Note: 

• This summary constitutes no part of the Judgment but is prepared by the Department of Clerks for the Constitutional Court only for the readers' reference.
• Original paragraph numbers that the summarized texts correspond to are put into lenticular brackets after each paragraph. 
• In case of any conflict of meaning between the Traditional Chinese version and the translated English version, the Traditional Chinese version shall prevail.

Headnotes

    Article 21 and Article 22, Paragraph 2 of the Medical Care Act, which stipulate the competent authority for determining the standards of medical fees and the prohibition of unauthorized or excessive medical charges, do not violate the principle of clarity of law. Under current medical practices, it is comprehensible and foreseeable for the medical institutions that: (1) the term "standard of fees,” other than simple items and prices, also includes fees for medicaments, treatments, and facilities; and that (2) multiple authorized medical treatments or procedures charged upfront is an individual kind if “(charged) item” under Article 22, Paragraph 2, thus requiring authorization. 

    The said two provisions and Article 11, Paragraph 3 of the Enforcement Rules of the Medical Care Act are proportionate to protect people’s right to health and to reduce the information asymmetry between patients and medical service providers. The provisions also do not violate the doctors’ freedom to practice an occupation and freedom of contract under Articles 15 and 22 of the Constitution. 
 

Background Note

    Article 21 of the Medical Care Act (hereinafter “Provision I”) stipulates, “Standards for medical fees charged by the medical care institution shall be determined by the municipal or county (city) competent authority.” Article 22, Paragraph 2 of the same act (hereinafter “Provision II”) stipulates “Medical fees charged by medical care institutions shall not violate or exceed the standard for the fees, nor shall medical institutions charge for items without authorization.” Article 11, Paragraph 3 of the Enforcement Rules of the Medical Care Act (hereinafter “Provision III”) stipulates that the term “authorization” under Provision II means the authorization following Provision I. Per competent authorities, without authorization, charging prepayments in the name of “preordered medical treatments or procedures” violates said provisions. In other words, medical care institutions shall not request prepayments for their services unless authorized to do so by competent authorities. 

    The petitioner of this case is a doctor at a private clinic, which was reported to the Department of Health of the Taipei City Government for charging an upfront payment for six laser hair removal sessions. The Department of Health fined the clinic NT$50,000 for violating the Medical Care Act. After unsuccessful administrative appeal and judicial litigations, the petitioner filed a constitutional complaint against the court’s final decision, calling for a review on the constitutionality the pertinent regulations. The petitioner mainly argued that: (1) Relevant medical care laws did not explicitly prohibit medical institutions from charging for multiple authorized medical treatments or procedures upfront, which violates the principle of clarity of law; and that (2) Even if the provisions were explicit enough, the burden imposed on practitioners to obtain authorization disproportionately restricts their freedom to practice an occupation, particularly when it involves only a different payment option for authorized medical treatments or procedures.

Summary of the Judgment 

Holding

1. Provision I provides that “Standards for medical fees charged by the medical care institution shall be determined by the municipal or county (city) competent authority.” Provision II provides that “Medical fees charged by medical care institutions shall not violate or exceed the standard for the fees, nor shall medical institutions charge for items without authorization.” Reading the two provisions conjointly, the terms “standards for medical fees” and “(charged) items” do not violate the principle of clarity of law. 
2. Provisions III, which stipulates that “The term ‘charge for items without authorization’ under Article 22, Paragraph 2 of the Medical Care Act shall be construed as charging fees that have not been authorized under Article 21 of the Act,” and Provisions I and II, do not violate the principle of proportionality, freedom for the medical institutions to practice their occupation, and freedom of contract under Articles 23, 15, and 22 of the Constitution.
3. The petitioner’s constitutional complaint shall be dismissed.

