Furthermore,
Insurance refuses pay treatment saves:
It is too expensive for the sick leave, which refuses to reimburse. Nevertheless, Legally, it has the right.dr
A seriously ill Switzerness claims in vain to his sick person’s reimbursement of a medication which not only relieves it. Similarly, but can also prolong his life. Similarly, The European Court of Human Rights has just given reason to the insurer.
06.08.2025, 05:3706.08.2025. Additionally, Similarly, 05:37
Léony HAG / CH STYAI
In this case, it is not only a insurance refuses pay treatment saves question of life or death, but also of a lot of money. Similarly, A Swiss patient fought against her insurance to find out who will take care of the cost of a. Therefore, drug that could prolong her life. Meanwhile,
The woman pushed the file to Strasbourg, where European judges agreed with the sick person. Nevertheless, This decision raises a fundamental question: How much is a human life worth?
Only his index finger moves
And of course, it is a question of who pays for this life. Nevertheless, The patient in question suffers from spinal amyotrophy. Furthermore, Nevertheless, a genetic disease which, from birth, prevents the transmission of nervous signals to the muscles, which end up gradually deteriorating. Therefore, Incurable, the disease can only be slowed down insurance refuses pay treatment saves by certain treatments.
In her case, this means that the young woman has used a wheelchair since childhood. Similarly, At 16, she had to be fed by gastric probe. Similarly, At 29, she needed respiratory assistance, and her lungs should be emptied several times a day.
His only link with the world is his index, which allows him to control his chair and his phone. Moreover, This little gesture still allows him to lead his daily life, to see his friends, to do research at university. Nevertheless, But in 2018, the strength of this finger began to decline.
A new medication could relieve it
The Spinraza, a new medication, could slow down, even stop the disease. For example, But each injection costs 90,000 francs. insurance refuses pay treatment saves Nevertheless, The first year of treatment requires six doses, then two per year.
It is too expensive for the sick leave, which refuses to reimburse. Legally. it has the right, because if the drug is authorized, it is not on the list of special treatments fixed by the Confederation.
This list determines which drugs can be reimbursed for each rare disease. It is not enough for a drug to be effective, it must also be appropriate and profitable. So, bring sufficient added value to its price. The question is what defines such value.
For its list, the Federal Office for Public Health (OFSP) is recovering from science. But for rare diseases, it is difficult to obtain solid statistical data.
A long fight before the insurance refuses pay treatment saves courts
This is noted by the patient with spinal amyotrophy. This appeals to the Federal Court, presents new scientific studies proving the effectiveness of the drug. The young woman collects money to finance a first dose without insurance assistance. then provides expert reports demonstrating that she can again move several fingers and speak more distinctly thanks to the treatment.
But the courts end up rejecting all its arguments. The number of patients studied being low, statistical results are not deemed significant. Expert opinions do not change anything, because an individual case is not enough to justify generalized care.
Although the effectiveness of the drug is not disputed, the Swiss judges therefore join the advice of insurance. It was in the spring of 2020 that Spinraza was finally added to the list of special treatments.
But that hardly helps the patient concerned. The reimbursement is only planned for patients over 20 years old who are not under artificial ventilation. If she wants to continue her treatment, she will have to continue to pay him herself. She then seized the European Court of Human Rights (ECHR) in Strasbourg. The latter. four votes to three, believes that the decision of the sick person has not violated any article in the European Convention on Human Rights.
The Court invokes the “national margin”. When it comes to balancing individual and collective interests in a legal framework, states have a certain freedom. This is what she says here.
A question of life or death
For the patient’s lawyer, Philip Stolkin, this verdict constitutes a surprise. insurance refuses pay treatment saves For him, the case is clear:
“The drug works. If the patient does not receive it. she dies “
According to the lawyer, requiring evidence going beyond reason is only used to hide economic considerations that take precedence over life. “Our courts protect insurance rather than people, it is a sad reality. But that the ECHR endorses it amazed at me. ”
According to him, imposing such restrictions amounts to deciding what lives are worth saved and which do not deserve it. However. there are other means for the State to fight against the exorbitant prices of drugs, such as the single fund. That Switzerland does not show it. according to Philip Stolkin, that the interests of banks, insurance and the pharmaceutical industry take precedence over human dignity.
“The price comes before dignity”
“Arbitrary. discriminatory” criteria
The OFSP defends itself, the Spinraza is now on the list of specialties. This is not an opposition in principle to reimbursement, says the Office, and “the price is absolutely not” the problem. What is at stake are reimbursements outside the defined criteria. And this requires solid evidence of efficiency, deemed in this insufficient case.
The Pro Raris Foundation, which defends people with rare diseases, does not agree. For her, these restrictions are “totally arbitrary and discriminatory”.
This case certainly does not create case law, but it illustrates what many patients experience. Rare diseases are included only by some specialists. and when they are more generally assessed, the risk is great that the persons concerned are not taken seriously.
Philip Stolkin intends to carry the case in front of the Grande Chamber of the ECHR. The voting of the court having been very tight, nothing says that the latter would confirm the decision. He hopes for a turnaround, because for him, “it is still the right to life, the most fundamental human right.”
The lawyer left for two months to submit his request. But a decision could be long in coming a year or more. In the meantime, the patient remains delivered to herself.
Translated from German by Joel Espi
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The port of the mask is generalized in Switzerland and worldwide during the year 2020.
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The American president returned to the telephone conversation he had Thursday with Karin Keller-Sutter. “She was kind, but she didn’t want to listen to,” he said, calling her “Prime Minister”.
During an interview with the CNBC channel. Donald Trump spoke of the telephone conversation he had last Thursday with the president of the Confederation, Karin Keller-Sutter. At the end of this interview. the Minister of Finance had announced that she could not find an agreement on customs duties.
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