1Bund und Kantone sorgen im Rahmen ihrer Zuständigkeiten für eine ausreichende, allen zugängliche medizinische Grundversorgung von hoher Qualität. Sie anerkennen und fördern die Hausarztmedizin als einen wesentlichen Bestandteil dieser Grundversorgung.
2Der Bund erlässt Vorschriften über:
- a.
- die Aus- und Weiterbildung für Berufe der medizinischen Grundversorgung und über die Anforderungen zur Ausübung dieser Berufe;
- b.
- die angemessene Abgeltung der Leistungen der Hausarztmedizin.
Overview
Art. 117a BV obligates the Confederation and the cantons jointly to ensure sufficient, high-quality primary medical care that is accessible to all. Family medicine (general internal medicine, pediatrics and adolescent medicine) is particularly recognized and promoted (Gächter/Renold-Burch, BSK BV, Art. 117a N. 6-23). This constitutional provision emerged as a direct counter-proposal to the popular initiative «Yes to family medicine» and was clearly adopted on 18 May 2014 with 88% yes votes (BBl 2010 2939; 1C_282/2014).
Primary medical care encompasses all outpatient and inpatient services of primary health care that serve as the first point of contact for health problems. This includes family doctors, pediatrics and adolescent medicine, emergency services, but also other health professions such as midwives. An example: When a child has a fever, the parents first turn to the local pediatrician. This practitioner must be accessible, affordable and professionally qualified.
The Confederation must regulate two specific areas by law: First, the education and continuing education of primary care providers and second, appropriate remuneration for their services (Gächter/Renold-Burch, BSK BV, Art. 117a N. 34-38). Unlike the social goals in Art. 41 BV, Art. 117a BV is directly enforceable (BGE 151 V 100). Citizens can invoke violations of primary care before the courts.
The cantons may limit the number of licensed physicians, but must ensure that primary care is not endangered. The Federal Supreme Court confirmed this practice, as long as regional distinctions are made: Where there is a shortage of doctors, promotion must be provided; where there is oversupply, restrictions may be imposed (BGE 151 V 100).
The provision strengthens local medical care and combats the shortage of family doctors. It forms the constitutional basis for the «Master Plan Family Medicine», which provides for concrete promotion measures such as practice assistance and improved continuing education support (Gächter/Renold-Burch, BSK BV, Art. 117a N. 39-40).
Art. 117a FC — Primary Medical Care
#Doctrine
#1. Legislative History
N. 1 Art. 117a FC originates from the popular initiative «Yes to Family Medicine» («Ja zur Hausarztmedizin»), which was declared valid on 27 April 2010 (BBl 2010 2939). The initiators were responding to the shortage of general practitioners that had been emerging for years and to the financial disadvantage of family medicine compared with specialist fields. The aim was to enshrine in constitutional law a «sufficient, universally accessible, comprehensive and high-quality outpatient primary medical care» (BBl 2011 7553, 7560).
N. 2 The Federal Council rejected the initiative but acknowledged a fundamental need for action. In its dispatch of 16 September 2011 it noted that the demands of the initiative had already been partially met at the level of legislation and ordinances (BBl 2011 7553, 7571 f.). The explicit mention of a single professional group (general practitioners) and the high degree of detail in the initiative text were assessed as problematic. The Federal Council submitted instead a direct counter-proposal intended to address the issue on a broader basis.
N. 3 In the Federal Assembly the Federal Council's counter-proposal was modified: the Council of States inserted the provision on «appropriate remuneration for the services of family medicine» (para. 2 let. b) (AB StR 2012 404, 407). This compromise — which took up the central financial demand of the initiative — prompted the initiative committee to withdraw its initiative on 26 September 2013 (BBl 2013 7989). The principal political driving force behind the popular initiative, namely the financial disadvantage of family medicine, had thereby been addressed by the Constitution; cf. Trümpler/Werder, OFK BV, Art. 117a N. 3 f.
N. 4 Alongside the constitutional article, the master plan «Family Medicine and Primary Medical Care» («Masterplan Hausarztmedizin und medizinische Grundversorgung») was developed, providing for concrete implementing measures for the cantons (practice assistant posts) and the Confederation (education, tariffs, research). On 18 May 2014, Art. 117a FC was adopted with a yes vote of 88.0 % and by all cantons (BBl 2014 6346, 6349 ff.).
