INTERNATIONAL LABOÜH OFFICE
STUDIES AND REPORTS
Series M (Social Insurance) No. 4
SICKNESS INSURANCE
Comparative
Analyses
of National
Laws
\
J
GENEVA
1925
CONTENTS
INTRODUCTION
Page
The origin of collective protection against sickness
The first compulsory sickness insurance laws
Evolution until the War
The present position of legislation on sickness insurance
PART
1
2
3
4
I
THE SCOPE OF SICKNESS INSURANCE LAWS
INTRODUCTION:
Factors determining the scope of the legislation
Compulsory insurance laws in general
CHAPTER I:
>, .
7
8
The Scope of General Workers' Insurance.
§ 1. — Persons liable to insurance
The conditions of compulsion
11
11
§ 2. — Limitation of the general formula
Absolute exceptions
Relative exceptions
14
15
18
§ 3. — Special occupations under the general formula
Civil servants and other public employees
Domestic workers
Home workers
21
21
25
26
§ 4. — Position of Non Wage-Earners
Apprentices
Independent workers . . . ;
27
27
28
§ 5. — Voluntary insured persons
Continuation of compulsory insurance
Voluntary insurance
28
29
30
| 6. — The position of unemployed workers
31
§ 7. — The territorial limits to the scope of compulsory insurance
laws
Special position of seamen
, . . . . ,
33
35
— VI —
Page
§ 8. — Time limits to the application of general workers' insurance laws
Commencement of insurance
End of insurance
CHAPTER I I :
National Insurance.
The Portuguese sickness insurance system
Persons insured
Territorial limits
Time Limits
CHAPTER I I I :
39
39
40
40
The Scope of Limited Workers' Insurance Systems.
Persons liable to insurance
Class of undertaking
Exceptions
The insurance of independent persons
CHAPTER IV:
36
36
38
_. . . .
41
42
43
43
The. Scope of Voluntary Insurance Systems.
§ 1. — Voluntary insurance laws in general
Voluntary insurance
44
44
§ 2. — Subsidised voluntary insurance
Scope
45
45
§ 3, .— The Swiss sickness insurance system
Scope of compulsory insurance enacted by the cantons
Scope of subsidised voluntary insurance
47
48
48
PART
II
INSURANCE I N S T I T U T I O N S : CONSTITUTION AND MACHINERY
INTRODUCTION:
General functions of sickness insurance institutions
49
CHAPTER I : Constitution and Machinery of Compulsory Sickness Insurance Institutions.
§ 1 . — Principles of organisation of compulsory sickness insurance :
Main features of its development
. . :
51
§ 2. — System of free affiliation
Main features
British legislation
52
52
53
§ 3. — System of subsidiary legal affiliation
Main features
Mutual benefit funds
Trade funds (caisses professionnelles)
Territorial insurance funds
56
56
58
59
62
.
VII
Page
§ 4 . — System of legal affiliation
Main features
Territorial insurance funds
Trade funds
.
64
64
65
66
CHAPTER I I : Constitution and Machinery of Voluntary Sickness Insurance Institutions.
Approved sickness insurance funds
Preliminary remarks
Conditions required for approval
Membership
68
68
68
69
PART III
SICKNESS INSURANCE BENEFITS
INTRODUCTION:
Development in general features of the system
CHAPTER I :
71
Benefits in Cash.
§ 1 . — Conditions of benefit
Physiological condition: Incapacity for work . . . .
Legal conditions
.
Waiting period (délai d'attente, Wartefrist, Wartezeit) .
73
73
75
78
§ 2. — Rates and period of sickness benefit
Legal sickness benefit . . . ,
Table showing rates of fixed benefit laid down by the
British Act
Table showing the rates of "arrears penalty" and the
reduced rates of sickness (disablement) benefit for
compulsory contributors
Table showing the legal scale and period of sickness
benefit in a number of sickness insurance systems
| 3. — Additional sickness benefit
Conditions upon which insurance institutions are
authorised to introduce additional benefit . . . .
Conditions governing payment
The measures of additional benefit afforded
81
81
90
90
91
§ 4. — Grants for funeral expenses
92
CHAPTER I I :
82
83
89
90
Benefits in Kind.
S 1. — Conditions of benefit
94
§ 2. — Medical benefit and the supply of drugs, etc. to contributors
95
— VtlI —
§ 3 . — Medical benefit afforded to the contributor's family . .
§ 4. — Institution treatment and Additional benefit in kind . .
Special and additional forms of benefit in kind for
contributors
Additional benefits in kind afforded to the contributor's family
§5.—
Organisation of the medical service
Responsibility for organising the medical service . . .
Organisation of the medical service
The working of the medical service
PART
Page
97
98
99
101
102
102
102
106
IV
RESOURCES OF SICKNESS INSURANCE
INTRODUCTION:
<>
The financing of sickness insurance
CHAPTER I:
Financial
Resources
of Compulsory
: .
Sickness
107
Insurance.
§ 1. — Insurance contributions: Contributions at flat rates and
on a sliding scale
Contributions at flat rates
Contributions on a sliding scale
109
109
109
§ 2. — Apportionment of contributions between the insured
worker and his employer
112
§ 3. — State subsidies
114
§ 4 . — The levying of contributions: Deduction at source
CHAPTER I I :
. . .
115
Resources of Free Sickness Insurance.
Members'contributions and state subsidy
117
APPENDIX
List of Principal Legal Texts chiefly used in the Sickness Report
119
INTRODUCTION
THE ORIGIN OF COLLECTIVE PROTECTION AGAINST SICKNESS
The idea of the collective protection of individuals against the
consequences of the most usual physical risk, th,at of sickness,
dates from of old. It came into being as soon as production began
to be organised on the principle of the division of labour and there
were persons with only a single factor of production at their call,
that of labour.
The guilds of the medieval urban communities, with their
fraternal funds, were the first to carry out the idea of collective
protection against sickness, and they thus became the pioneers
of mutual aid. They affected only a very small fraction of the
population, and this fraction, by the power of its privileges and
the unity with which it defended them, established a bond of
brotherhood between the members of the guild.
The need for collective protection against sickness assumed a
different aspect with the creation of the class of industrial wage
earners by the introduction of machinery at the beginning of last
century, which led to the most varied physical risks in conditions
of life and work. A worker in one of the earliest industrial factories, although personally free, was crushed, from the economic
point of view, by the competition of thousands of workers who had
been deprived of their means of livelihood by the introduction of
machinery. If ever he became physically unable to work, he was
liable to fall a victim to want, for his wages were barely enough
to satisfy his immediate needs and could not allow of sums being
set aside to secure his livelihood and that of Ms family in the event
of illness.
¡
When the workers began to realise the benefits of solidarity,
they united in mutual aid societies to guard against economic and
physical risks. Often, the first body formed to protect their
occupational interests at the same time became the nucleus of
collective provident organisations. Occasionally, the mutual aid
fund served as a screen for militant organisations for the protection of occupational interests. Mutual aid societies thus sprang up
in the atmosphere of occupational solidarity which imbued the
labour world. Being dependent on the occupational organisations
which founded them, they were certain of the support of the trade
unionists, but could not act outside the membership of the unions.
Mutual aid was still in a state of isolation; its resources, being
derived solely from the contributions of members, were low, and
the aims it pursued could not but be modest.
From time to time, employers took the initiative of protecting
their sick workers against distress, an initiative which sprang from
a sentiment of humanity and the desire to attach to the factory
a stable body of labour which appreciated the liberality of its
employers.
The State was still dominated by the individualist outlook and
would not undertake the functions of protecting public health. By
very slow degrees, the idea gained ground that it was necessary for
the public authorities to intervene to protect the workers in the most
dangerous branches of industry. The first to be protected by
compulsory provident action were miners and seamen, for the risks
run by these .workers were too serious for their protection to be
neglected. But the vast majority of workers in industry and
commerce were still without legal protection against sickness.
THE FIRST COMPULSORY SICKNESS INSURANCE LAWS
Although the idea of making collective protection against sickness compulsory and applying it to any person altogether or
mainly dependent on his labour, took form as far back as the
French Convention of 1794, it was not carried into effect until the
adoption of the German Act of 16 June 1883. In spite of being
limited to workers in industrial undertakings, this Act was nevertheless a bold innovation and a most important social reform.
The motive of the reform was a desire to improve the conditions
of life of the workers in order to reconcile them with the State as
an institution defending the capitalistic organisation of production,
— 3 —
and at the same time to deprive the workers' occupational organisations of the potential weapon they possessed in the numerous
mutual aid and provident bodies attached to the trade unions.
As soon as the principle of compulsory insurance had been extended
to workers in transport undertakings and to agricultural workers
(Acts of 1885 and 1886) Germany became the first country to have
a system of compulsory sickness insurance covering practically
all workers.
EVOLUTION UNTIL THE WAH
Other industrial States were slow to follow the German example.
Former Austria, by the Act of 30 March 1888, and former Hungary
by the Act of 9 April 1891, were alone in introducing a system
of sickness insurance applying to workers in industry, transport
and commerce.
Although other States rejected the principle of compulsory
insurance or accepted it only for certain classes of workers exposed
to special risks, such as seamen, miners and railwaymen, their
attitude towards the mutual aid societies created on the initiative
of the workers themselves changed. They gradually lost the
indifference they had hitherto shown towards the very functions
of mutual aid, which began to be recognised as an instrument for
public utility, and sometimes even received subsidies out of State
funds. This process was indicated more especially by the Italian
Act of 15 April 1886, the Spanish of 30 June 1887, the Danish of
12 April 1892, the Belgian of 23 June 1894 and the French Charter
of Mutual Aid Societies of 1 April 1898. Mutual aid, thus recognised and subsidised and open to anyone applying for admission,
became an instrument for the protection of public health. In
spite of defections, it waB able to gain ground and to reach the
large masses of the workers, although it was not in a position
completely to hold them and force itself upon them. There were
still many improvident persons for whom mutual aid had no
appeal.
The idea of compulsory sickness insurance, at the outset so
slow in evolving, found more rapid acceptance at the beginning
of the twentieth century. The Luxemburg Act of 31 July 1901
was the first of a new series of laws introducing a general system
of compulsory sickness insurance. It was followed by the Norwegian Act of 18 September 1909, the Serbian of 11 July 1910
— 4 —
and the Russian of 20 November 1911, all more or less inspired by
the German example. By the Act of 16 Deeember 1911, Great
Britain, the cradle of classic liberalism, gave her full support to the
principle of compulsory insurance by making virtually all workers
liable to insurance against sickness and disablement. The Roumanian Act of 25 January 1912 concluded the victorious progress
of the principle of compulsory insurance in Europe until the world
war.
THE PRESENT POSITION OF LEGISLATION ON SICKNESS INSURANCE
Legislation on compulsory sickness insurance was held up during
the war, Norway being the only country to re-organise its system
by the Act of 6 August 1915, but it was resumed with fresh vigour
at the end of the war.
Those European states, whose territorial status was defined by
the Treaties of Peace, hastened to extend and perfect the legislation on compulsory sickness insurance they had inherited- Thus,
the principle of compulsory insurance for all workers was established
in Czechoslovakia by the Act of 15 May 1919, in Poland by that
of 19 May 1920, in Austria by that of 21 October 1921 and in the
Kingdom of the Serbs, Croats and Slovenes by that of 14 May
1922. Similarly, in Soviet Russia, when the system of relief
created in 1918 had been given up as a result of the introduction
of the new economic policy, the Labour Code of 1922 embodied
the principle of compulsory insurance. In Bulgaria, the Act of
6 March 1924 extended the system of social insurance, set up by
the Act of 15 December 1918, to all classes of workers. In Western
Europe, the principle of compulsory insurance was accepted in
Portugal by the Decree of 10 May 1919, which applies to any person
who may need the assistance of the community. By the Act
of 16 July 1922, Greece, too, joined the group of states in which.
the principle of compulsory collective protection against sickness
had been adopted. Among the chief states outside Europe, Japan
by establishing compulsory insurance for workers in industrial
undertakings under the Act of 22 April 1922, took a definite step
in the direction of compulsion.
The following table illustrates the remarkable development of
compulsory sickness insurance during the last forty years :
>
— 5 —
LAWS INTRODUCING COMPULSORY SICKNESS INSURANCE
Date of compulsory
sickness insurance Acts
Country
Workers covered
Germany
15 June 1883 . . .
28 Mav 1885 . . .
5 May 1886 . . .
30 March 1888
21 October 1921. .
9 April 1891
Hungary
Luxemburg
. . . .
. .
31 July 1901 / .
24 April 1908 1 .
Norway
18 September 1909)
6 August 1915
)
Serbs, Croats and Slovenes (Kingdom of)
12 July 1910
14 May 1922
Russia
20 November 1911)
9 November 1922 )
•
Great Britain
. . .
/
\
.
.
16 December 1911
Róumania
25 January 1912
.
Bulgaria
15 December 1918)
6 March 1924
\
Portugal
10 May 1919 . . .
Czechoslovakia . . .
30 March 1888 . .
15 May 1919 . . .
19 May 1920
. . .
