conditions under which deputies, assistant activities, and the continuation of a practice are permissible in the event of the prevention or death of a healthcare professional.

**1. Healthcare Professionals are Obligated:**

a) to practice their profession diligently and in accordance with professional ethical guidelines,

b) to engage in necessary continuing and further education,

c) to observe the rights and obligations of patients as per the provisions of Articles 20 and following,

d) to adhere to the limits of their competencies,

e) to collaborate with other healthcare professionals when it is in the interest of a patient.

1. Healthcare professionals and their employees are prohibited from disclosing information they have obtained in the course of their professional duties.

2. The healthcare professional can be released from their duty of confidentiality by the patient or by the Department of Health and Social Affairs.

3. Subject to the statutory provisions regarding the obligation to provide information to authorities or the duty to testify in court, as well as the professional confidentiality in medical research according to Article 321bis paragraph 2 of the Swiss Criminal Code.

1. Physicians and dentists with a license to practice their profession are obligated to participate in outpatient emergency services. They may be partially or completely exempted from this obligation for important reasons.

1bis. The organization of outpatient emergency services is the responsibility of the professional associations. The Department of Health and Social Affairs provides them with the necessary information on its own initiative.

2. The government council may set organizational guidelines. If healthcare provision is not guaranteed by the organization, it shall take the necessary measures.

1. Professional associations shall levy a substitute fee from doctors and dentists who are exempted from their duty to cooperate.

2. The substitute fee amounts to CHF 4,000 per year. It shall be reasonably reduced if the doctors and dentists

a) fulfill their duty to cooperate for part of the year;

b) earn AHV-liable income from medical or dental practice that is less than CHF 100,000 in the relevant year; or

c) are exempted from their duty to cooperate due to illness, accident, pregnancy, or other valid reasons.

3. The substitute fee is earmarked for covering the costs of the outpatient emergency service.

1. Healthcare professionals are obligated to provide assistance in urgent cases. Beyond this, there is no obligation to accept patients.

1. Health professionals with their own practice are obliged to create a separate dossier for each patient. This dossier must specifically record the medical history, findings obtained, proposed measures, and measures actually carried out. Any changes and their originators must be identifiable.

2. The dossier may be maintained electronically, provided that data protection is ensured and any changes and their originators remain identifiable.

3. Unless federal law specifies otherwise, the dossiers must be retained for as long as the interests of the affected person and their relatives require, but at least for ten years.

4. Anyone who temporarily or permanently discontinues their activity as a health professional must inform their patients. Upon request, patients will be provided with their dossiers or these will be forwarded to a health professional designated by them.

1. Health professionals are obligated to promptly report all unnatural deaths as well as the intentional spread of dangerous communicable diseases to the police.

2. Any suspicion of animal diseases must be reported to the veterinary service. Veterinary professionals are further obligated to report suspicions of gross violations of animal welfare legislation to the veterinary service.

3. Health professionals are also entitled, without being released from their duty of confidentiality, to report observations to the competent authorities that suggest a crime or misdemeanor against life and limb, public health, or sexual integrity.

1. Advertising one's own services in the field of healthcare may only be conducted by those who possess the necessary license for professional practice.

2. The advertising must not be intrusive, exaggerated, or offensive and must not give rise to deception.

1. The review of fees is fundamentally the responsibility of professional associations.

2. If these do not provide an effective and neutral review, the government council shall establish, through an ordinance, a fee review commission consisting of at least three members and shall regulate the procedure.

1. An institution of the healthcare sector is considered to be any facility whose duties include the promotion, improvement, protection, assessment, monitoring, rescue, transportation, maintenance, or restoration of health, as well as the care of persons regularly in need of nursing care.

2. This specifically includes

a) Hospitals and clinics;

b) Nursing and care homes;

c) Institutions for outpatient health and nursing care;

d) Medical laboratories;

e) Facilities for combating substance addiction;

f) * Institutions for health promotion, prevention, and rehabilitation;

g) * Facilities for people with disabilities, notably residential homes, workshops, and day centers.

