Health insurer 'must pay childbirth costs of blacklisted patient'
Two recent cases highlight the problems surrounding so-called blacklisted patients in Switzerland who are behind on their health insurance payments and only entitled to emergency treatment.
In 2016, a woman in the canton of St Gallen gave birth and then spent the night in hospital. Her medical costs came to a little over 2,000 francs.
Read also: how can health insurance in Switzerland be made cheaper?
The hospital asked the woman’s health insurance firm to pay the bill but there was a hitch: the woman was one of an estimated 30,000 people in Switzerland blacklisted by health insurance firms for failing to keep up payments towards the compulsory health insurance that every resident in Switzerland must take out.
Not all cantons have these controversial blacklists. To date only nine cantons have introduced them since they were authorised in 2012. But for people who in live in the cantons affected, such as the woman referred to above, inclusion in this group means they can only access emergency treatment – a term that has, to date, not been clearly defined.
In her case, the health insurance firm Assura argued a birth could be planned for and was therefore not an emergency.
A recent similar case saw the health insurer ÖKK in 2016 refusing to pay for HIV medication for a man in the city of Chur who was also blacklisted. The firm argued the man’s situation was not an emergency as he did not yet have full-blown AIDS. His condition deteriorated, ÖKK again refused to cover the costs of his medication and he died in hospital in 2017 despite efforts to save him.
But now a ruling by an insurance tribunal in St Gallen that finds Assura responsible for the medical costs of the woman who gave birth in 2016 could finally mean some clarity about what constitutes emergency treatment for blacklisted patients.
In the ruling, the court said a medical situation did not have to be “life-threatening” to be an emergency. Any “urgent” situation where “help was required” because a person's health would otherwise suffer could be classified as an emergency, the court ruled.
Under this definition, it would be impossible to deny an HIV patient medication or a woman access to a maternity ward to give birth, Swiss weekly SonntagsZeitung reported.
The St Gallen ruling is not yet legally binding and it is not known whether Assura will appeal.
Speaking to Switzerland's Aargauer Zeitung late last year, health economist Heinz Locher described the black list situation as "absurd".
Only paying emergency medical costs will lead to a bigger, more expensive problem in the long run, he said.
“In numerous cases that will be more expensive than treating an illness when it first presents,” he added.
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In 2016, a woman in the canton of St Gallen gave birth and then spent the night in hospital. Her medical costs came to a little over 2,000 francs.
Read also: how can health insurance in Switzerland be made cheaper?
The hospital asked the woman’s health insurance firm to pay the bill but there was a hitch: the woman was one of an estimated 30,000 people in Switzerland blacklisted by health insurance firms for failing to keep up payments towards the compulsory health insurance that every resident in Switzerland must take out.
Not all cantons have these controversial blacklists. To date only nine cantons have introduced them since they were authorised in 2012. But for people who in live in the cantons affected, such as the woman referred to above, inclusion in this group means they can only access emergency treatment – a term that has, to date, not been clearly defined.
In her case, the health insurance firm Assura argued a birth could be planned for and was therefore not an emergency.
A recent similar case saw the health insurer ÖKK in 2016 refusing to pay for HIV medication for a man in the city of Chur who was also blacklisted. The firm argued the man’s situation was not an emergency as he did not yet have full-blown AIDS. His condition deteriorated, ÖKK again refused to cover the costs of his medication and he died in hospital in 2017 despite efforts to save him.
But now a ruling by an insurance tribunal in St Gallen that finds Assura responsible for the medical costs of the woman who gave birth in 2016 could finally mean some clarity about what constitutes emergency treatment for blacklisted patients.
In the ruling, the court said a medical situation did not have to be “life-threatening” to be an emergency. Any “urgent” situation where “help was required” because a person's health would otherwise suffer could be classified as an emergency, the court ruled.
Under this definition, it would be impossible to deny an HIV patient medication or a woman access to a maternity ward to give birth, Swiss weekly SonntagsZeitung reported.
The St Gallen ruling is not yet legally binding and it is not known whether Assura will appeal.
Speaking to Switzerland's Aargauer Zeitung late last year, health economist Heinz Locher described the black list situation as "absurd".
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