16 July 1922
. )
8 December 1923 \
22 April 1922 . .
Industry
Commerce
Agriculture
I Industry
/ Commerce
Agriculture
i Industry
| Commerce
t Industry
/ Commerce
Í Industry
} Commerce
( Agriculture
Í Industry
< Commerce
( Agriculture
j Industry
( Commerce
( Industry
< Commerce
f Agriculture
Industry
Í Industry
¡ Commerce
( Agriculture
All persons in a weak
economic position
J Industry
/ Commerce
Agriculture
Í Industry
1 Commerce
f Agriculture
t Industry
i Commerce
Industry
In certain countries, where collective action is binding only for
workers employed in undertakings which have achieved a certain
degree of organisation (mines, railways, shipping), more attention
is paid to facilitating the development of mutual aid bodies created
— 6 —
by the persons actually concerned. Mutual aid societies in receipt
of public subsidies on the Belgian (Act of 1894) and French (Act
of 1898) model, may extend their scope and win new members.
This system of "subsidised freedom", in its developed and perfected form, is the basis of the Swedish Act of 4 July 1910, the
Swiss of 13 June 1911 and the Danish of 10 May 1915.
Whereas in Europe, collective protection against sickness is
almost general, the great oversea countries still adopt a waiting
attitude, placing, as they do, individual initiative above all. The
authorities intervene only to regulate private initiative for providing against sickness; but the freedom to create provident
institutions is not accompanied by their right to count, in the
performance of their work, on the behests of the law for obtaining
members, or on subsidies from public funds.
The absence of active intervention on the part of the authorities
is characteristic of the present position of sickness insurance
legislation in the American States, Australia, New Zealand, South
Africa and several other industrial communities. Nevertheless,
in nearly all these countries, the question of wider State intervention is under consideration.
For this reason, it would seem particularly appropriate at the
present time to discuss the legal principles on which sickness
insurance laws are based and which involve active State collaboration in the form, either of imposing compulsory insurance, or of
giving moral and material encouragement to free insurance.
*
*
*
The comparative analysis of national laws will be dealt with
under the following heads:
Part I :
The scope of sickness insurance laws.
Part II :
Insurance iristitutions, their constitution
:
organs.
Part III:
Sickness insurance benefits.
Part IV:
Sickness insurance finance.
and
PART I
THE SCOPE OF SICKNESS INSURANCE LAWS
INTRODUCTION
FACTORS DETERMINING THE SCOPE OF LEGISLATION
The scope of sickness insurance laws varies with the type of
insurance, which may be either compulsory or voluntary. It is
also dependent on the territorial limits within which the law
applies and the period du'ing which the beneficiaries or insured
persons are covered.
Compulsory or Voluntary Insurance
The object of this legislation may be either to assist or to compel
individual persons to insure against the risk of illness.
A voluntary insurance law sets up a system of insurance, and
defines the rules for its working, but leaves each person free to be
provident or not as he chooses. It defines the persons who may
take advantage of the system, and thus fixes "the maximum scope
of the law. This may be — and as a matter of fact is — much
wider than the actual field covered, for many persons who might
insure do not make use of theii right.
A compulsory insurance law does not merely set up a system
of insurance. It carefully defines persons or groups of persons foi
whom it is compulsory to make provision for the future undei the
conditions laid down. The text of the law thus clearly defines its scope.
The classical division of this legislation into two chief groups,
compulsory insurance laws and voluntary insurance laws, is explained and justified by the fundamental difference in scope
according as the individual is under an obligation to insure or is
left free to do so.
Territorial Limits
The two other factors in the scope of insurance laws are less
important. An insurance law forms part of the general body of
— 8—
law introduced by positive legislation, the operation of which
is limited not only with respect to the persons covered, but also
with respect to the area to which it applies. As a rule at least,
it does not operate outside the frontiers of the state, but in view
of the numerous exceptions to this general rule, the territorial
limits to the scope of insurance laws must be studied.
Timé Limits
Finally the application of an insurance law to the individual,
like that of any other law, is limited as to time. It begins at a certain date, lasts for a certain period, and then ceases.
COMPULSORY INSURANCE LAWS IN GENERAL
The feature common to all compulsory sickness insurance laws
is that they make insurance binding on all persons in a weak
economic position, who therefore need to be helped by the community when they fall ill.
At present only one country is content with this single ciiterión.
The Portuguese Decree of 10 May 1919, No. 5636, introducing
compulsory sickness insurance, defines insured persons as all those
whose annual income is not more than 900 escudos. It does not
matter whether the insufficient income is made up or not by remuneration for an occupation carried on dependently or independently. As long as the income remains below the fixed limit,
insurance is compulsory. The Portuguese system is therefore an
example of social insurance in the literal sense of the term.
Several compulsory insurance laws, while maintaining the criterion that the community should make provision for the future
on behalf of persons who are socially weak, define insured persons
as those who carry on an economic occupation in a dependent position. The compulsory insurance system thus applies to the social
class of wage-earners or persons living on the proceeds of their
work performed on behalf of another. It becomes an institution
for this particular social class, and may either apply to all wage
earners in general or be limited to those wage-earners whose resources are not sufficient to allow them to dispense with compulsory
collective provision for the future. As a rule the criterion adopted
by the law for. deciding whether a person is to be considered as
belonging to the class of wage-earners is that the remuneration for
his work done on behalf of another should be his regular and principal means of livelihood.
— 9 —
General Workers'1 Insurance
The first compulsory sickness insurance Acts (German Act of
1883 and Austrian Act of 1888) defined insured persons as those
in the employment of industrial undertakings. This example has
not been followed, and the laws which make insurance compulsory
for all wage-earners no longer require that the insured should be
connected with an undertaking in a specific class.
Germany introduced a system of general workers' insurance by
the Act of 10 April 1892. She was followed by Norway in 1909
and Great Britain in 1911, and the example has had its influence
on a considerable number of post-war laws introducing general
workers' insurance. This evolution is clearly indicated by the
Czechoslovak Act of 15 May 1919, the Polish Act of 19 May 1920,
the Austrian Act of 21 October 1921, the Jugoslav Act of 14 May
1922, the Russian Act of 9 December 1922, and the Bulgarian Act
of 6 March 1924.
Although these laws are far from being the same in detail, they
are fairly closely related as far as the determination of their scope
is concerned. They all define any worker as insured if he performs
work for remuneration on behalf of another.
Limited Workers' Insurance
In a certain number of other states compulsory insurance is
similarly instituted as an integral part of the labour system,
but it is not applied to all wage-earners, being limited to workers
and employees in industrial and commercial undertakings. Agricultural workers and other wage-earners in branches of industry
which are not sufficiently organised are without any collective provision against the risk of sickness, unless extensive use is made of
the voluntary right to insure. This group of laws includes those
of Luxemburg of 30 July 1901, Hungary of 1907 (No. XXIX),
Latvia (consolidation of 1922), Japan of 22 April 1922, Greece of
16 July 1922, administered in accordance with the Decree of 8 November 1923.
The Roumanian Act of 25 January 1912 occupies a special
position. Taking the guilds of manufacturers and artisans as a
basis, it organised compulsory insurance both for the employing
members of the guild and the workers and employees in their
service.
— 10 —
Special Systems of Compulsory Insurance
In addition there are several states which maintain the principle of voluntary insurance in general, but have introduced one or
more special systems of compulsory insurance limited to wage
earners employed in certain classes of undertakings. These are as
a rule industrial or transport undertakings which are highly organised and involve special risks for a large and unchanging staff.
Although these special systems are based on compulsion, they, do
not come within the scope of this study. Being limited to the
wage-earners in a specific branch of industry or commerce, they
have acquired specialised characteristics, which make it hardly
practicable to extend them to other groups of wage-earners.
CHAPTER I
THE SCOPE OF GENERAL WORKERS' INSURANCE
§ 1.— Persons liable to Insurance
As already stated, after Germany adopted the principle of general
workers' insurance (Act of 10 April 1892), several countries followed
her example, introducing this system either at once or in stages:
Norway in 1909, Great Britain in 1911, Czechoslovakia in 1919,
Poland in 1920, Austria in 1921, the Kingdom of the Serbs, Croats,
and Slovenes in 1922, Russia in 1922, Bulgaria in 1924.
The general rule to be deduced from all these laws is that of
•compulsory insurance for all persons performing work for remuneration on behalf of another. The first workers' insurance laws
confined insurance to wage earners in undertakings belonging to
specified classes, but now such laws no longer demand that the
workers affected should be connected with an undertaking in a
given group.
The conditions on which compulsory insurance applies to any
person are as a rule the following:
(1) He must be employed in a dependent position on behalf
of another;
(2) The work must be performed under a contract of employment;
(3) The work performed on behalf of another must constitute
his ordinary means of livelihood.
The occupation as defined above is the factor determining
whether the worker is an insured person.
THE CONDITIONS OF COMPULSION
Employment in a Dependent Position
When a person is employed in a dependent position, he is subject
to the orders of one or more employers. The nature of the employment is as a rule without importance, as also the place of employ-
— 12 —
ment, whether in a factory or undertaking (centre of production)
or in the household of the employer (centre of consumption).
The employment must be effective, in other words, the employer
must be able to dispose of the labour of the worker. The insurance
dates, not from the conclusion of the labour agreement, but from
the entry into employment. Further, once the worker has become
subject to the orders of the employer, it is obviously not required
that the employment should be uninterrupted, provided that the
legal obligations arising out of the labour agreement still hold
good, and that neither the worker nor the employer have cancelled
the agreement or made it impossible to resume the employment.
Employment under a Contract
The mere fact of employment is not sufficient. The employment
must be in accordance with a contract. It is a matter of indifference
whether the contract is a contract of employment in the strict
sense of the word, a contract to hire labour, or some other kind
of contract, provided that it subordinates the worker to the orders
of the employer, who in return must remunerate him. Nor is it
necessary that either the form or the matter of the contract should
be actually agreed. Insurance is compulsory even if the contract
is concluded with a person who is not in a position to bind himself
without the consent of his legal representative, or if the forms
prescribed by the civil code have not been observed (e.g. absence
of a written agreement;, conclusion without witnesses), etc. If
effective employment under a contract is a necessary condition,
it follows that the mere existence of a contract without effective
subordination to the orders of an employer is not enough to justify
the insurance being continued.
Paid Work the Ordinary Means of Livelihood
Finally, the employment giving rise to insurance must have
some economic importance for the worker. Although he is not
required to have worked for a specified period, as a rule casual
work, which is insufficient for his ordinary livelihood, is not taken
into account. Although no conditions are laid down for the minimum remuneration which the worker is to secure in return for
his work, no account is taken of an occupation from which he
derives only an insignificant part of his necessary means of livelihood. Whatever the differences in the actual methods of settling
this point, it is certain that only workers who are able to live on
their paid work are entitled of right to benefit by insurance.
— 13 —
The attitude adopted under the different systems of general
workers' insurance will be discussed below and illustrated by
examples.
The British Act (Consolidation Act of 7 August 1924) states
that any person is compulsorily insured (an employed contributor)
who is employed "under any contract of service or apprenticeship" (First Schedule, Part I (a)). The work must be paid for,
but the method of remuneration, whether in cash or in kind or in
some other economic form, is of no importance. Further, no account
is taken of "employment ofca casual nature otherwise than for the
purposes of the employer's trade or business", or of "employment
which may be specified in a special order as being of such a nature
that it is ordinarily adopted as subsidiary employment only and
not as the principal means of livelihood". (First Schedule, Part II
(I) (m).)
The German Insurance Code (Section 165) makes insurance compulsory for workers, journeymen, employees, foremen, etc., who
are actually in employment and paid in some form or other. Although no definition is given of the period of employment rendering
the worker liable to insurance, persons temporarily employed (vorübergehende Dienstleistung) are not so liable. Thus a person is exempt
if he does not generally live on the proceeds of his paid work, and
is occasionally employed on work which was a rule lasts not more
than a week, or which has been limited to a week by the contract
of employment, or if his employment, though regular, is only
from time to time and of a subsidiary nature, and his remuneration
is not an important means of livelihood (Decree of 17 November
1913, p, 756).
Section 1 of the Czechoslovak Act of 15 May 1919 (reproduced
in full in the new Act of 9 October 1924, Section 2) states that any
person is liable to insure who carries out work of other than a
subsidiary or casual nature under a contract of labour, service or
apprenticeship. The Act does not specify that the work must be
paid for, but by excluding subsidiary and casual employment it
presupposes an employment which occupies if not all, then at,
least the greater part of the worker's time, and provides him with
his regular and permanent means of livelihood. No minimum
remuneration at which insurance ceases to be compulsory is fixed.
The examples can easily be multiplied. The Norwegian Act of
6 August 1915, the Austrian Act of 30 March 1888 (text of the
— 14 —
Order of 20 November 1922) \ the Polish Act of 19 May 1920, the
Jugoslav Act of 14 May 1922, to mention no others, make insurance
compulsory for all paid workers employed under a labour agreement,
whatever the agreement or the nature of the work. These laws
exempt :
(a) Workers who are temporarily employed (Polish Act, Section 7) ;
(b) Persons whose employment in an occupation subject to
compulsory insurance is only casual or temporary, or to
whom employment in the occupation is subsidiary. (Austrian Act, Section 2, subsection 7.)
(c) Persons whose work or service cannot exceed six days owing
to the nature of t h e said work or service. (Norwegian Act,
Section 1, subsection 3.)
The method followed in the Jugoslav Act is slightly different. It applies t h e principle of compulsion also to casual
and temporary workers, but provides that administrative
regulations may be issued to exempt "any persons who
become liable to insurance only at intervals on account of
occasional and temporary employment for wages" (Section 4).