1. The institutions of the healthcare sector require an operating license from the Department of Health and Social Affairs.

2. The license is granted if the institution

a) has management with the necessary qualifications and a sufficient number of qualified staff,

b) is appropriately organized,

c) has suitable premises and necessary equipment, and meets the requirements for patient hygiene and safety.

3. Any changes in the conditions under which the license was granted must be reported to the Department of Health and Social Affairs without delay.

4. Regarding advertising, healthcare institutions are subject to the same regulations as healthcare professions.[14]

5. The license may stipulate that the institution participates in professional training, continuing education, and advanced training as part of its capabilities.

6. The government council may regulate details in the ordinance.

1. The Authorization is to be Restricted or Revoked

a) if all the prerequisites for granting are no longer fulfilled;

b) in the case of serious or repeated breaches of professional duties by the responsible persons despite warnings;

c) due to repeated abusive billing towards patients or their cost carriers;

d) in the case of serious deficiencies in the organization or the services offered;

e) in the event of non-compliance with conditions or stipulations imposed in connection with the authorization.

1. Health care institutions are obligated to admit individuals who require emergency treatment.

2. Hospitals and similar facilities providing inpatient medical and nursing care are obligated, within the scope of their service mandate and capacities

a) to provide outpatient or inpatient care to patients residing in the canton, or to admit them;

b) to provide outpatient or inpatient care to patients from outside the canton, or to admit them, insofar as an inter-cantonal or international agreement so provides.

1. A hospital, clinic, maternity home, or nursing home provides the following services

a) Inpatient and outpatient services covered by mandatory health insurance and other social insurances;

b) Additional inpatient and outpatient services;

c) Further services assigned by law, inter-cantonal or international agreements, or service contracts, particularly including community service activities as well as services in the training and education of professionals working in hospitals, clinics, maternity homes, and nursing homes.

1. The canton prepares a medium- and long-term plan, updated annually, for the inpatient medical and nursing care of residents according to the Federal Law on Health Insurance. It coordinates this planning with other cantons in accordance with the Federal Law on Health Insurance.

2. The planning specifically includes the areas of examination, treatment, and care of patients, including medical prevention and rehabilitation.

3. The planning is based in particular on the current state of care, foreseeable needs, expected services, and development goals.

4. Service providers are evaluated as part of the planning process, taking into account, notably, the standards and quality of medical care, the cost-effectiveness and appropriateness of the services offered, the accessibility of services for the population, and the long-term assurance of these services.

5. In areas where the demand or capacities within the canton are low or nonexistent, specific cantonal planning statements may be omitted in favor of referencing out-of-canton services and coordination with these.

1. The Government Council periodically establishes the hospital list based on hospital planning in accordance with the Federal Health Insurance Act. This list includes hospitals, clinics, and maternity homes that have received a mandate for providing inpatient medical care.

2. Accordingly, it establishes the list of nursing homes that have received a mandate for care, medical supervision, and the rehabilitation of long-term patients.

3. It periodically publicly invites hospitals and similar inpatient healthcare institutions within the canton to submit their service offerings and corresponding cost calculations to the Department of Health and Social Affairs within a specified deadline.

4. The Government Council may, if necessary, invite out-of-canton hospitals and similar healthcare institutions to provide specific services.

5. The hospital and nursing home list is published.

1. Service providers in the canton are included in the hospital list if they

a) receive a corresponding service mandate based on the evaluation of the claimed services (Art. 52e);

b) fulfill the admission obligations according to Art. 51;

c) demonstrate a minimum number of cases for certain medical treatments and care services or meet quality criteria of treatments, insofar as such minimum numbers or quality criteria are uniformly agreed upon or are generally recognized;

d) fulfill their service mandates economically and effectively and have a medically and technically up-to-date infrastructure;

e) have a sufficient number of appropriately qualified employees for the agreed services and ensure that their working conditions correspond to generally valid collective labor agreements or, in the absence of such agreements, to the local and professional conditions;

f) offer an appropriate number of training places or further training opportunities in relation to the size of the operation and the cantonal need at various educational levels in important professions for hospitals and nursing homes in accordance with the vocational training law.