Reasoning

1. Reading Provisions I and II conjointly, the terms “standards for medical fees” and “(charged) items” do not violate the principle of clarity of law: 

    The legislators stipulated Provision I to prevent medical institutions from obstructing patient rights by inflating charges and overbilling. Said provision also protects the healthcare industry’s development by preventing unfair competition. Provision I required medical institutions to request prior authorization from local competent authorities on the medical service fees they plan to provide. It also authorizes the authorities to determine standards for medical fees when reviewing such requests. Based on Provision I, legislators also stipulated Provisions II and III, which prohibit the medical institutions from violating the determined standards. Charges unauthorized under Provision I constitute exceeding standards or charging for unauthorized items under Provision II, which shall be fined. Provisions I and II combined form the regulatory framework for medical fees. The clarity of these regulations should be reviewed in the context of Provisions I and II conjointly, and judged from the professional understanding of the regulated entities, i.e., the medical institutions. 【26】

    It can be known from Provision II that the scope of “standards for medical fee” under Provision I includes the monetary amount and the items charged. In addition, under common sense, the scope also includes medicament fees, treatment charges, and the facility expenses that are necessary for a medical institution to run and manage its practice. In this sense, the scope of the term “standards for medical fee” is foreseeable and comprehensible for the regulated—the medical institutions—and may be reviewed by a court through legal interpretation in general.【27】

    Although patients undergo the same medical treatments multiple times, they may display different reactions due to their biological differences or other factors, such as environment influences. To achieve optimal therapeutic or corrective outcomes, medical service providers must examine and treat each patient on a case-by-case basis during each session. Even where the same medical treatment must be repeated multiple times to achieve its purpose, and that appropriate times of such procedures must be decided at the outset of treatment, decisions still rely on medical customs recognized within the professional field. This is because there is a significant information asymmetry in medical knowledge between practitioners and patients.【28】

    The terms “violate or exceed the standard for the fees” and “charge for items without authorization” under Provision II concern not only the issue of whether a single charge exceeds the scope authorized by the local competent authority. From the perspective of the medical profession, the term “(charged) items” should also encompass the frequency and fees in instances where medical science or customary practice requires repeat treatments, for which fees may be charged upfront. Therefore, such prepaid charges shall gain prior authorization. This requirement (under Provision II) is foreseeable and comprehensible for the regulated, and may be reviewed by a court. Actually, there were also medical institutions that filed for prior authorizations for such types of charges. Provisions I and II conform to the principle of clarity of law.【29】

2. Provisions I, II, and III do not violate the principle of proportionality, freedom for the medical institutions to practice their occupation, and freedom of contract, which are enshrined in Articles 23, 15, and 22 of the Constitution: 

    Provisions I, II, and III impose a certain degree of restriction on the medical institutions’ (including the doctors) freedom to practice and their freedom to form medical service contracts with their patients. Such restriction shall be of legitimate public interest; Its means shall be rationally connected to its purpose. Otherwise, it would be unconstitutional.【31】

    The legislators conferred the competence to prior-authorize medical fee standards to the local authorities, specifically because medical knowledge and practice are highly professional and technical. There is a high level of information asymmetry between medical practitioners and their patients. Therefore, it is hard for people with no medical background to determine whether the charges and payment terms for medical services are reasonable. The price of medical services also concerns the patients’ financial ability to afford treatments and whether they can regain their health through them. In order to provide the minimum level of protection for people’s right to health, the State imposes restrictions on medical institutions when drafting relevant legal frameworks. These restrictions require medical institutions to apply for prior authorization for their charged items and the scope of charges. The purpose of Provisions I, II, and III is therefore of legitimate public interest. Prior authorizations under these provisions are reviewed and decided by local competent authorities with medical backgrounds, or by medical review committees set up by local authorities and comprising medical professionals. Such a measure takes into account the reasonable rights of the medical institutions. It also helps reduce the information asymmetry, prevent unreasonable medical charges, and protect patients’ right to health. It is sufficient to say that there is a rational connection between the measures set out in Provisions I, II, and III, and the purpose of these provisions.【32】

3. In terms of the constitutional complaint of the petitioner’s final court decision: 

    Provisions I, II, and III, cited in the disputed decision, are constitutional. The legal opinion in the said decision, including the part that cited the disputed letter, did not demonstrate an erroneous understanding of people’s fundamental rights. Nor did the decision fail to consider or demonstrate apparent flaws in weighing the conflict of relevant fundamental rights. Therefore, the petitioner’s constitutional complaint is meritless and shall be dismissed.