The importance of the general formula fixing the scope of systems of general workers' insurance is easy to realise. Under tins
formula, any person is liable to insure who lives on the proceeds
of work in a dependent position. In view of the proportion of
labour to the other factors of production, this is equivalent to
admitting the large majority of the active population to the benefits
of sickness insurance, t h u s affording an important means of correcting inequalities in the conditions of paid workeis. More than
this, if any worker falls ill, a system of general workers' insurance
will provide him not only with the living he is unable to earn, but
also with suitable and individual medical treatment, and would
therefore appear to offer a sound basis for constructive public health
policy.
§ 2. — Limitation of the General Formula
A general formula for t h e scope of social insurance has thus been
found and its factors have been analysed. The next point to
1
By a decision of the Constitutional Court, the Federal Act of 21 October
1921, extending compulsory insurance to agricultural wage-earners, has been
invalidated, with effect from 6 February 1925, as being unconstitutional.
Since then insurance of agricultural wage-earners is provided under regional
legislation.
— 15 —
consider is the circumstances under which the general formula
is limited in effect and no longer applies to the individual.
These exceptions will be described without entering into their
sociological basis. In origin, they may be physiological (age, sex,
invalidity), political (nationality), or economic (wage or income
limits) and are then absolute, or they may be merely relative.
ABSOLUTE EXCEPTIONS
Physiological Conditions
Age
Some laws fix age limits outside which insurance is not compulsory. The underlying assumption is that persons who have
not yet reached, or have passed, a certain age cannot perform the
paid work which is the regular means of livelihood of the workers.
Thus, the British Act fixes a minimum age limit of 16 years and
a maximum of 70 years. If a worker's age is not between these
two limits, he is not insured of right nor entitled to insure voluntarily (Section 1, subsection 1; Section 7,- subsection 9; Section 13,
subsection 8).
In the Norwegian Act, a minimum age limit of 15 years is fixed
(Section 1, subsection 1). Other general workers' insurance laws,
on the other hand, fix no such limit; sometimes, however, a limit
is imposed indirectly by the laws concerning the school leaving age
and the minimum age for entering employment.
Sex
The factor of sex does not enter into the creation of a liability to
insurance although it may influence both contributions and benefits1.
The question whether a married woman working under a contract
of employment has obtained the consent of her husband, which
may be required under civil law, is of no importance in compulsory
insurance.
Working Capacity
Since one of the three conditions for applying the general formula
is that the worker should be actually employed, the liability to
insurance must depend on his being able to perform the work
incumbent on him under his contract. Obviously, the worker
does not lose his position as an insured person if, after he is admitted to insurance, he loses the physical capacity to work, for
1
See, e.g. pp. 82 and 109.
— 16 —
this is in point of fact the risk covered by the insurance. The
Norwegian and German Acts contain special provisions concerning persons whose earning capacity has been much reduced after
prolonged illness.
Under the German Act, persons who are unable to carry on
regular work are not excluded from compulsory insurance. A person
in receipt of an invalidity pension may, however, obtain exemption
on application. Exemption is also granted to workers who have
exhausted their right to sickness benefit, for as long as they ave
unable to work or continue to need medical treatment for the same
illness. It would be useless to compel workers to pay contributions if they have exhausted their right to benefit and are, therefore
unable to obtain further relief from the insurance institution.
(Section 173 of the Insurance Code.)
Like the German Act, the Norwegian Act provides for the
exemption of workers whose earnings capacity is much reduced by
chronic disease or other permanent infirmity or complaint (Section 1, subsection 4). The reason for this optional exemption is
the same as in Germany. For when an insured person has been
paid benefit for thirty-nine weeks in respect of one illness, the
Norwegian Act withholds all further benefit until two years from
the date of the last payment (Section 19, subsection 4). The
exemption also applies to persons suffering from an infirmity before
they first entered employment; under Section 17, subsection 1 of
the Act, any person suffering from a disease before being insured
in a sickness fund is not entitled to benefit if he has another attack
of the same disease, unless a year has passed since he was admitted
to the fund.
Political Conditions
Nationality
As a rule, the liability to insurance as a measure in public law
applies both to nationals and foreigners. The position is different
for voluntary insurance or the voluntary continuation of compulsory insurance.
Political status is not taken into account, the treatment of foreigners working in a country being the same as that of nationals as far
as the liability to insurance is concerned. Sometimes the law
explicitly formulates this legal condition (e.g. the British Act,
Section 1, subsection 2; the Polish Act of 6 July 1923; the Jugoslav Act, Section 8; the Bulgarian Act, Section 7). Sometimes the
— 17 —
condition is implicit in the general status of foreigners under the
law of the State, which has enacted the insurance legislation.
Occasionally, optional exemption is allowed in respect of persons
working temporarily in frontier districts (e.g. for Germany the
Decree of 17 November 1913).
Under some laws, this equality of treatment for foreigners may
l e modified as a measure of retaliation, to the detriment of nationals
of countries which do not provide the same treatment for foreigners as for their nationals. Such measures of retaliation do
not apply automatically but require administrative action by
the competent authorities. Once the conditions for applying
measures of retaliation have been fulfilled, the competent authorities are free to determine whether they shall be applied. It is
uncertain whether the measures may altogether exclude foreigners
from insurance or whether they should be confined to limiting the
benefit derived from insurance.
An example may be found in Section 158 of the German Insurance Code, empowering the Government, on the advice of the
Federal Council, to enforce the right of retaliation against nationals
of a foreign State. The Jugoslav Act is much more definite. It does
not authorise the application of special regulations for nationals
of States with a system of workers' sickness insurance, unless such
States refuse Jugoslav nationals employed in their territory equality
of treatment with their own nationals (Section 8, subsection 3).
The Polish Act of 6 July 1923 contains similar provisions.
Economic Position
Wage or Income Limits
The general formula, under which every wage-earner working
under an agreement is liable to insurance, is limited if the legislature
considers that certain groups of workers are strong enough to do
-without the assistance of the community. This limitation, applying only to non-manual workers, is to be found in the German,
British, and Norwegian Acts, and in an attenuated form in the Polish
Act. On the other hand, the Austrian, Bulgarian, Russian.
Czechoslovak, and Jugoslav Acts contain no limitation of the kind,
The German Act (Section 165) exempts the officials of an
undertaking, the foremen and other employees in a similar economic position, commercial employees, the members of theatrical
companies and orchestras, teachers and instructors, provided that
.their annual income is over 2,400 marks (Decree of 29 February
2
— 18 —
1924). For the purposes of this limit, the income is calculated.
exclusive of any family allowances (allowances for wife or children)
which the above-mentioned non-manual workers may receive.
The British system is very similar to the German. Under the
First Schedule (Part II (k)) of the Act, all persons are exempt who
are employed "otherwise than by way of manual labour and at a
rate of remuneration exceeding in value £250 a year". The same
provision applies to non-manual part-time employment at a rate
of remuneration which is considered "equivalent to a rate of remuneration exceeding £250 a year for whole time service ". Private
income may not be taken into account.
Under Section 1, subsection 2 of the Norwegian Act (text of
10 December 1920), any employee with a total annual income of
more than 6,000 kroner is exempt from the liability to insurance.
Unlike the German and British Acts, the Norwegian Act takes into
account not only the employee's salary, but also his private income
as declared in the last income tax return.
The Polish Act (Section 4, subsection 1) introduces a similar
limitation, but it is modified in two directions. In the first place,,
exemption is allowed only for persons who act as the immediate
representatives of the owners of industrial or commercial undertakings (managing directors, directors) and whole salary exceeds.
7,500 zloty a year (Decree of the Ministry of Finance of 30 June
1924). Secondly, the exemption of these groups of non-manual
workers is not automatic, but must be applied for. If the conditions for exemption are fulfilled, the application cannot be refused.
RELATIVE EXCEPTIONS
Degree of Relationship with the Employer
The general formula is often limited when applied to members
of the family working in the undertaking or household of their
employer. To avoid possible misunderstanding, it must first beexplained that there can be no question of limiting the application
of the formula when the member of the family is not employed
permanently for remuneration and his services are given without
an intention to establish regular relations on the basis of a labour
agreement. In these cases, there is no question of paid work, and
therefore the general formula does not apply. The legal position is.
different when the member of the family is employed regularly
for remuneration, whether in cash or in kind, in the undertaking,
— 19 —
or household of his relative. Then the general formula applies,
in the absence of special exceptions.
Exemption of Husband or Wife
Almost all insurance laws exempt employment in the service of
the husband or wife of the employed person, even if the work is
paid for. In view of the legal obligations of the husband, the
insurance of the wife would involve a duplication of rights. It
should be observed that the exception applies to husbands as well
as to wives.
The German Insurance Code (Section 159) exempts the husband
or wife of the employer.
The provisions of the British Act are the same in every respect
as those of the German Act (First Schedule, Part II (p)).
The Czechoslovak Act states that a husband or wife is not to
be considered as employed under a contract of service or apprenticeship (Section 2, subsection 3) ; the new Act of 9 October 1924
does not maintain this restriction.
The position is the same under the Austrian Act which exempts
employment in the service of the husband or wife (Section 2,
subsection 4).
Exemption of the Children and other Members of the Employer's Family
The considerations on which the exemption of the husband or
wife of the employer are based do not act in the same way for the
children and other members of his family working in his undertaking or household. Accordingly, legislation is not unanimous in
placing the children and members of an employer's family outside
the general system.
Unlike the husband or wife of the employer, a child working in
the undertaking or household of his parent for remuneration in
cash, and not living with his parent, is liable as a rule to insure,
without the option of exemption.
Certain laws, however, exempt children, either automatically
or on application, if they work on behalf of their parent without
money remuneration at a rate fixed in advance.
The exemption is automatic in Great Britain, Norway and
Czechoslovakia. It is granted on the application of the employer
in Germany, whereas in Austria it is automatic in certain cases,
in others, granted on the application of those concerned. As a
— 20 —
rule, it applies only to children employed by their parent, but
the Czechoslovak and Austrian Acts admit of exemptions for
other members of the employer's family.
In Germany the exemption, which is limited to children working
as apprentices in the undertaking of their parents, does not apply
of right, but only on the application of the parent employer.
Neither ascendants nor collaterals are entitled to exemption
(Section 174, subsection 1).
The system in force under the British Act differs from thatunder the German Insurance Code in two respects. The exemption applies of right whatever the wishes of those concerned, and
relates not only to children as apprentices, but to any child employed
by his parent without right to remuneration in cash. The criterion
is therefore the method of remuneration. It may be added that a
similar exemption applies to persons maintained by the employer and not in receipt of money payment (First schedule, Part
The situation in Norway is very similar. The Norwegian Act
exempts all children working on behalf of their parents in their
home if they are not paid in cash at a rate determined in advance
(Section 2, subsection 2).
On the other hand, the exemption allowed under the Czechoslovak
Act of 15 May 1919 (Section 2, subsection 2) is much wider. It
applies of right, not only to the children of the employer, but to
any member of his family living with him who is not in receipt of
money payment, although over 14 years of age and engaged in an
occupation subject to compulsory insurance. The persons thus
automatically exempt are free to insure voluntarily, but the new
Czechoslovak Act of 9 October 1924 contains no such provision.
The exemptions allowed by the Austrian Act are as wide.
Section 2, subsection 5, provides not only for the exemption of the
children (including illegitimate or adopted children) but also of
the grandchildren, parents and grandparents of the employer.
Unless they are employed in agriculture, the exemption does not
apply if they are remunerated in the same manner and degree as
a worker liable to insurance. If, on the other hand, they are
employed in an agricultural undertaking, the exemption does not
apply unless at least one worker liable to insurance is normally
employed in the undertaking in addition to the members of the
employer's family. These two exemptions were recently extended
— 21 —
by the nineteenth amendment Act of 21 June 1923, according to
which exemption must be granted on the application of an agricultural employer for members of his family employed by and
living with him, provided that he undertakes to pay for their
maintenance and medical treatment if they fall ill.
§ 3. — Special Occupations under the General Formula
The previous section dealt with the limitations of the general
formula resulting from either absolute or relative exceptions based
on the particular position of the individual worker. The next
point to consider is the application of the general formula to certain
occupations which, because of their stability (civil servants and other
public employees) or of the special conditions under which they
are carried out (domestic workers, home workers, call for different methods to meet their special requirements.
CIVIL SERVANTS AND OTHER PUBLIC EMPLOYEES
The staff of public administrative offices, unlike the workers
and employees in the undertakings of the state and other public
bodies, have only recently been considered as proper beneficiaries of
the special measures of protection in the event of illness. As long
as the principal form of insurance benefit was the money payment
intended to make up for the loss in wages due to sickness, a public
official, being in receipt of a fixed salary that would still be paid
during periods of incapacity to work owing to illness, appeared to
enjoy the most important benefit which other wage-earners acquired
only by inclusion in the system of compulsory sickness insurance.
With the realisation that from the point of view of public health
pecuniary benefit alone was ineffective, and with the growing
importance attached to medical benefit, the public official, being
certain only of the continuation of his salary, in most cases insufficient to secure suitable medical treatment, was found to be in
a less satisfactory position. When several laws adopted the general
formula of the liability of wage-earners to insurance, the relative
disadvantage in the position of the public official could no longer
be ignored.
The problem to be solved was that of enabling officials with
fixed salaries to profit bj the material, not the pecuniary, benefits
of sickness insurance. Although the object in view was the same,
the solutions adopted differ considerably from one country to
another. One consists simply in including public officials in the
— 22 —
general insurance system. Another finds it better to entitle public
officials to benefits in kind under a special system of insurance
devised to meet the requirements of workers with fixed salaries.