#2. Systematic Classification
N. 5 Art. 117a FC is to be classified as a competence norm in the field of social objectives and state duties of the Confederation, and stands in systematic connection with Art. 117 FC (health and accident insurance) as well as Art. 118a FC (complementary medicine) and Art. 118b FC (research on human beings). The provision has a dual normative character: para. 1 is a programmatic norm without direct subjective entitlement effects; para. 2 contains a specific legislative mandate to the Confederation.
N. 6 The provision is not a fundamental rights norm within the meaning of Arts. 7–34 FC and does not establish individually enforceable entitlements to medical services (→ Art. 12 FC for the minimal right to emergency assistance). It differs from the social objectives under Art. 41 FC in that Art. 117a para. 2 FC obliges the Confederation to legislative action — para. 1, by contrast, shares with Art. 41 FC the characteristic of non-justiciability. Cf. Biaggini, BV Kommentar, 2nd ed. 2017, N. 2 on Art. 117a FC.
N. 7 Para. 2 establishes a subsequently derogatory federal competence in the field of education and training and professional practice for professions in primary medical care: this competence extends — beyond the federal competence already laid down in Arts. 95 and 117 FC in the area of private law — also to the public-law sector; cf. Gächter/Renold-Burch, BSK BV, Art. 117a N. 27. No shifts of competence between the Confederation and the cantons follow from para. 1; to that extent the provision is «compatible with federalism» (Opinion of the Conference of Cantonal Directors of Public Health [GDK] of 24 February 2014; similarly BBl 2011 7553, 7576). → Art. 3 FC.
N. 8 When interpreting other norms of federal law, Art. 117a FC is to be used as a standard of interpretation; in particular it influences the interpretation of the Federal Health Insurance Act (HIA) and related enactments. In the field of public procurement law the Federal Supreme Court held that Art. 117a para. 1 FC reflects the public mandate to guarantee primary care and must be taken into account when classifying hospitals as institutions governed by public law (BGE 145 II 49 cons. 4.4.2). ↔ Art. 117 FC.
#3. Elements of the Provision / Normative Content
a. Para. 1 Sentence 1: Programmatic Obligation
N. 9 Para. 1 sentence 1 obliges the Confederation and the cantons, «within the scope of their respective responsibilities», to ensure a primary medical care that cumulatively fulfils three qualifying characteristics: it must be (1) sufficient, (2) accessible to all, and (3) of high quality. The term «ensure» («sorgen») signals a high degree of obligation, albeit without an enforceable entitlement (BBl 2011 7553, 7576 f.; Gächter/Renold-Burch, BSK BV, Art. 117a N. 21, 26).
N. 10 The concept of primary medical care is an indeterminate legal concept which, according to Gächter and Renold-Burch, is to be interpreted along three dimensions (Gächter, Was ist «medizinische Grundversorgung»?, Pflegerecht 2015, p. 101 ff.): (a) profession-specific (general practitioners, nursing professionals, pharmacists, physiotherapists, clinical psychologists, and others); (b) needs-specific and functional (oriented towards the «ordinary needs of the population for basic preventive, curative, rehabilitative and palliative medical goods and services», BBl 2011 7553, 7577); (c) conceptually on the basis of the international «Primary Health Care» concept of the WHO (Declaration of Alma-Ata, 12 September 1978). Excluded are services that are required only occasionally or that, for reasons of quality and safety, can be provided exclusively in a concentrated and specialised form, in particular services of highly specialised medicine (BBl 2011 7553, 7577; Gächter/Renold-Burch, BSK BV, Art. 117a N. 13).
N. 11 The characteristic sufficient designates a dual substantive threshold: neither under-supply, over-supply, nor mis-supply should occur. The Constitution thus contains, alongside a duty of supply, also a limiting function that mirrors Art. 43a para. 5 FC (needs-based and economical fulfilment of tasks). The Federal Supreme Court confirmed that maximum-number regulations under Art. 55a HIA restricting the admission of new service providers in well-supplied regions are compatible with this criterion (BGE 151 V 100 cons. 10.3).
N. 12 The characteristic accessible to all is to be understood geographically (reachability close to one's place of residence), financially (affordability for all segments of the population) and temporally (availability within a reasonable time) (BBl 2011 7553, 7577; Kahil-Wolff Hummer, CR Cst., Art. 117a N. 8). The accessible form of care is not limited to physical consultations but can evolve with advances in medicine and technology (telemedicine, digital care).
