Blacklisting Health Insurance Premium Defaulters: Is Denial of Medical Care Ethically Justifiable?

Health Care Anal. 2023 Dec;31(3-4):156-168. doi: 10.1007/s10728-023-00464-w. Epub 2023 Jul 27.


Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons - who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies.In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure.Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced.

Keywords: Access to health care; Blacklist; Defaulting premium payers; Ethics; Health policy.

MeSH terms

  • Costs and Cost Analysis
  • Delivery of Health Care*
  • Humans
  • Insurance, Health*
  • Switzerland