The third, and at present most usual solution excludes public
officials from the general system only if their conditions of employment are such that in the event of illness their treatment is at
least as favourable as that enjoyed by workers in private undertakings under the general system of insurance. Thus officials are
not exempt automatically from the liability to insurance, but only
if there has been a serious improvement in their conditions.
Certain typical examples of the position of public officials with
respect to compulsory sickness insurance are given below.
Exclusion on Condition of Equivalent Treatment
The German Insurance Code (Section 169) grants exemption from
the liability to insurance t o persons holding a public appointment
(officials) under the Federal Government, the States, the communes,
the federal railways, or social insurance institutions, and to persons
engaged by the Federal Government, the States or the communes for
life or for employment not subject to dismissal (employees), with the
right to superannuation to be paid for by the employer. The exemption is conditional on the right of these persons either to benefit
at least equivalent in nature, duration and amount to the statutory
benefit payable by sickness funds under the Insurance Code, or
to full sick pay, or to a pension of not less than one and a half
times the statutory sickness benefit for at least 26 weeks. The
exemption applies under the same conditions to teachers and
instructors in public schools. It should therefore be noted that
the exemption is subject to the existence of conditions of employment at least as favourable as the provisions of the law on sickness
insurance; otherwise the liability to insurance under the general
system remains intact.
Public officials and employees of public bodies other than those
mentioned above (artisans' guilds, medical associations, etc.) may
be exempted on the application of their employers if they are
entitled in the event of sickness to the same privileges as Federal
officials or employees who are exempt from the liability to insurance
(Section 170).
Public employees who are not appointed for life or a term
during which they are not subject to dismissal, and who are not
«ntitled to superannuation are covered by the general system,
unless they are engaged for purposes of training.
— 23 —
The system introduced by the British Act differs markedly from
the German system. Insurance is compulsory for all persons
•employed "under any local or other public authority except in so
far as such employment is excluded by a special order" (First
Schedule, Part I (d)). An exception is allowed for "employment as
a teacher within the meaning of the School Teachers' Acts 1918
and 1922, or the Elementary School Teachers' Act of 1898" (First
Schedule, Part II (d) — (Ä)).
For other employment under the Crown or any local or public
authority the exemption applies only if the Minister of Health
certifies "that the terms of the employment are such as to secure
provision in respect of sickness and disablement on the whole
not less favourable than the corresponding benefits conferred by
this Act" (First Schedule, Part II (6)).
In its present form at least, the Czechoslovak law is on the same
lines. Section 3 of the Act exempts officials and employees with
fixed salaries employed by the State, a province, commune or
public foundation, if they are entitled to sick pay for not less than
one year. These provisions apply to employees in administrative
offices as well as to workers in public undertakings. On the other
hand, manual workers employed by the state or public bodies
are not considered to be engaged at fixed salaries, for the salary
cannot be described as fixed unless the worker is entitled to it, at
least for a certain period, irrespective of the quality and quantity
of work done.
Under the new Czechoslovak Act (Section 5) administrative
offices may choose between two ways of exempting their staff
from the liability to insurance. They may grant them either sick
leave on full pay, or benefits at least as favourable as those conferred under the general system of insurance, for a period of not
less than one year. With a view to the practical operation of the
second system, a Bill has been introduced in Parliament for setting
up a special system of sickness benefit in kind for public officials.
The position is very similar in the Kingdom of the Serbs, Croats
and Slovenes. The Act (Section 7) exempts persons employed in
offices, institutions or undertakings belonging to the State, the
province, a commune or any other public body, as well as employees
of public transport undertakings, if they are entitled to sick pay
for not less than 26 weeks. The exemption is automatic if this
condition is fulfilled, irrespective of whether the salary is sufficient
to secure proper medical treatment. In order that public employees
— 24 —
may not be placed at a disadvantage as compared with insured
wage-earners, a special system for providing medical treatment and
requisites, as also maternity and funeral benefit, is to be instituted
for officials.
The Bulgarian method differs slightly. The exemption applies,
without reference to equivalent treatment, to the workers and employees of the State and local authorities, provided that deductions
are made from their wages or salaries with a view to superannuation.
It is proposed, however, to investigate whether the benefits granted
under the general system are more favourable than those conferred
by the insurance fund for public employees. If this proves to be
the case, such employees may join the general system of insurance
and demand the transfer of any contributions they may have paid
(Section 1 of the Act and Section 11 of the Decree of 25 Juné 1924).
Special Systems of Insurance or Relief
Not long ago the Austrian law departed from the principle
generally followed in legislation based on the general formula of
workers' sickness insurance. It excludes from the general system
nearly all Federal officials and employees if they are entitled to
not less than six months' sick pay. In view of the special requirements of such officials and employees, an Act was passed on 13 July
1920 setting up special insurance for State employees under which
they are entitled to benefits in kind, as a rule at least as favourable
as the corresponding benefits conferred under the system of workers'
insurance. Public bodies are free under certain conditions to join
in this system for their permanent staff, who in this event are
exempt from the liability to insurance under the general system.
The Polish law is nearest to the Austrian method. It, too, distinguishes between persons employed in undertakings owned by the
State and by local authorities or by the railways, who are liable to
insurance (Sections 1 and 3), and State officials nominated to appointments and not engaged under a contract of work, who are
exempt from the liability (Section 4). The officials thus exempt,
without reference to their treatment as compared with persons
insured under the general system, are guaranteed free medical
treatment under section 10 of the Act of 9 October 1923 on the
salaries of public officials. This guarantee came into operation by
a Decree of 2 July 1924, and was extended to superannuated officials
and the members of the family of an official in respect of whom
he is in receipt of a family allowance.
— 25 —
Full Application of the General Formula
Unlike all the laws referred to above, the Norwegian Act allows
no exemption for officials and other public employees. The general
formula applies in full. Further, the income limit (6,000 kroner),
beyond which the liability to insurance ceases, holds good for public
employees.
DOMESTIC WORKERS
The general formula of compulsory sickness insurance applies
not only to wage-earners employed in an industrial, commercial
or agricultural undertaking, but also to persons who work in the
household of the employer without direct participation in the process of production. From the mere fact that the domestic worker
is attached to the person of the employer and his family and lives
under the same roof, the relations between the employer and his
domestic staff have acquired special characteristics. Other workers
are in a position determined by the law of contract, but the relations between an employer and his domestic staff long remained
and are sometimes still subject to family law. The limited personal
liberty enjoyed by domestic workers, because the quantity and
quality of their work is not defined in advance, has been compensated to a certain extent by the employer's obligation to provide
for them and assist them if they fall ill. Such protective measures,
explicity adopted in certain civil codes (e.g. the German Civil Code,
Section 617), have made it less urgent to include domestic workers
in the sickness insurance system.
As the relations between employers and servants ceased to be
governed by family law and took the form of a labour agreement,
the protection given to servants had to be made more consistent
and defined more clearly. The customary care in the family of
the employer has proved inadequate and domestic workers can no
longer be deprived of advantages which collective action alone
can provide.
Apart from a few exceptions, under the system of general
workers' insurance domestic workers — whether household or
agricultural — are liable to insurance. This is prescribed in the
German Act (Section 165, subsection 1), the Norwegian Act (Section 2, subsection 2), the Polish Act (Section 3), the Bulgarian
Decree (Section 7). In Czechoslovakia the liability of domestic
workers to insurance is no longer in doubt since the Amendment
Act of 21 December 1923. In the Kingdom of the Serbs, Croats
and Slovenes and in Austria, on the other hand, domestic workers"
— 26 —
employed in the household of an agricultural employer are not liable
(Jugoslav Act, Section 6). The terms of the British Act are more
restricted, according to which insurance is not compulsory for
persons employed in an agricultural household without money
payment, nor for persons maintained by the employer (First
Schedule, Part II (/)).
HOME WORKERS
The general formula, under which all paid workers are liable to
insurance irrespective of the place of work, applies also by definition to persons working on behalf of an employer away from his
undertaking, either at home or elsewhere. Certain features peculiar to home work make it necessary, however, to define more precisely the wage-earners who, as home workers, are entitled to
insurance. For instance, they work at the same time or successively for one or more employers, and sometimes even on their own
account. They often provide not only the tools but also the
materials they use in manufacturing or working-up the goods.
It is interesting to note that in certain countries compulsory
sickness insurance was the first institution to regulate the conditions of work of home workers by law. The methods adopted
differ so much in detail that only the more characteristic laws can
be examined here.
Under German law, insurance was compulsory after 1892 for
persons who, though not themselves artisans, worked for industrial
employers away from the undertaking; it was the first to include
home workers in the system of compulsory sickness insurance.
The British Act also applies to home workers, but limits the
definition of "outworkers" to persons working either at'home or
in premises not under the control of the employer, if they are
engaged in making or working-up goods on behalf of an industrial
or commercial undertaking. This limited group may be further
reduced by the exclusion of given classes of home workers (First
Schedule, Part I (c)).
A wider definition of the home worker liable to insurance is given
in the Austrian Act (Section 1, and Act of 19 December 1918),
the Jugoslav Act (Section 3, subsection 3), and especially the
Polish Act (Section 6) which covers any person working either in
his own place of residence or in a workshop solely or mainly on
account of one or more employers, even if he furnishes his own
— 27 —
materials and tools and employs members of his family or other
workers, provided that the home work constitutes his principal
means of livelihood.
The Czechoslovak Act (Section 1, subsection 2) makes insurance
compulsory for any homeworker who, not being an artisan within
the meaning of the Industrial Code, works regularly on behalf
of one or more employers away from their undertakings.
§ 4. ~ Position of Non Wage-Earners
According to the general formula, any worker employed in a
dependent position, whose wages are his ordinary means of livelihood, is an insured person. The scope of the formula is extended
in only two cases, those of apprentices and certain independent
workers, which incidentally differ markedly, being based on entirely
different considerations.
APPRENTICES
The first group of unpaid workers who as a rule belong of right
to the workers' insurance system is that of apprentices and other
persons working on little or no pay, with a view to their technical
training. Far from being a departure from the principle of
workers' insurance, the inclusion of apprentices is an indispensable
complement. It may be said to anticipate the dependent economic
position of the apprenticed persons when their training has been
completed. All general workers' insurance laws uniformly include
apprentices, voluntary workers, and other untrained persons, but
the regulations differ somewhat in detail.
The German Act (Section 165, subsection 2), the Norwegian Act
(Section 2, subsection 3), the Jugoslav ¡Act (Section 3, subsection 2),
and the Polish Act (Section 5, subsection 3) include in the system
all persons whose training is not finished and who work for an
employer, even if they are not paid. The Czechoslovak (Section 1,
subsection 1) and Austrian (Section 1, subsection 1) Acts allow no
doubt of the liability of apprentices and voluntary workers, since
they expressly include all persons employed "under a contract of
apprenticeship" (Czechoslovak Act) or "as an apprentice" (Austrian
Act). The British Act alone requires that if an apprentice is to
be insured he must be in receipt of a money payment. Moreover,
all apprentices, even those in receipt of money payment, are not
liable to insurance until they have reached the age of 16 (Section 1,
subsection 1, and First Schedule, Part I (a)).
— 28 —
INDEPENDENT WORKERS
The second group of unpaid workers who are compulsorily
insured against sickness under some of the laws on general workers'
insurance, is that of certain workers whose position, although
independent, is not more stable from an economic point of view
than that of the majority of paid workers. They are persons
working on behalf of another but without a contract of employment, and in their work they are mainly dependent on their
own labour. The German and Jugoslav Acts may be quoted as
examples.
The German Act (Sections 165) makes insurance compulsory for
artisans working in their own workshops without being supervised
by the employer, if their work is mainly on behalf of one or more
employers and their annual income is not more than 2,700 marks.
Under the Jugoslav Act (Section 3, subsection 5), the employer
on seagoing vessels with a gross tonnage of not more than 50 tons,
which cannot be propelled by steam or mechanical power, is liable
to insurance if he is a member of the vessel's crew.
§ 5. — Voluntary Insured Persons
As a rule the system of compulsory sickness insurance denies
the right to become insured at will, but there are two groups of
exceptions in which the law leaves it open to the individual to
decide whether he wishes to join the scheme or not.
Every insurance law allows a person who has been compulsorily
insured to continue his insurance if he ceases to carry on the
occupation rendering him liable, whether because his new occupation — although economically dependent — is no longer subject
to compulsory insurance, or because he has become economically
independent. In general, the prolongation of formerly compulsory
insurance is not subject to the same conditions of admission as
apply to voluntary insurance. A simple declaration within the
prescribed period is enough to protect the rights of a person who
used to be compulsorily insured.
Except in Austria and Russia, general workers' insurance laws
allow persons who are not liable to insurance to join a scheme
(voluntary or optional insurance). The detailed regulations on
voluntary insurance differ widely from one country to another.
The right to insure voluntarily may be open to paid workers only
— 29 —
(Great Britain), or to certain classes of independent workers as
well (Germany, Norway, Czechoslovakia, Bulgaria), or to any
person fulfilling the required conditions (Poland). Similarly,
the right to insure may be limited to persons whose incomes
are below a certain limit (Germany, Norway, Bulgaria, Poland),
or the law itself may not fix such income limits (Great Britain,
Czechoslovakia). Nearly every country lays down conditions
of admission to prevent an accumulation of bad risks as the result
of voluntary insurance, e.g. maximum age of admission, satisfactory
state of health, etc.