2. The government council can associate the inclusion in the hospital list with special conditions, namely by

a) requiring a service provider to provide a specific, integral range of services to ensure the basic supply of a region;

b) demanding from a service provider, exceptionally, a special service to ensure acute inpatient care that was not offered;

c) requiring the provision of a medical service in-house for 24 hours;

d) obligating a service provider to collaborate with one or more other service providers within or outside the canton in the provision of services;

e) obligating a service provider to offer a pastoral care service;

f) obligating a service provider to offer a social service for the counseling of patients;

g) obligating a service provider to ensure patient rights and data protection.

3. The government council determines the specific requirements and any conditions for inclusion in the nursing home list.

4. It can include out-of-canton service providers in the hospital or nursing home list if necessary.

1. The Service Mandate encompasses the following provisions in particular: It

a) outlines the purpose and objectives of the mandate as well as its legal foundations;

b) specifies the individual services of the contracting parties and their responsibilities, including the modalities of remuneration for medical and nursing services as well as special conditions and requirements for these services;

c) establishes the cooperation between the contracting parties and between these parties and third parties;

d) determines the relevant indicators for reporting and controlling, as well as the requirements for quality assurance by the service providers; in this context, the canton aims for uniform criteria;

e) regulates the contract duration, the possible contract amendments, and the termination of the contract;

f) determines the consequences of poor performance or non-performance;

g) specifies the jurisdiction, the applicable law, and the methods of dispute resolution and decision-making.

2. The Government Council may conclude agreements with out-of-canton service providers and issue them service mandates.

1. The Government Council can, insofar as it is necessary to ensure healthcare provision, obligate healthcare institutions in the canton to provide certain services.

1. The Government Council may, in justified cases and following a prior warning to the service provider, restrict or terminate an ongoing service contract with immediate effect.

**1. The responsible cantonal authorities and, insofar as necessary, the insurers shall have access to the data, particularly medical service data, quality data, and accounting records and cost accounting data, which are relevant for the issuance of a performance mandate and the monitoring of contract fulfillment.**

**2. The service providers on the hospital list and the nursing home list of the canton are obliged to timely and comprehensively deliver the data of medical statistics and hospital statistics, as well as the statistics of social-medical institutions, to the Federal Statistical Office and the Department of Health and Social Affairs.**

**3. The canton and the insurers shall uphold the trade secrets of the service providers and protect the privacy of the patients.**

1. Healthcare providers on the hospital list and nursing home list shall prepare an annual report on their business activities regarding the contracted services for the attention of the governing council.

2. Hospitals and other institutions with a service mandate shall periodically provide data to the Department of Health and Social Affairs for the evaluation of the service mandate.

3. Legal disputes with patients and liability claims from them or third parties must be reported to the Department of Health and Social Affairs.

4. Information from healthcare providers shall be transmitted in an anonymized form as far as possible. Sensitive personal data must only be processed as necessary and not disclosed to third parties.

5. The Department of Health and Social Affairs shall periodically evaluate the services provided and report to the governing council on the results.

1. For the financing of services provided by hospitals and nursing homes, which are listed on the cantonal hospital and nursing home list, the provisions of the Federal Act on Health Insurance as well as other federal social insurance laws apply.

2. Special agreements between the canton and the service providers remain reserved, insofar as they are provided for or permitted by federal law.

3. The canton can finance services of general economic interest. The government council determines the tasks of the service providers and their compensation in the service agreements. The compensation for services of general economic interest in the form of university teaching and research is regulated in inter-cantonal agreements.

4. To ensure adequate provision for the resident population, the canton can grant service providers contributions for investments and extraordinary operating contributions.