N. 13 The characteristic of high quality encompasses three dimensions: (1) well-coordinated education and training of service providers; (2) networked and coordinated delivery of services; (3) individual quality of the service by individual service providers (BBl 2011 7553, 7577). The quality characteristic establishes a mandate for state health policy but is not in itself judicially enforceable.
b. Para. 1 Sentence 2: Recognition and Promotion of Family Medicine
N. 14 Art. 117a para. 1 sentence 2 expressly obliges the Confederation and the cantons to «recognise and promote» family medicine as an «essential component» of primary medical care. The mention in the constitutional text already fulfils the recognition mandate in itself; the promotion mandate requires concrete implementing measures by the levels of government.
N. 15 Family medicine denotes, according to the Federal Council and legal scholarship, «a field of medical activity focused principally on primary care» (BBl 2011 7553, 7578; BBl 2013 6205, 6214). Accordingly, the concept encompasses the postgraduate specialist titles «General Internal Medicine» (in its family medicine orientation), «Paediatrics and Adolescent Medicine» («Kinder- und Jugendmedizin») and — historically — «General Medicine» («Allgemeinmedizin») and «General Practitioner» («Praktische Ärztin/Arzt») (Gächter/Renold-Burch, BSK BV, Art. 117a N. 17; BBl 2011 7553, 7578). These professional groups were explicitly exempted from the restriction when the admission freeze was reintroduced under Art. 55a HIA (2013), documenting the legislative recognition of their status as primary care providers; cf. Werder, Die Zulassungsbeschränkung zur OKP, Jusletter of 31 August 2020.
N. 16 The promotion mandate obliges the Confederation and the cantons to take concrete measures. The Federal Supreme Court recognised as examples cantonal practice assistant programmes as well as financial support for training posts in the specialties of General Internal Medicine, Paediatrics and Adolescent Medicine, Psychiatry and Child and Adolescent Psychiatry as constitutionally compliant implementation of the promotion mandate (BGE 151 V 100 cons. 10.3).
c. Para. 2: Legislative Mandates to the Confederation
N. 17 Art. 117a para. 2 confers on the Confederation two substantively delineated legislative mandates:
-
Let. a (Education, training and professional practice): The Confederation has comprehensive authority to regulate education and training as well as the requirements for professional practice for all professions in primary medical care. «Education and training» is to be understood as a continuum extending from basic education through university of applied sciences and university degrees to postgraduate specialist training (BBl 2011 7553, 7578 f.). The federal legislature has fulfilled this mandate with the Medical Professions Act (MedBG; SR 811.11), the Psychology Professions Act (PsyG; SR 935.81) and the Health Professions Act (GesBG; SR 811.21, in force since 1 February 2020). All enactments were subsequently supplemented in their preamble with a reference to Art. 117a para. 2 FC (Trümpler/Werder, OFK BV, Art. 117a N. 27).
-
Let. b (Appropriate remuneration): The Confederation must enact provisions on the appropriate remuneration of services rendered in family medicine. The addressee of this mandate is exclusively family medicine — not all professions in primary medical care under let. a; cf. Kahil-Wolff Hummer, CR Cst., Art. 117a N. 19; Filippo, Angemessene Abgeltung der Leistungen nur für die Hausarztmedizin?, Pflegerecht 2015, p. 107 ff. Remuneration is effected not through direct payments but via the tariff structures of social insurance law (TARMED, Analysenliste); cf. Gächter/Renold-Burch, BSK BV, Art. 117a N. 36. The Federal Council implemented this mandate with the Tariff Adjustment Ordinance 2014 (adaptation of the TARMED tariff structure) by upgrading tariff positions for family medicine services while simultaneously reducing technical services in other specialties.
#4. Legal Consequences
N. 18 Programmatic obligation without entitlement effect (para. 1): Para. 1 does not establish subjective rights of individuals to a specific care service. Private parties cannot rely directly before a court on Art. 117a para. 1 FC to claim state care services (BBl 2011 7553, 7576; Gächter/Filippo, Stärkt der neue Grundversorgungsartikel die Rechte auf Gesundheit?, Bioethica Forum 8[3]:85–89, p. 88). The provision nonetheless operates as a standard of interpretation when applying the implementing norms of the HIA and of cantonal health acts.