CONTINUATION OF COMPULSORY INSURANCE
V
Under the German Act (Sections 313, 313A) any person liable
to insurance who has been insured either for 26 weeks during
a period of 12 months, or for not less than the six preceding
weeks, and who leaves the employment under which he was liable
to insurance, is entitled to give notice within a period of three
weeks that he continues his insurance. No conditions as to age,
state of health, or income need be fulfilled. Thus, intellectual
workers may continue to benefit by insurance after their income
exceeds the 2,700 mark limit.
The British Act continues to treat an employed contributor as
such for a period of 12 months after he ceases to be employed
within the meaning of the Act, without requiring him to give
special notice or to pay contributions (free year). It is noteworthy
that the right to the free year is independent of the cause of the
cessation of the insurance, which may be the achievement of
economic independence, a rise in salary to more than £250 a year,
residence abroad, etc. After the free year, persons who have been
employed contributors for 104 weeks may continue to be insured
as voluntary contributors (Section 1, subsection 3 (a).)
Under the Norwegian Act (Section 6, subsection 1 and Section 10,
subsection 3) any compulsorily insured person may insure voluntarily when his liability to insurance ceases. When his annual
income reaches 6,000 kroner, he can no longer be insured (Section 13,
subsection 2).
The Czechoslovak Act (Section 13, subsection 2) allows a paid
worker who is no longer liable to insurance to continue his insurance
on the payment of the contribution. An insured person who
becomes economically independent has a similar right, but in both
— 30 —
cases the insured person must give notice of his desire to continue
his insurance and must not interrupt the payment of his contribution for more than four weeks. The Austrian regulations resemble
those in force in Czechoslovakia.
Under the Polish Act (Section 13) a compulsorily insured person
is unconditionally entitled to insure voluntarily during the four
weeks following his leaving the employment in which he was
liable to insurance.
According to the Bulgarian Decree of 25 June 1924 (Section 17)
workers and employees who achieve economic independence may
insure voluntarily without special notification.
VOLUNTARY INSURANCE
The German Code (Section 176) specifies certain groups of persons
who may insure voluntarily. The first consists of paid workers
who, for some reason or other, are not insured by right, and
members of the family of an employer working in his undertaking
without a contract of employment and without pay. The second
group comprises artisans and other persons working alone or with
the assistance of not more than two paid workers liable to compulsory insurance. The only condition of admission contained in
the law itself is that the annual income of the insured person must
not exceed 2,700 marks (Order of 10 January 1925). The sickness
funds are empowered, however, to lay down in their rules certain
other conditions, namely a maximum age limit and the presentation
of a medical certificate of health. If these two conditions are
not fulfilled, the fund may refuse the application, but it has no
power to impose other conditions.
The British Act does not encourage voluntary insurance. It
excludes persons in an economically independent position and
married women not engaged in paid work. Even in this restricted
form voluntary insurance is open only to persons approved by the
Ministry of Health (Section 1, subsection 3(e); Section 56, subsection 4).
Under the Norwegian Act (Sections 10-13) voluntary insurance
is open both to paid workers who are not insured by right and
persons not working under a contract of employment. The conditions of admission for the latter are fairly severe (minimum age
15 years, maximum 50 years, unless the applicant pays an additional contribution after the age of 50; income limit of 6,000 kroner;
— 31 —
satisfactory state of health). Paid workers, however, need in practice
only write out an application for admission. A bad state of health
is not an absolute bar to the admission of a person desiring voluntaryinsurance ; nevertheless, the sickness fund can, by medical examination, find out whether the applicant is suffering from diseases in
respect of which it will not be obliged to pay benefit. A bad state
of health, however, cannot be objected to the admission of an
applicant who has belonged to a sickness fund for the three preceding months without interruption, on condition that the application
is submitted within eight days after the insured person has ceased
to belong to a district sickness fund.
According to the Czechoslovak Act (Section 2), voluntary insurance is open to persons who are employed for pay in the undertaking
or household of several employers, e.g. charwomen, home dressmakers, etc. The provision applies also to persons belonging to
the household of a home worker, and to members of an employer's
family who, although they are over 14 years of age and are engaged
in an occupation rendering tbem liable to insurance, are not in
regular receipt of money payment. Other persons — whether
paid workers or not (e.g. persons engaged occasionally in paid
work, public officials, persons working on their own account) —
may insure, provided that the conditions of admission prescribed
by the rules are fulfilled.
The Polish Act (Section 8) provides for the voluntary insurance
of any person, whether a paid worker or not, if he is under 45 years
of age and his income does not exceed 7,500 zloty, provided that
his state of health is not a special risk to the fund.
Under the Bulgarian Act (Section 1, subsection 1), persons in
an independent position may insure voluntarily if their annual
income is not over 50,000 levas. This right is allowed to foreigners
only on a condition of reciprocity (Decree, Sections 15 and 16).
When the income of the insured person exceeds the limit fixed,
the voluntary insurance ceases to take effect (Decree, Section 18).
§ 6. — The Position of unemployed Workers
When a worker becomes unemployed, it is not enough that he
should be able to continue his compulsory sickness insurance by
remaining a voluntary member of the fund, as he is entitled to do
if he is no longer engaged in an occupation rendering him liable to
insurance. An unemployed worker must find it difficult to pay
the voluntary contribution, which in the absence of the employer's
— 32 —
«ontribution is generally twice that paid by the compulsorily
insured persons.
In order that the unemployed may not lose the advantages of
sickness insurance, two different legislative methods have been
used to keep them in the insurance funds. Under the first, a compulsorily insured person who becomes out of work remains entitled
to all or part of the sickness benefit without being required to pay
•contributions. If he falls ill the cost is borne by the insurance
institution, or rather the body of contributors. Under the second
method the functions of the unemployment relief institution are
•extended by a regulation that every unemployed worker must be
•compulsorily insured against sickness. The former system, under
which the unemployed worker is entitled without paying contributions to some or all of the benefits of sickness insurance, has been
adopted in Norway, Austria, and Poland.
Owing to widespread unemployment temporary measures have
been taken in Great Britain under an Act of 1921, whereby the
unemployed are, subject to certain conditions, kept in insurance.
They are also given cash benefits on a reduced scale, even though
their contributions in a particular year fall below 26, being the
minimum figure below which all right to cash benefit is generally
forfeited.
The Norwegian Act (Section 6, subsection 4) limits neither the
period during which benefit may be paid to unemployed workers,
nor the group of unemployed workers entitled to such benefit.
Any member of a sickness fund who loses his employment through
no fault of his own continues to belong to the fund without having
to pay contributions, provided that he has belonged to a sickness
fund for at least the six preceding months. If he falls ill, however,
after having been unemployed for more than fifteen days, he is
entitled only to medical treatment, which itself may not last more
than fifteen days.
Under the Czechoslovak, Austrian, and Polish Acts, the protection of unemployed workers who fall ill is much less effective, for
the period during which they are entitled to benefit without having
to pay contributions is comparatively short. Thus, the Czechoslovak Act (Section 13, subsection 2) guarantees an unemployed
worker the minimum legal benefit for a period corresponding to that
of his last employment but not more than six weeks1. A similar
1
See also Order of 1 May 1916 authorising sickness funds to afford benefits
in kind to the unemployed.
— 33 —
provision is contained in the Austrian Act (Section 13, subsection 3)
which also fixes a maximum period of six weeks. Under the
Polish Act unemployed workers remain entitled to medical benefit
if the sickness occurs within 13 weeks from the date they lose their
employment (Section 36, subsection 1).
In Germany, where the sickness funds had suffered severely
•during the period of currency inflation, it was thought impossible
to require them to bear the burden of paying benefit to unemployed
workers when they fell ill, unless the illness occurred within three
weeks of the cessation of compulsory insurance (Section 214;
see also p. 86). The commune, which is responsible for unemployment relief, must insure any worker in receipt of such
relief in a territorial sickness fund or any other fund granting
at least equivalent benefits, and it must pay the whole contribution in respect of such insurance (Order of 16 February 1924).
§ 7. — The Territorial Limits to the Scope of Compulsory Insurance Laws
As a legislative measure compulsory sickness insurance applies,
unless expressly provided otherwise, within the limits of the
territory of the State. No other general rule could be considered
in keeping with international law. A discussion of the practical
results of this general rule may be preceded by a brief survey of
the manner in which general workers' insurance laws associate the
person liable to insurance with a specific part of the territory of
the State^ This territorial definition is of particular importance
under systems which combine compulsory insurance with the
compulsion to belong to a given fund. The territorial basis of
insurance in a system of workers' sickness insurance is found in the
employment involving the liability to insurance. Whereas in
accident insurance the insurance relates to the undertakings as such,
in sickness insurance the various relations set up by it are centred
ia the place of work or occupation. Obviously this will be not
the temporary or casual, but the customary place of work.
The results of this closer definition of the general rule are both
positive and negative. On the positive side, the liability to insurance is found to apply in the first place to paid workers who carry
on their occupation in the country. Further, the position of the
worker as a compulsorily insured person is unaffected by temporary
or casual work or services outside the country, provided that his
connection with the country of ordinary employment remains
3
— 34 —
unbroken. On the negative side, the general rule implies that
insurance is not compulsory for workers who, although living in
the country, do not carry on their main occupation there, nor for
those whose work in the country is only temporary or casual
and who maintain the connection with their usual centre of
occupation situated outside the country.
The above statement may easily be verified in both directions
by examples from actual laws.
The subject is dealt with in Section 153 of the German Insurance
Code. According to subsection 1 insurance is compulsory for any
person who is employed as a paid worker in German territory.
Under subsection 2 it is compulsory for paid workers whose
ordinary place of employment is in the country and who are
engaged in work abroad for a comparatively short period. Again,
under subsection 3 a worker remains liable to insurance if, starting
with a fixed centre of work in the country, he is employed abroad
in different localities without a new centre of employment being
set up under this head. On the negative side, a worker who is
employed in German territory on behalf of a German or foreign
undertaking and whose ordinary place of work is abroad, is not
liable to insurance (see also the Decree of 17 November 1913).
Under the British Act persons engaged in "employment in the
United Kingdom" are liable to insurance. The Act thus establishes
the principle of territorialy of insurance. The insured person does
not lose his membership of an approved society by a stay abroad
of less than a year's duration. Section 19 is in keeping with this
legal situation, for it empowers approved societies to pay certain
benefit to members who are temporarily resident abroad with the
consent of the society.
In the present respect, the Norwegian Act is more complete than
all the other laws considered. On the positive side, insurance is
compulsory for all workers and employees working in the Kingdom,
and insured persons are still deemed to be employed in the country
if their employers give them temporary work abroad or instruct
them to travel abroad, provided that they are not absent from
the country for more than three months (Sections 1 and 3).
. On the negative side, any person is exempt from the liability
to insurance if owing to the nature of his work in the country
it cannot last more than six days. Moreover, irrespective of the
period of work or service in the country, the Act does not apply
to persons who are entitled under a foreign law to sickness benefit,
— 35 —
even during their stay in the Kingdom (Section 1, subsections 2 (c)
and 3).
Section 13 of the Czechoslovak Act establishes the territorial
principle by laying down rules of admission for any paid worker
employed in the territory of the State. In accordance with this
section the Administrative Court has decided that if a compulsorily
insured person is temporarily employed abroad, his insurance does
not cease unless his removal to another country involves the
cancellation of his former contract of employment and the substitution of another contract binding him to a new centre of employment situated abroad. On the negative side, the temporary
employment in the country of a person whose usual place of
employment is abroad does not render him liable to insurance,
since under Section 1, subsection 1, of the Czechoslovak Act
temporary paid work is exempt.
The Jugoslav Act (Section 3, subsection 1) also accepts the
territorial principle by making insurance compulsory for every
person working within the territory of the Kingdom. The principle
is extended to cover workers employed abroad, whether permanently
or temporarily, on behalf of a Jugoslav undertaking provided
that the workers are Jugoslav nationals. To prevent conflict
of laws, the insurance applies only if the workers in question
are not already insured under the legislation of the state in which
they are employed (Section 8, subsections 1 and 2). Sufficient
provision is made for definition in the negative direction by section 4, under which persons employed in Jugoslav territory only
at intervals and not permanently are exempt from the liability
to insurance.
A similar territorial delimitation may be found in other general
workers' insurance laws.
SPECIAL POSITION OF SEAMEN
In certain cases there is no direct physical connection between
the ordinary place of employment and the territory of the State.
The chief example is that of persons employed on board ship.
The ordinary place of occupation offers no criterion for determining
the liability of the crew to insurance. According to a custom which
has been incorporated in the international regulations observed
by maritime states, internal matters affecting the crew remain
subject to the regulations of the state whose flag is flown by the
— 36 —
ship, whatever its location. In general, this rule applies only to
seagoing vessels, inland navigation and fishery being nearly always
subject to the territorial principle (national waters). When seagoing vessels belong to t h e state they are considered a floating
part of its territory, and the territorial rule applies in full.
The German Insurance Code and the British Act may be quoted
in illustration. Section 16, subsection 7 of the former makes insurance compulsory, irrespective of the place of work, for the crews of
German seagoing vessels, i.e. vessels flying the German flag and
employed mainly or solely in maritime navigation. Under the
British Act, any person is liable to insurance who is employed "as
master or a member of the crew of any ship registered in the United
Kingdom or of any other British vessel of which the owner resides
or has his principal place of business in the United Kingdom."
The ship owner's weekly contribution is reduced in the case of
foreign-going ships in view of the owner's special obligations
imposed by the Merchant Shipping Act.