1. Service providers on the cantonal hospital list must separately report the received contributions for the settlement of investment and capital costs, as well as their depreciation, in the income statement and balance sheet, and must provide an account thereof.

1. If the tariffs do not cover the costs of economical service provision, and the uncovered costs cannot be offset by profits from additional services, the canton may grant listed hospitals contributions for the uncovered costs for

a) ambulatory compulsory services of the mandatory health insurance in pediatrics and psychiatry that are sensible from a healthcare policy perspective;

b) ambulatory or inpatient compulsory services of accident, disability, and military insurance that are sensible from a healthcare policy perspective;

c) services of innovative care models in pediatrics and psychiatry;

d) non-compulsory services within the framework of new diagnostic and treatment methods.

1. The Handling of Therapeutic Products (Medicinal Products and Medical Devices), namely their Production and Marketing, is governed by the Federal Act on Medicinal Products and Medical Devices.

1. The Government Council regulates the requirements and procedure for granting operating licenses (Art. 30 and Art. 34 para. 4 TPA).

2. The Department of Health and Social Affairs issues the cantonal permits provided for in the Therapeutic Products Act, in particular for

a) The manufacture of medicinal products as defined in Art. 5 para. 2 lit. a TPA;

b) the application of prescription medicines by appropriately trained professionals (Art. 24 para. 3 in conjunction with Art. 25 para. 1 lit. c TPA);

c) the dispensing of all non-prescription medicines by federally certified druggists (Art. 25 para. 4 TPA);

d) the dispensing of certain groups of medicinal products, such as holistic medicinal products, by persons with a cantonally recognized qualification (Art. 25 para. 5 TPA);

e) mail-order trade (Art. 27 para. 4 TPA);

f) retail trade (Art. 30 TPA);

g) establishments which only store blood or blood products (Art. 34 para. 4 TPA).

3. The Department of Health and Social Affairs is responsible for conducting periodic operational inspections.

1. The monitoring of the market and the conduct of inspections in the sense of Art. 58 and Art. 60 HMG are the responsibility of the Department of Health and Social Affairs.

2. This department files the reports in accordance with Art. 58 para. 5 HMG and takes the administrative measures that fall within its jurisdiction.

1. For authorizations, inspections, rulings, and services, fees are charged in accordance with the Act on Fees in Administrative Matters.

1. The Department of Health and Social Affairs shall take the administrative measures necessary for enforcement pursuant to Article 66, paragraph 3 of the HMG.

1. Physicians, dentists, and veterinarians are permitted to operate a private pharmacy as part of their authorized practice.

1. The Government Council shall issue the necessary regulations for the implementation of the federal health police provisions, particularly in the following areas

a) Communicable diseases;

b) Narcotics;

c) Foodstuffs and consumer goods;

d) Animal diseases;

e) Remedies.

1. In the event of disasters and other special incidents, the government council shall take all measures necessary to ensure the medical care of the population.

2. The Civil Protection Act and the Civil Defense Act shall apply accordingly.

3. The government council may, in particular

a) Obligate members of all professions and all healthcare institutions to participate;

b) Suspend the free choice of healthcare professionals and healthcare institutions;

c) Declare vaccinations mandatory.

1. To ensure the provision of rescue services and the transportation of the sick and injured, the government council grants service mandates to hospitals or other suitable institutions or organizations in the healthcare sector.

1. The burial services, subject to the following provisions, fall under the responsibility of the municipalities.

2. The government council may issue further regulations.

1. The burial shall generally take place in the cemetery of the municipality where the deceased had their last residence.

2. At the request of the deceased or the next of kin, the burial may also occur in another municipality, provided that municipality grants permission for this.

3. If the deceased had no fixed residence or no one assumes the costs for transporting the body back to the residence municipality, the burial shall occur in the municipality where the death occurred or where the body was found.