N. 19 Legislative duty (para. 2): Para. 2 obliges the Confederation to legislate. Should it fail to fulfil this duty, an unconstitutional legislative omission occurs. However, the Federal Supreme Court is bound under Art. 190 FC by (federal statutory) implementing law and cannot directly sanction a violation of Art. 117a para. 2 FC by quashing federal law norms. → Art. 190 FC.
N. 20 Standard for Federal Council ordinance-making: In the field of tariff-setting the Federal Supreme Court acknowledged that the Federal Council, when enacting adjustment ordinances on the TARMED tariff structure, may take into account the political objective enshrined in Art. 117a FC of promoting family medicine and that interventions based thereon are not without more to be classified as contrary to legislation (BGE 144 V 138 cons. 6.5). The Federal Council bears responsibility for the appropriateness of the measure; the court confines itself to a review of arbitrariness and competence (Art. 190 FC; BGE 144 V 138 cons. 2.4).
N. 21 Admission restrictions: Art. 117a FC does not preclude cantonal maximum-number regulations under Art. 55a HIA, provided these pursue the objective of ensuring needs-based care, limiting over-supply and at the same time specifically promoting specialties in primary care with a supply deficit. The Federal Supreme Court denied a violation of Art. 117a FC by the Bernese Admission Ordinance (BGE 151 V 100 cons. 10.3).
N. 22 Radiating effect on other areas of law: Art. 117a FC influences the interpretation of various areas of law. In public procurement law the constitutional supply mandate supports the characterisation of listed hospitals as institutions governed by public law that do not engage in commercial activity, since they fulfil a public, non-market-based supply mandate (BGE 145 II 49 cons. 4.4.2, 4.5.1–4.5.2). This assessment applies irrespective of the private-law form (stock corporation, limited liability company) of the hospital operator.
#5. Contested Issues
N. 23 Legal nature of para. 1: programmatic or justiciable? The Federal Council's dispatch expressly qualifies Art. 117a para. 1 FC as a programmatic mandate without individual entitlements to services (BBl 2011 7553, 7576). Gächter/Filippo share this view and doubt that the primary care article substantively strengthens the right to health (Bioethica Forum 8[3], p. 89). By contrast, Trümpler/Werder emphasise that Art. 117a para. 1 FC «can create new expectations regarding a state guarantee responsibility that did not previously exist to this extent» and thus exerts an indirect effect on state health policy (OFK BV, Art. 117a N. 7). The Federal Supreme Court examined a concrete complaint alleging a violation of Art. 117a FC on the merits in BGE 151 V 100, thereby implicitly affirming a limited justiciability as a standard for reviewing state action, without, however, recognising subjective entitlements.
N. 24 Scope of the competence title in para. 2 let. a: private-law sector only or also the public-law sector? Gächter/Rütsche attribute to the legislative mandate a purely aspirational character, since the corresponding competences had already vested in the Confederation under Arts. 95 and 117 FC (Gesundheitsrecht, 4th ed. 2018, § 2 N. 142). Gächter/Renold-Burch contend, with convincing reasons, that Art. 117a para. 2 FC establishes an additional, subsequently derogatory federal competence extending to the public-law sector (BSK BV, Art. 117a N. 27). Practice has aligned with the second view: the preambles of the MedBG, the PsyG and the GesBG were subsequently supplemented with a reference to Art. 117a para. 2 FC.
N. 25 Demarcation of «professions in primary medical care» (para. 2 let. a) vs. «family medicine» (para. 2 let. b): Kaufmann advocates a narrow interpretation and would subsume under para. 2 let. a only medical primary care providers (Was muss oder soll der Bund bei den Berufen der medizinischen Grundversorgung regeln?, Pflegerecht 2015, p. 104 ff.); the Federal Council's dispatch and Gächter/Renold-Burch (BSK BV, Art. 117a N. 28) favour a broad interpretation that also includes non-physician health professionals (nursing, pharmacy, physiotherapy). The enactment of the GesBG demonstrates that the legislature regards the broad interpretation as authoritative. For the remuneration mandate in let. b, however, the legislature deliberately chose the narrower formulation «services of family medicine», thereby restricting the constitutional privilege to that professional group; cf. Filippo, Pflegerecht 2015, p. 107 ff.