The Norwegian Act, on the other hand, applies the territorial
principle more rigidly, making insurance compulsory for the crewsof ships navigating in territorial waters, as well as of ships navigating outside such waters provided that the route of the voyage
is fixed and the time between leaving and returning to a Norwegian port is not more t h a n 10 days (Section 1, subsection 2(e)).
§ 8. — Time Limits to the Application of General Workers'
Insurance Laws
A compulsorily insured person is not liable for life, but only when
and as long as he is engaged in an occupation in which insurance
is compulsory; thus the dates at which the insurance begins and
ends are fixed by the law itself.
COMMENCEMENT
OF
INSURANCE
Whatever the term used, a compulsorily insured person is not
merely liable to insurance, he is included of right in the insurance
system. Once he has entered an employment in. which insurance
is compulsory the worker is considered to be insured under the
law, even in default of the necessary notifications from the
employer, the worker, or a third party, or of the prescribed
payment. The strength of compulsory insurance lies in this very
— 37 —
automatism, which, pays no attention to the observation of formalities. The actual methods adopted differ considerably.
In principle, the German Act (Section 306) considers a compulsorily
insured person to be a member of a local sickness fund from the
date on which he enters the occupation rendering him liable to
insurance. An exception to this rule is that of persons employed
only temporarily, who are insured only from the date of their
inclusion in a register opened for this purpose (Section 442).
Neither employer nor worker is entitled to make the insurance date
from any other day than that defined by law.
Voluntary insurance, on the other hand, begins only on the
date on which the application for admission is made. For a
month from receiving an application, the fund may refuse admission as from the date of the application, provided that the conditions justifying refusal are fulfilled (Section 310).
The British regulations differ in several respects from the German
Code. Any person liable to insurance may apply to an approved
society for membership. If no application has been made before
1 April or 1 October next after the end of the half year during which
entry took place into an employment in which insurance is compulsory, the worker automatically becomes a deposit contributor as
from the date of entering the employment. A worker who joins
an approved society not later than six months after entering an
employment in which insurance is compulsory may be deemed
by the society to have been admitted a member since the beginning
of his employment (Section 41). If the insured person becomes a
deposit contributor he can at any time transfer to an approved
society, the date of entry into insurance being the date of entering
into insurable employment.
Under the Norwegian Act any person liable to insurance is
deemed to be a member of the district fund as from the date his
employment begins, no account being taken of any delay in making
the prescribed declaration (Section 5).
Examples may easily be multiplied. It will be enough to refer
to Section 13, subsection 1, of the Czechoslovak Act, Section 13
of the Austrian Act, Section 10 of the Polish Act, and Section 55
of the Jugoslav Act, all of which define compulsorily insured
workers as insured from the date on which the employment rendering them liable to insurance begins. For technical reasons workers
in temporary employment are treated differently. They do not
become members until they have been entered in special registers.
— 38 —
E N D OF INSURANCE
Once the insurance has begun, it continues as a rule until the
labour agreement on which the liability to insurance is based is
dissolved. By itself, neither the cessation of actual employment
owing to illness (the risk covered) nor the failure to pay contributions can put an end to the insurance of a compulsorily insured
person. The actual regulations on this point are A^arious.
Under the German Code (Section 311) the insurance of persons
unable to work holds good for as long as they are entitled to
benefit. Otherwise, a compulsory insurance expires, unless voluntarily continued b y the insured person, when the engagement on
which the compulsion is based comes to an end. On the other
hand, the failure to pay the insurance contribution is without
effect on the operation of the insurance.
Under the British Act (Section 3 and Section 43, subsection 5) the
insurance of an employed contributor comes to an end for one of
two reasons: either if he obtains a certificate of exemption, or if lie
ceases to be an insured person within the meaning of the Act. If
he fails to pay his contributions, he forfeits his right to cash benefit,
b u t not to the insurance. Even after he ceases to be employed
within the meaning of the Act an insured person remains a member
of the society with full right to benefit for the so-called "free year".
Under the Norwegian Act an insured person ceases to belong
to a sickness fund from the beginning of the week following on
the last week for which the compulsory contribution was due.
A sick person belongs to t h e fund as long as he is entitled to sickness benefit (Section 6, subsections 1 and 2).
Similar provisions are t o be found in the Czechoslovak Act
(Section 13, subsection 1), the Jugoslav Act (Section 55) and the
Polish Act (Section 13), in the latter very similar to the British
"free year" system.
CHAPTER II
NATIONAL INSURANCE
The Portuguese Sickness Insurance System
The Portuguese Act is at present the only law to include the majority of the population in a system of compulsory sickness.insurance
not based on the principle of general workers' insurance. On the
model of the invalidity and old-age insurance scheme introduced
in Sweden in 1913, Portugal established a national sickness insurance system by the Decree of 10 May 1919.
PERSONS INSURED
No other compulsory sickness insurance system reaches so wide
a circle as that covered by the Portuguese Decree. It includes "any
person, irrespective of sex, engaged in an occupation which has
been recognised as worthy and honest by custom and tradition,
and has been sanctioned by the law." (Section 1). The criterion
of paid work is not adopted in the Portuguese law. Subject to the
fulfilment of all other conditions, insurance is compulsory for both
dependent and independent workers unless their occupation is
contrary to the law. The only limitation to the principle is that
the insurance system excludes persons of under 15 or over 75
years of age, on the grounds that they are not as a rule capable
of carrying on a regular occupation.
Further, the position of the insured person in the scheme is
determined by his economic situation. As soon and as long as his
total annual income (wages, fees, profits, dividends) exceeds a
limit, fixed at 900 escudos, the insured person is entitled to no
benefit from the insurance institution even should he fall ill. This
income limit divides the insured into two groups, that of the
"torn insured" (socio nato) who, while belonging to the insurance
institution, have no share in benefits, and that of the "effectively
insured" (socio efectivo) who share both in the cost and in the
benefit payable in the event of illness (Section 1, subsection 3).
— 40 —
TERRITORIAL LIMITS
Since this national sickness insurance is a sort of life insurance
covering every member of the population, the place in which the
work is performed is without influence. On the positive side, the
insurance even covers persons temporarily staying abroad, provided
they still have their home in the country; and on the negative
side, it does not apply to persons who are staying temporarily
in the country without settling there (Section 3).
TIME LIMITS
The insurance does not begin automatically, but on the date
on which the insured person is entered in a register intended for
the purpose (Section 5),
CHAPTER III
THE SCOPE OF LIMITED WORKERS' INSURANCE SYSTEMS
Persons Liable to Insurance
As already stated, the majority of states which have adopted
the principle of compulsory sickness insurance apply it to nearly
all persons in a position of economic dependence. Nevertheless,
there are at present certain laws which, embodying the principle
of compulsion, limit the application of insurance to a section only
of the group of wage earners. The criterion for dividing wage
earners into those who are insured compulsorily and those who
are not is the nature of the undertaking in which the paid work
takes place. The fact of performing paid work is not sufficient to
define the worker as an insured person, as under a system of general
workers' insurance. In addition, he must be employed in an undertaking belonging to one of the groups specified in the compulsory
sickness insurance law. This system is at present in force in the
following countries, among others: Luxemburg (Act of 31 August
1901), Hungary (Act No. XIX of 1907), Roumania (Act of 25
January 1912), Esthonia (Labour Code of 1911 amended in 1917
and 1921), Latvia (Code of 1922), Greece (Decree of 8 December
1923).
The definition of the persons liable to insurance differs considerably in the above Acts, but they have one feature in common:
the insurance system applies to paid workers, not as member of
the class of persons in a position of economic dependence, but as
workers employed in undertakings of a specified nature. Consequently, the employment giving rise to the liability to insurance
is not an economically dependent employment as such, but a
dependent employment in or on behalf of an undertaking of a
specific kind. The decision whether a person is liable to insurance
or not depends on two factors : firstly, the definition of the groups
of undertakings in which all or some of the staff may be liable
to insurance and, secondly, the definition of the persons employed
in such undertakings who are so liable.
— 42 —
CLASS OF UNDERTAKING
Like the first compulsory sickness insurance laws — the German
Act of 1883, the Austrian Act of 1888 — limited workers' insurance
laws relate either to classes of undertakings in which the workers
are exposed to more serious physical risks, or to all undertakings
which have reached a certain degree of organisation. Without
discussing in detail the very complex enumerations contained in
these Acts, it may be stated that they all apply to industrial
undertakings of a factory nature (e.g. Luxemburg Act, Section 1,
subsection 1(4); Hungarian Act, Section 1 (1); Roumanian Act,
Section 2, subsection 2); the industrial exploitation of mines, openair mines, quarries, etc. (e.g. Luxemburg Act, Section 1, subsection 1
(2); Hungarian Act, Section 1, subsection 3; Roumanian Act, Section 2, subsection 2), industrial building undertakings (e.g. Luxemburg Act, Section I, subsection 1 (5); Hungarian Act, Section 1, subsection 1 (4); Greek Decree, Section 1, subsection 1). Handicrafts
are similarly covered, but commercial and transport undertakings
are included only by the Luxemburg Act (Section 1, subsections
1 and 6), the Hungarian Act (Section 1, subsections 1, 8, 9) and
the Greek Decree (Section 1, subsection 1). All the laws in question
exclude agricultural and forestry undertakings, and it is in this
respect that their difference from general workers' insurance systems is most serious.
Nature of Employment
Persons employed in paid work, whether manual or non-manual,
in an undertaking belonging to one of the specified groups are
liable to insurance. Temporary or casual employment in such an
undertaking is as a rule insufficient to make insurance compulsory,
and it is normally required that the paid work should be the
principal means of livelihood of the worker.
Nature of the Liability to Insurance
Subject to the important restriction that the liability to insurance
is limited to workers in certain classes of undertakings, the rules
laid down by the laws of the present group will be found to be
similar to those deduced from the analysis of general workers'
insurance systems. This applies more particularly to the liability
to insurance as a public measure. The persons concerned have no
choice, once the employment in which insurance is compulsory
has begun. Their wishes concerning the application of the principle of compulsion have no legal force.
— 43 —
Neither sex, age, nor nationality constitutes a reason for exemption or exclusion. On the other hand, wage or income limits are
fixed, above which the worker ceases to be liable. Under the
Hungarian Act (Section 1, subsection 1) any manual or non-manual
worker whose earnings exceeds a certain figure (80,000 kronen
a year) is no longer liable to insurance. A similar maximum limit
of 3,750 francs is fixed in the Luxemburg Act (Section 1, subsection 7) but it applies only to employees, foremen, and other
non-manual workers.
EXCEPTIONS
As compared with general workers' insurance systems, the laws
on limited workers' insurance contain certain important omissions.
Thus, as already stated, all agricultural and domestic workers
are excluded from compulsory insurance. Home workers are
liable to insurance only under the Luxemburg Act (Section 1,
subsection 2), and the Hungarian Act. (Section 2, subsection 2).
Under the Greek Decree they may join the scheme voluntarily.
Apprentices, voluntary workers, and other persons who are unpaid
because their technical training is not finished are not insured
compulsorily, except in Hungary (Section 2, subsection 1 of the
Act).
THE INSURANCE OF INDEPENDENT PERSONS
On the other hand, more attention is paid to the employers in
the undertakings covered than in general workers' insurance
sjrstems. Reference has already been made to a feature peculiar
to the Roumanian system, namely, that the employers in all the
undertakings covered are compulsorily insured, whether they
employ apprentices, journeymen or labourers, or not. Under
certain other laws it is considered sufficient to allow employers
the right to insure voluntarily under certain conditions (Luxemburg, Latvia). The Hungarian Act, on the contrary, although
attaching considerable importance to voluntary insurance, which
is even open to agricultural workers, does not allow persons in a
position of economic independence to insure voluntarily (Section 7).
CHAPTER IV
THE SCOPE OF VOLUNTARY INSURANCE SYSTEMS
§ 1. — Voluntary Insurance Laws in General
VOLUNTARY INSURANCE
In states in which the law has not accepted the principle of
compulsory provision for illness, the attempt to find suitable
means of protection against the vicissitudes of life is left to individual initiative. No use is made of the power of compulsion against
persons who under-estimate the risk and over-estimate their
physical and economic powers of resistance, and remain indifferent
to the dangers of the morrow. Although this indifference threatens
the interests of the community as a whole and not merely the
individual person, the state does not consider it an integral part
of its functions to provide against illness.
Persons who realise the seriousness of the risk form associations
of their own free-will and promise to help each other should any
of them fall ill. Although the outcome of a feeling of egoism, easy
to understand, which is ready to give so that it receive more in
case of need, this system of mutual aid brings together those who,
realising the community of interests, are prepared, if they themselves are safe, to give up their share to those in greater need.
This social phenomenon, which took the form of mutual aid organisations, called for new legal regulations defining the social position
of such bodies. State intervention was necessary and took place
everywhere although in different forms.
Regulated Voluntary System
A certain number of states have hitherto been satisfied to make
regulations on the subject; mutual aid societies are given legal
personality, and their responsibilities towards the state on the
one hand and their members on the other are thus defined. Certain
action is compulsory for them, certain other prohibited (regulated
voluntary systems).
— 45 —
Subsidised Voluntary System
Other states, while maintaining the individualist principle of
free insurance, are not satisfied to make regulations for the external
conditions of mutual aid as developed by private initiative. Recognising that it is to the general interest that mutual aid should
be allowed free play, they have placed it above the common law
to which private associations are subject. Mutual aid is not
merely recognised and governed by regulations; it also receives
pecuniary assistance from the state, which thus takes an active
part. This is the subsidised free system in force under the Belgian
Act of 23 June 1894 and the French Act of 1 April 1898; it has
been adopted also in the Swedish Act of 4 July 1910 and the
Swiss Act of 13 June 1911, and has been more particularly elaborated
in the Danish Act of 10 May 1915 amended by the Act of 6 May 1921.