1. Burial in the municipality of residence is free of charge.

2. For burials outside the municipality of residence, an invoice may be issued to the persons who have requested it or to the heirs.

1. The Department of Health and Social Services may conduct or have conducted inspections and controls at any time. Its officials must be granted unrestricted access to practice and business premises. Confidentiality and data protection provisions must be observed in this context.

2. The Department of Health and Social Services may order all measures necessary to eliminate an unlawful condition in the field of healthcare. In particular, it may order the closure of premises or the seizure, confiscation, or destruction of items that serve or have served in the commission of an unlawful act, or that are the result of such an act.

1. Anyone who intentionally or negligently violates this law or the regulations and orders issued based on it, or participates in their violation, shall be punished with a fine of up to 20,000 Swiss Francs, unless specific penal provisions are applicable.

1. Patients, persons close to them, or next of kin, as well as legal representatives if applicable, can request a contestable order due to the violation of patient rights. They must address the management of the healthcare institutions for this purpose. If the violation is attributable to a healthcare professional outside a healthcare institution, the Department of Health and Social Affairs must be contacted.

2. The management of the institution or the supervisory authority attempts to reach an amicable agreement. If no amicable agreement can be reached within 30 days, they issue a written, reasoned order with an instruction on legal remedies.

1. Decisions by health authorities concerning healthcare professionals, healthcare institutions, or affected third parties are subject to appeal to the Department, or, if decided by the Department, to the Government Council.

2. Disputes arising from service agreements must be brought before the High Court through an administrative lawsuit pursuant to Article 57 of the Law on Administrative Jurisdiction.

3. Decisions by the Ethics Committee of Eastern Switzerland can be appealed to the High Court in accordance with the inter-cantonal agreement.

4. Orders issued by professional associations within the framework of Article 42 and Article 42a can be contested by filing an appeal with the Department.

1. In addition to the federal legal authorizations, the Department of Health and Social Affairs may systematically use the AHV insurance number for the following tasks

1. the examination of cost approvals and hospital bills;

2. the implementation of the provisions for the protection of the population against communicable diseases;

3. for professional practice authorizations of healthcare professionals.

1. Any person who was authorized under previous law to practice a profession or operate a healthcare institution in the Canton of Appenzell Ausserrhoden is entitled to continue exercising this activity. This also applies to additional and special permits, as long as they do not conflict with the new law.

2. Anyone who wishes to exercise this entitlement must inform the Department of Health and Social Affairs in writing within six months from the effective date of this law.

3. The rights and obligations of healthcare professionals and healthcare institutions, as well as the dispensing and application of medicinal products, are governed by the new law.

1. The canton shall provide contributions of up to a maximum of 50 percent of the recognized costs for new constructions, renovations, and expansions of nursing homes and care departments until the year 2015.

2. The prohibition according to Art. 16 para. 3 shall come into force for freely accessible vending machines one year after the Health Act comes into effect.

3. The regulation according to Art. 17 para. 1 shall come into force for all areas of gastronomy three years after the Health Act comes into effect.

1. Upon the entry into force of this law, the following are repealed

a) Law of April 24, 1965, on Healthcare;

b) Ordinance of December 8, 1986, on the Health Law;

c) Examination Regulations for Cantonal Licensed Dentists of June 8, 1993;

d) Ordinance of September 9, 1996, on Residential Supervision (Residential Ordinance);

e) Law of March 12, 2000, on Public Nursing Care;

f) Ordinance of December 6, 1993, on the Legal Status of Patients of Cantonal Hospitals;

g) Ordinance of June 14, 2004, on the Support of Non-Hospital Health and Nursing Care (Spitex Ordinance);

h) Ordinance of December 6, 1965, on the Traffic with Pharmaceuticals;

i) Art. 7 of the Introductory Law of April 30, 1989, to the Federal Narcotics Act;

j) Art. 5 of the Ordinance of June 19, 1995, on the Funeral Services.

1. This law is subject to a mandatory referendum.

2. The government council determines the commencement.