N. 26 Appropriate remuneration: legal binding force of the standard? Gächter/Renold-Burch hold that the appropriateness of remuneration «must be measured against the objective of strengthening […] family medicine» (BSK BV, Art. 117a N. 36). How concretely the Federal Council is bound by this standard is disputed: in BGE 144 V 138 cons. 6.5 the Federal Supreme Court acknowledged that the Federal Council, when adjusting tariffs, may give consideration to «political concerns» (here: strengthening family medicine) without thereby exceeding the limits of Art. 43 para. 4 HIA. The Federal Supreme Court thereby allows a wide margin of discretion whose limits can hardly be determined from Art. 117a FC alone.
#6. Practical Notes
N. 27 Admission restrictions and primary care: Cantons enacting maximum-number regulations under Art. 55a HIA must demonstrate that the restriction does not lead to under-supply in areas of primary medical care. This can be shown in particular by means of regionalised needs planning and by promotion measures in specialties with a supply deficit (BGE 151 V 100 cons. 10.3, 12.2.1). Where an under-supply exists despite admission restrictions, exception rules or adjustments to the maximum numbers must be provided (cf. Arts. 3 and 6 para. 3 cantonal ZulaV/BE).
N. 28 Tariff-setting: When challenging Federal Council tariff adjustment ordinances (Art. 43 para. 5bis HIA), Art. 117a FC offers no independent ground of challenge. The Federal Supreme Court reviews only whether the ordinance manifestly exceeds the limits of the statutory discretion or is arbitrary (BGE 144 V 138 cons. 2.4, 6.5). Service providers alleging an infringement through adjustment ordinances must specifically demonstrate that the remuneration no longer covers the efficient costs of service delivery (cons. 6.1.2).
N. 29 Procurement law and hospitals: The classification of a hospital as an institution governed by public law in procurement law depends decisively on whether it is subject to the pressure of effective competition. Hospitals with a cantonal service mandate (listed hospitals) are subject to public procurement law in the absence of genuine competition, since their supply mandate under Arts. 117a and 117 FC serves the general interest (BGE 145 II 49 cons. 4.4.2, 4.5.1–4.5.6). This assessment applies regardless of the private-law legal form (stock corporation, limited liability company) of the hospital operator.
N. 30 Demarcation from Art. 12 FC (emergency assistance) and Art. 41 FC (social objectives): Art. 117a para. 1 FC supersedes neither Art. 12 FC (subjective minimal right to a subsistence minimum, including emergency care) nor Art. 41 FC (social objectives in health care). Art. 117a para. 1 goes qualitatively and substantively beyond Art. 12 FC — it targets regular, nationwide primary care, not the emergency situation. Vis-à-vis Art. 41 para. 1 let. b FC (access to necessary health care), Art. 117a FC refers to a more specific and institutionally shaped field. → Art. 12 FC; → Art. 41 FC.
N. 31 Cantonal implementing measures: The promotion of family medicine (para. 1 sentence 2) can be implemented through a variety of cantonal measures: practice assistant programmes, training post promotion grants, innovation programmes for establishing new training posts. A violation of the promotion mandate does not arise where a canton introduces admission restrictions for over-supplied specialties but simultaneously creates targeted incentives for under-supplied primary care specialties (BGE 151 V 100 cons. 10.3). The Confederation and the cantons enjoy broad discretion in the choice of promotion measures; Biaggini, BV Kommentar, 2nd ed. 2017, N. 2 on Art. 117a FC; Gächter/Renold-Burch, BSK BV, Art. 117a N. 18.
Case Law
#Origin and Scope of Application
#Voting Procedure 2014
1C_282/2014 of 7 July 2014
Appeal against voting concerning federal referendum on basic medical care
The Federal Supreme Court dismissed appeals against the conduct of the referendum on Art. 117a Cst.
«On 18 May 2014, the Federal Decree on Basic Medical Care (new Art. 117a Cst.) as a direct counter-proposal to the withdrawn popular initiative "Yes to Family Medicine" was put to vote. The proposal was accepted nationwide with 2,478,470 yes votes (88 percent) to 337,240 no votes (12 percent).»
These parallel proceedings (1C_279/2014, 1C_280/2014, 1C_281/2014, 1C_283/2014) confirmed the clear voting result and the proper conduct of the ballot.