§ 2. — Subsidised Voluntary Insurance
SCOPE
As compared with compulsory insurance systems, there is a
fundamental difference in the determination of the scope of subsidised voluntary systems. The principal condition for the application of the insurance law is that the individual person should have
joined the insurance organisation voluntarily. The insurance no
longer arises out of a situation in fact and in law in which the
person concerned has no say. He himself decides whether he
wishes or not to make use of his power to belong to the mutual
aid organisation. His freedom is subject, however, to certain
legal limitations. The right of the individual to apply for admission to the insuring institution may be limited by a legislative
prohibition applying to certain classes of persons.
Further, the systems at present under consideration involve a
condition which is not met with under systems of compulsion.
The establishment of the insurance depends on the mutual aid
society accepting the application for admission. In principle, it is
free to accept or refuse an application from any person entitled
to apply. The definition of this freedom, however, is only negative in the sense that a refusal to admit an applicant may not be
in opposition to a legal provision prohibiting refusal in specified
cases.
The scope of voluntary insurance systems is not determined bylaw.
The actual extent to which they will apply depends on the use made
— 46 —
by individual persons of their right to join and by the funds of
their power of refusal. It will therefore vary considerably from
one country to another. The following examples may be given
of laws of subsidised voluntary insurance.
The Belgian Act of 23 June 1894 (Section 10, subsection 1) lays
down that any person having attained the age of 18 years or his
majority may become a member of a recognised mutual aid society.
Thus, membership is not open to minors of under 18 years of age
except with the consent of their parents or guardians. Sex is no
obstacle to making an application, except for married women whose
husbands have registered a protest which has not been rendered
ineffective by a decision of the competent justice of the peace
(Section 11). Consequently, the right to make an application is
almost unconditional. Moreover, the freedom of the recognised
mutual aid society may similarly be said to be unrestricted. The
question whether application for membership can be accepted is
governed by the rules of the society. Once an application has been
accepted, the member is subject to the insurance law until he ends
his membership. If not in practice, at least from the legal point
of view, his social status and economic position have no importance.
The French Act of 1 April 1898 places no restrictions on the
right of the individual to apply for admission, or the power of the
mutual aid society to refuse it. On the other hand, it takes the
economic position of the members into account by allowing the
societies to classify their members in two groups: participating
members and honorary members, only the first of whom are entitled
to share in the material assistance granted by the society.
Similarly, under the Swedish Act of 4 July 1910, there is practically no restriction of the freedom of the individual to apply for
admission and of the sickness fund to refuse it. Any member may
leave the fund at any time on giving written notice, but the power
of the fund to expel members is limited by the Act. For instance,
the rules of the fund may not lay down that a member may be
expelled on reaching a certain age, or after he has received sickness
benefit for a given period, or for an unsatisfactory state of health
(Section 11).
Under the Danish Act of 10 May 1915 the members entitled to
benefit must be either paid workers of small means or persons who,
— 47 —
although economically independent, are in a similar position, such
as artisans, small employers, small farmers, etc. Other persons
applying for membership to a sickness fund may be admitted only
as honorary members (Sections 6 and 8). The conditions of admission for participating members may lay down a maximum age
(40 years) limit and may require that the applicant should be in
good health.
Territorial Limits
The territorial determination of the scope of voluntary insurance
systems offers no difficulty. An insured person who leaves the country may give up or retain his membership of a mutual aid society
unless the rules provide to the contrary. On the other hand,
persons who temporarily settle in the country may join the society,
provided that its rules do not require members to be resident within
the district it covers.
Time Limits
Finally, the time limits of the scope of insurance are, as a rule,
defined freely by the member on the one hand and the mutual
aid society on the other. Unless the member has agreed otherwise,
he may at any time leave the society. On the other hand, once the
member has been admitted, the society may not expel him unless
empowered to do so by its rules.
§ 3. — The Swiss Sickness Insurance System
The Swiss Federal Act of 13 June 1911, although belonging to
the group of laws based on the principle of subsidised freedom,
has one special feature. It empowers the cantonal legislative
authorities to make sickness insurance compulsory either for the
whole population of the canton, or for certain sections of the
population. The result of delegating to the cantons the power to
legislate on compulsory sickness insurance has been that, whereas
some cantons have maintained the system of subsidised voluntary
insurance in full, others have introduced compulsory insurance
for certain sections of the population. That the Swiss sickness
insurance system is discussed here under the head of laws based
on the principle of subsidised freedom, is due to the fact that at
least at present a large proportion of the members of Swiss sickness
funds have joined voluntarily and not because they were compelled
to insure.
— 48 —
SCOPE OF COMPULSORY INSURANCE ENACTED BY THE CANTONS
No canton has made insurance compulsory for the whole
population, but a certain number have introduced compulsion for
more or less important sections of the population, e.g., the two
cantons of Appenzell (Act of 30 April 1916 and Decree of 29 November 1920); Basle Town (Act of 19 November 1914, rendering all
persons liable to insurance who live alone and have an. annual
income of under 4,500 francs, and all members of a family with a
total annual income of under 6,000 francs) ; St. Gall (Act of 28 May
1914). Certain other cantons have found it sufficient to introduce
compulsory insurance only for children in elementary schools,
e.g. Fribourg (Act of 20 December 1919); Geneva (Act of 11
October 1919).
SCOPE OF SUBSIDISED VOLUNTARY INSURANCE
Persons who are not required to insure under cantonal or municipal
laws, are free to join a sickness fund under the Federal Act of 13
June 1911. Any person may apply for admission to a recognised
sickness fund. Such admission cannot be refused to a Swiss national
fulfilling the conditions of admission laid down in the rules (Section
5, subsection 1), but a foreigner may be refused even though he
fulfils these conditions. Such conditions may relate to the age of
the applicant, to his state of health and, in certain cases, to his
religious denomination or his occupation. As a rule, fulfilment of
the conditions is not required of an applicant who has already
been a member of a recognised sickness fund and applies for membership of another fund owing to a change in his place of residence
and employment, or in his occupation, or to the dissolution of the
fund to which he belonged (Sections 7 and 11).
PART II
INSURANCE INSTITUTIONS :
CONSTITUTION AND MACHINERY
INTRODUCTION
GENERAL FUNCTIONS OF SICKNESS INSURANCE INSTITUTIONS
The object of all systems of sickness insurance, whether compulsory or voluntary, is to guarantee the insured person some
partial compensation for the loss caused by illness; thus, the
economic consequences of illness are no longer entirely borne
by the insured person who has fallen ill, since they only affect
him to the extent to which he is not relieved by insurance.
In order that the insured may in fact enjoy such relief, the
liability for insured persons who fall ill must be transferred, under
the insurance system, to an economic entity distinct from the
individual: or in other words, to a special group composed of a
certain number of actual persons. The members of such a group,
which thus becomes a collective security, are neither directly nor
individually liable towards individual invalids: their liability
remains a collective one; in other words, they are only answerable
for the payment of the compensation due to invalids in respect
of a certain fraction corresponding to their individual share in the
obligations of the insuring group.
This two-fold limitation of the liability of members of the group
is obtained by conferring legal personality on the insuring group;
and the legal personality which represents members of the insuring
group, in so far as they participate in the system of insurance is
the insurance institution. This body acts as intermediary between
invalids who possess a claim and the group liable to such claim.
It therefore pays compensation for part of the loss caused to
4
. — 50 —
invalids out of the financial resources placed at its disposal by
the group.
The promotion, therefore, of a system of insurance presupposes
the existence of an insuring group as an established fact of social
life, and its legal recognition as an effective agency of mutual
assistance. To enable them to make decisions and to carry them
out, such groups are provided by law with deliberate and executive
machinery.
The method adopted under different systems of sickness insurance
legislation for facilitating -the formation of insuring groups is
described in this part of the report; while the manner in which
insuring groups, duly constituted by law, acquire legal personality
and are provided with administrative and representative machinery
will be dealt with subsequently.
Legislation regulating the formation and working of insurance
institutions differs considerably in the case of compulsory or
voluntary systems of sickness insurance. Any legal system oí compulsory insurance must be such as to afford facilities for the affiliation to an insurance- institution of individuals who are compelled
to insure themselves, even in cases where mutual aid institutions
have not yet been created through the personal initiative of the
parties concerned. It must, therefore, where necessary, promote the
creation of insuring groups ; whereas a legal system of voluntary
insurance need do no more than facilitate and encourage the formation of such groups and need take no direct steps for the purpose.
This distinction between the different forms of legislative intervention forms the basis of the division adopted in this part of the
report.
CHAPTER
I
CONSTITUTION AND MACHINERY OF COMPULSORY SICKNESS
INSURANCE INSTITUTIONS
§ 1. — Principles of Organisation of Compulsory Sickness Insurance :
Main Features of its Development
In most countries where a system of compulsory sickness insurance has been introduced, there were in existence at the date
when the relevant legal provisions came into force, a certain
number of persons, subject to the obligation of insuring, who were
freely and spontaneously associated in some form of mutual
benefit organisation. Compulsory insurance legislation merely
converts the free association of such persons for mutual aid into
a compulsory association. The mutual benefit group becomes a
statutory insurance organisation. . In this way, mutual benefit
societies, trade union sickness funds, and institutions due to private
enterprise are the first to be entrusted with the duty of putting
a compulsory sickness insurance system into force. Their fitness
to undertake the new work varies very considerably from one
country to another, and determines to a great extent the position
they occupy in a system of compulsory insurance.
The work of social organisation involved, on the introduction
of compulsory insurance, in grouping persons subject to insurance,
is comparatively easy where the great majority of compulsorily
insurable persons are already voluntarily and spontaneously insured.
The classic example of this state of things is afforded by Great
Britain, when the National Health Insurance Act came into force
(15 July 1912). At that date the majority of persons covered
by the Act had been insured for a considerable time. All that
was needed, therefore, was to convert insuring groups already in
existence into legal institutions of the same character, and to
include therein such persons as had not spontaneously adhered to
a freely constituted group. A proportion of insurance societies
had only to comply with the requirements of the Act to attain the
rank of "Approved Societies"; and to this day societies of this
— 52 —
kind can be formed and can acquire the status of legal insurers.
The development in Great Britain of freely constituted insurance
societies and the efforts of insurance companies who hâve taken up
industrial insurance have been such that it has been unnecessary to
constitute insuring groups ad hoc for the purpose of insuring persons
who have not joined an Approved Society (system of free affiliation).
In countries where, at the time of the introduction of compulsory
insurance legislation, the spontaneous mutual benefit movement
was not sufficiently developed to become the only existing system,
the process of organisation was twofold: in the first place, it was
necessary to assign to existing mutual benefit organisations a part
in the new system corresponding to their importance; secondly,
it was necessary, by means of government intervention, to create
statutory insuring groups, comprising all insured persons who had
not j oined a free insurance institution. Persons subj ect to insurance
remain free to join private funds; but if they fail to do so, they
automatically become insured with the appropriate statutory fund.
This is the basis of organisation adopted in most Central European
countries, as well as in Norway and Portugal (system of subsidiary
legal affiliation).
In a certain number of other countries, where a system of general
workers' insurance has recently been adopted, and where a voluntary mutual benefit system was virtually non-existent, the insuring
group has been formed almost without exception by State intervention. Persons subject to compulsory insurance are not entitled
to exercise any choice, but are automatically insured with the
competent legal insurance organisation. Generally speaking, the
group insuring against sickness in these countries may be likened
to the central pillar supporting the whole edifice of social insurance
covering all physical risks. Typical examples of the system are
to be found in Serb-Croat-Slovene and Russian legislation (system
of legal affiliation).
The main features of these three systems of affiliation are given
below.
§ 2. — System of Free Affiliation
MAIN
FEATURES
Under a system of free affiliation, individuals subject to insurance are free to select their own insurer against sickness. Nor are
they subject to any form of coercion intended to compel them to
adhere to any given insuring group.
— 53 —
Individuals, though subject to insurance, may even remain outside any insuring group. In this case they are not ipso facto
affiliated to an insurance institution, but are merely required to
accumulate personal savings to provide against illness. This freedom within the system is only restricted in the case of improvident
persons who are destitute of all resources, and become a charge
on the Poor Law authorities.
BRITISH LEGISLATION
Complete freedom of affiliation, within the framework of the
compulsory system of sickness insurance, is ensured by the British
Act; nor do the authorities intervene in any way for the purpose
of constituting insuring groups, the formation of which is due
entirely to private enterprise. These, if they conform to statutory
requirements can, at their own request, be registered as statutory
insurers.
Constitution
A great number of different types of Approved Societies exist:
those known as Friendly Societies, whether registered or not in
accordance with the Friendly Societies Act, 1896; trade union
funds; employers' provident funds; industrial assurance companies;
co-operative societies, and various other bodies.
The conditions required for obtaining recognition as an Approved
Society are few: to be approved, a society must not be carried on
for profit. This implies that it must confine itself to administering
any surplus funds for the benefit of its members in accordance with
the provisions of the Act and its constitution. The management of
the society's affairs must also be subject to the absolute control of
its members being insured, either directly or indirectly, by means of
delegates. This implies that members other than active members
(i.e. honorary members) have no share in the management of
that part of the society's affairs connected with compulsory insurance (National Health Insurance Act, 1924, Section 29). Societies
such as employers' provident funds, confined to the undertaking,
are exempt from the second condition: in this case the employer
may have a quarter of the representation on the committee or
other body administering the fund, on condition, however, that
he is responsible for the solvency of the fund, or for the benefits
payable therefrom, or becomes personally liable for additional contributions supplementary to those payable under the Act (Section 31).