#Relationship to Other Constitutional Provisions and International Obligations
#Hospital Procurement Law
BGE 145 II 49 of 21 February 2019
Applicability of public procurement law to hospital companies
The Federal Supreme Court examined Art. 117a Cst. in the context of constitutional hospital care and procurement law.
«Art. 117, Art. 117a Cst. establish constitutional obligations to ensure health care provision, which must be taken into account when interpreting public procurement law.»
The judgment clarifies that the health care obligations under Art. 117a Cst. influence the interpretation of other areas of law.
#Proportionality of Admission Restrictions
#Medical Basic Care and Admission Stop
BGE 151 V 100 of 15 January 2025
Limitation of physician numbers in the ambulatory sector versus basic medical care
The Federal Supreme Court confirmed the compatibility of cantonal admission restrictions with Art. 117a Cst.
«Neither a violation of the right to basic medical care enshrined in Art. 117a Cst. nor of the cantonal ambulatory needs planning stipulated in Art. 5 of the Maximum Numbers Ordinance can be seen in this.»
The decision shows that Art. 117a Cst. does not require unlimited admission of all service providers, but rather aims for needs-based care. Admission restrictions are constitutional if they serve cost control and do not endanger basic care.
#Regional Needs Planning
BGE 151 V 100 (continuation)
Regional differentiation in basic care
The Federal Supreme Court recognised the necessity of regional needs planning for implementing Art. 117a Cst.
«The respondent restricts OKP admission only where demand is covered. In the sense of adequate, accessible basic care of high quality according to Art. 117a para. 1 Cst., it promotes those ambulatory specialties of basic care in which there tends to be a shortage of physicians.»
The case law confirms that Art. 117a Cst. aims to prevent both over- and under-supply.
#Interpretation of Family Medicine
#Continuing Education Promotion
BGE 151 V 100 (consideration 10.3)
Promotion of family medicine as a constitutional mandate
The Federal Supreme Court evaluated concrete measures to promote family medicine.
«To promote family medicine, the "Practice Assistance" programme was launched in 2008, which was renewed for another four years as of 2023 [...] Within the framework of the new regulation of medical continuing education, continuing education positions in the four specialties General Internal Medicine, Paediatrics and Adolescent Medicine, Psychiatry and Psychotherapy and Child and Adolescent Psychiatry and Psychotherapy are also promoted.»
The decision concretises the promotion mandate for family medicine through specific continuing education measures.
#Other Health Professions
#Midwives
Judgment 2C_326/2024 of 26 August 2025
Professional practice licence for midwives and basic care
The Federal Supreme Court mentioned Art. 117a Cst. in the context of basic medical care by midwives.
The decision shows that Art. 117a Cst. is relevant not only for physicians, but for all professions in basic medical care.
#Distribution of Powers between Confederation and Cantons
#Implementation Powers of the Cantons
BGE 151 V 100 (consideration 8)
Cantonal implementation of the federal constitutional provision
The Federal Supreme Court confirmed the shared competences in implementing Art. 117a Cst.
«The cantonal Bernese legislation includes the competence of the Government Council of the Canton of Bern to establish or restrict the admission of physicians who provide services in the ambulatory sector at the expense of the OKP in the Canton of Bern in quantitative terms by ordinance, in accordance with Art. 55a HIA in conjunction with Art. 1 of the Maximum Numbers Ordinance.»
The case law shows the interaction between the constitutional mandate under Art. 117a Cst. and its legislative concretisation.
#Justiciability and Enforceability
#Direct Applicability
BGE 151 V 100 (implicit)
Legal nature of the constitutional provision
The Federal Supreme Court examined concrete violations of Art. 117a Cst., which indicates its direct applicability.
Practice shows that Art. 117a Cst. is not merely programmatic, but as a justiciable constitutional provision establishes enforceable claims.
#Relationship to Cost Control
#Economic Efficiency of Care
BGE 151 V 100 (consideration 12.2.1)
Efficiency potential and basic care mandate
The Federal Supreme Court recognised the tension between basic care and cost control.
«According to the study commissioned by FOPH on the efficiency potential of HIA-mandatory benefits, an efficiency potential of a total of CHF 1.46 to 1.60 billion or 3.2% to 3.5% was estimated for ambulatory medical services.»
The case law shows that Art. 117a Cst. does not contradict cost control, but requires efficient basic care.