Security must also be given in order to protect the interests of
members against the possibility of alienating the society's capital
— 54 —
should the competent authority (in this case the Minister of Health)
consider this necessary (Section 35 (1)).
As soon as an insurance institution has become an Approved
Society, it becomes responsible for administering the pecuniary
benefits conferrred on all insured persons by the National Health
Insurance Act. Contrary, however, to the practice in other systems
of compulsory sickness insurance, an Approved Society is not responsible for the administration of medical benefit, which is organised
by "insurance committees", which are territorial associations
created for this purpose by the Act x.
When a society has become a legal insurer, and has in this capacity
assumed public duties, it cannot cease its operations without the
consent of the authorities. Further, the latter are at liberty to
withdraw the approval granted to any society if it fails to conduct
its business in accordance with the provisions of the Act (Section
38 (1)).
Machinery of Approved Societies
Approved Societies enjoy great liberty under the Act in the
choice of their deliberative or executive machinery. As stated
above, the Act only requires that members of the society shall,
under its statutes, have absolute control over its affairs, and, in
particular, that the management committee shall be elected or
removed from office solely by active members or their delegates.
Provided the above requirements are complied with, Approved
Societies are free to organise themselves as they think fit; but their
constitution must be submitted to the authorities for approval
before a society starts business.
The insured members are therefore the only ones who participate
in the management of Approved Societies, and employers are not
represented in any way. In the case of employers' provident funds,
however, one-quarter of the representation on the management
committee may be reserved for employers who have assumed
financial liabilities greater than those imposed by the Act (Section 31).
Membership of Approved-Societies
All persons subject to insurance may apply for membership
of an Approved Society, provided they fulfil the required conditions
for admittance; and the individual's right to apply is balanced by
the society's right to refuse a request for admission. To prevent
1
See p. 102,
— 55 —
Approved Societies, however, from pursuing an unduly restrictive
policy of choosing good risks only, the applicant's age is not considered as in itself a sufficient reason for refusing membership.
While complying with this rule, however, Approved Societies
are at liberty to admit only applicants belonging to a given occupation, or resident in a district specified in their constitution.
In the case of new entrants into insurance application for
membership must be made before 1st April or 1st October next
following the end of the half year during which the applicant entered
the employment entailing obligation to insure; failing which, the
applicant automatically becomes a "deposit contributor". If an
applicant does not receive notice, within three months of the date
of his application, that his application for membership has been
opposed, he becomes ipso facto a member of the society. An
insured person who is a deposit contributor may apply for admission to an Approved Society at any time and in the event of his
acceptance a transfer from the Deposit Contributors' Fund is.
arranged.
Membership ceases either when a member (subject to certain
restrictions imposed in the interests of the society), joins another
society, or when a member has been guilty of an act rendering him
liable to expulsion and is consequently expelled, or because the
obligation to ensure has lapsed, owing either to a change of occupation or because exemption from insurance has been obtained.
No one may belong to more than one Approved Society at a
time (National Health Insurance Act, 1924, Sections 41, 42, 43).
Deposit Contributors
Persons subject to compulsory insurance who have failed within
the prescribed period to become members of an Approved Society,
or have ceased to be members without joining another society,
automatically become deposit contributors. In this capacity they
are not members of an insuring group, but are compelled to pay
certain statutory contributions to an account standing in their own
name with the Deposit Contributors' Fund. This Fund is also
maintained by contributions from employers, and by a State
subsidy. The administration of cash benefits of Deposit contributors is in the hands of Insurance Committees.
. In case of illness, deposit contributors are only entitled to receive
benefits corresponding to the sums standing to their credit: thus,
— 56 —
the system is not really an insurance system ; it is merely a system
of saving, under the supervision of the authorities.
The system of affiliation set up by the British Act involves the
minimum of compulsion, and has resulted in practically all persons
subject to compulsory insurance becoming members of an Approved
Society: scarcely 2 per cent, of such persons have remained deposit
contributors.
As already stated, the British Act has operated to extend and
make compulsory insurance of a character which was already
fairly widerspread on a voluntary basis; by instituting a system
unfavourable to deposit contributors, however, it has provided a
powerful incentive towards increasing the membership of Approved
Societies.
§ 3. — System of Subsidiary Legal Affiliation
MAIN FEATURES
In countries where, on the introduction of a system of compulsory
sickness insurance, applicable to large classes of the population
(e.g. general workers' assurance or national insurance), the mutual
benefit movement was not supported by a large number of those who
were henceforth to be subject to compulsory insurance, the legislative system adopted had to provide for including persons, not
hitherto insured, in the collective insuring group. This was generally
done by constituting territorial insurance institutions, comprising
all persons subject to insurance, resident or employed within the
territorial limits covered by the institution, who had not hitherto
spontaneously joined a mutual insurance fund ranking as a legal
insurance institution.
Even under a compulsory system, therefore, persons remain free
to join mutual insurance funds ; but if they fail to do so in accordance
with legal requirements, they automatically become attached to a
collective insuring group organised on territorial lines. This system
of affiliation is found in Central European countries, and also in
Norway and Portugal.
The principle, however, is subject to modifications of a more or
less important character, according as a general system of compulsory insurance is set up de novo (e.g. Portugal) or arises out of
successive extensions of a system of workers' insurance which was
at first confined to certain classes of wage-earners more particularly
subject to certain risks (e.g. Germany and Czechoslovakia).
— 57 —
In these cases (i.e. in proceeding from a restricted system to one
of general workers' insurance), it was thought inexpedient to abolish
existing insurance institutions on a trade basis (e.g. employers'
provident funds, guild fund, mining funds). Institutions of this
kind have therefore been maintained were they were working
satisfactorily. What has been done is to subject the formation of
new trade funds (caisses professionnelles) to restrictions intended
to prevent the working of the district funds from being hampered.
Individuals are still free to join an approved mutual benefit
fund; if they fail to do so, however, they automatically become
members of a trade fund or, if no such fund has been set up in
the undertaking or industry to which they belong, of a territorial
fund.
The latter are, moreover, sometimes sub-divided, and special
funds for insuring agricultural wage-earners have been established
side by side with the ordinary district funds, as, for example, in
Austria, Czechoslovakia and certain German States, but not in
Norway.
However important the part played by trade funds, the insurance system as a whole is based on the territorial fund. Unlike
British legislation, under which insured persons who are not members of an Approved Society are not included in a collective insurance group and are merely compelled to save, German, Austrian,
Norwegian, Portuguese and Czechoslovak legislation has set up
district funds through the medium of the authorities, which funds
include all persons subject to insurance who are not members
of trade or mutual benefit funds.
Territorial funds enjoy certain privileges not possessed by those
which are the result of private enterprise. It is forbidden in some
cases to set up trade or mutual benefit funds where their existence
might hamper the working of the territorial fund ; further, approval
may be withheld if they fail to offer their members advantages
at least equivalent to those afforded by territorial funds. To sum
up, although territorial funds do not possess a monopoly of insurance
business, they may be taken as the main and most common type
of insurance institutions, offering, as they do, security that the
obligation to insure will be in no case evaded.
The working of the system of subsidiary legal affiliation may be
illustrated by a few examples from certain legislative systems.
For this purpose, some account may be incidentally given of the
provisions regulating mutual benefit funds, trade funds, and territorial funds.
— 58 —
MUTUAL BENEFIT FUNDS
Constitution
The position of mutual benefit funds is, as a general rule, somewhat precarious. They are merely tolerated in Germany, Austria
and Czechoslovakia, and newly formed mutual benefit funds
cannot obtain recognition as legal insurers. Only those funds
which were in complete and satisfactory working order at the date
when general compulsory insurance came into force have been
maintained. The new Czechoslovak Act (Sections 28-29), for instance, stipulates that mutual benefit funds must, in order to obtain
recognition, include at least 4,000 members on 1 January 1924,
while Section 503 of the German Act cancels approval in the case
of all mutual benefit funds with less than 1,000 permanent
members.
On the other hand Section 54 of the Norwegian Act and Section
82 of the Portuguese Decree provide for newly formed mutual
benefit funds being recognised as substitute funds for territorial
funds; but here, too, the conditions required for approval are
somewhat exacting. The Norwegian Act stipulates that funds
applying for recognition must guarantee their members benefits
at least equivalent to those paid by territorial funds: further,
only funds with a permanent effective membership of 200 (or in
exceptional cases 100) can be admitted (Sections 55-56).
Machinery
Mutual benefit funds are administered by a mangement committee, whose members are appointed, either directly or through
delegates, by the whole body of members. The work of the management committee is subject to a supervisory commission, also
appointed by the members as a whole. The number of members
on the committee and the commission, and their term of office,
are not generally specified by law; but the statutes of societies
applying for approval must not contain any provision which constitutes an obstacle to the absolute control of the management of
the fund by the General Meeting of the members.
Membership
Legal provisions concerning the right of individuals to apply
for membership of a mutual benefit fund, as well as those concerning the right of the fund to reject applicants, vary considerably.
Generally speaking, funds are entitled to refuse applications for
— 59 —
membership where the applicant is obviously a bad risk; on the
other hand a member, once admitted, cannot be expelled merely
because he has become a bad risk owing to old age or bad health.
The act of joining an approved mutual benefit fund is not
regarded as the act of a private individual under the law, but as
the performance of a legal obligation of a public character arising
out of the individual's liability to insure against sickness. The
laws of all the states in this group are in agreement on this point,
and regard persons, subject to compulsory insurance, who have
joined a recognised benefit fund, as having complied with the
obligation to insure (Section 517 German Act ; Section 13 (1)
Austrian Act; Section 58 Norwegian Act; Section 3 (1) Portuguese
Act; Section 24 (1) Czechoslovak Act).
TRADE FUNDS (CAISSES PROFESSIONNELLES)
As already stated, in countries where a system of general workers'
insurance was established by developing a previously existing
limited system of workers' insurance, several kinds of trade funds
have been preserved, even after all wage-earners, irrespective of
occupation, have been made subject to insurance.
Nor is this difficult to understand: it seemed inexpedient to
insist on the dissolution of existing trade funds, which had won
an established position at the date when the insurance system was
being extended. Certain trade funds, on the other hand, such as
those of the great transport undertakings, or mining funds, afforded
and still afford various special benefits to their members, which
the latter would be unable to obtain from an ordinary general
trade fund. For these reasons, therefore, trade funds, generally
in the form of employers' provident funds 1 , or special guild funds,
have been recognised as legal insurers side by side with the territorial fu'nds.
Their position in a system of affiliation may be defined as follows :
trade funds act as sole legal insurers, that is to say, all wageearners employed in an undertaking where a fund has been set
up, are ipso facto members of that fund, unless they are members
of a mutual benefit fund; on the other hand, the competence of
trade funds in the matter of compulsory insurance extends only
to wage-earners employed in the undertaking involved, and in
no way to third parties.
1
Employers' funds of this kind are not, strictly speaking, trade funds, but
may be treated as such, as the great majority of the insured belong to the
same occupation.
— 60 —
Before undertaking a brief description of the various types of
trade funds, it would be well to note that, states which assign a
comparatively important position to trade funds, do not possess
a system of old age and invalidity insurance organised on common
administrative lines with sickness insurance (e.g. Germany and
Norway). Similarly, in Austria and CzechosloA^akia it was thought
necessary to restrict the functions of trade funds before establishing
a system of workers' old age and invalidity insurance organically
linked with that of sickness insurance, the object being to prevent
the former hampering the formation of territorial sickness funds.
Employers'' Provident Funds
Constitution
Employers' provident funds are approved as legal insurers
under German, Austrian, Norwegian, and Czechoslovak legislation.
Under Section 245 of the German Act, for example, an employer
can set up a fund in agreement with the Works Council, if the
number of workers permanently employed in the undertaking
exceeds 150 (50 in the case of agricultural and inland navigation
undertakings). The Superior Insurance Office may only authorise
the establishment of funds of this kind provided they do not
interfere with the working of the territorial fund; the latter must
retain at least 1,000 members, after the resignation of insured
members who have joined the new fund; and provided always
that the members if the new fund enjoy minimum benefits at least
equivalent to those granted by the district fund (Section 248).
Similarly, Sections 55 and 56 of the Norwegian Act provide for a
minimum permanent membership of 100, and exact a guarantee
that members shall obtain benefits at least equal to those enjoyed
by members of the territorial fund.
Section 26 of the Czechoslovak Act, on the contrary, does not
permit the formation of new employers' provident funds. Only
those in existence before 1 January 1924 are authorised to
continue to act as legal insurers.
Machinery
As a general rule, the employer himself,
represented on the managing bodies of funds
with representatives of tke insured.
For instance, the Management Committee
schuss und Vorstand) of German employers'
or his nominees, are
of this kind, together
and. the Office (Ausfunds include repre-
— 61 —
sentatives, in equal numbers, of the insured and the employer,
under the chairmanship of the employer or his nominee (Section 238).
A different solution has been adopted by the Czechoslovak Act,
according to which the Management Committee consists of ten
members, including eight representatives of the insured and two
representatives of the employer, whereas the distribution of members on the Supervisory Commission is in inverse ratio (Section 26)¿
Membership
In all the countries in this group, all wage earners employed
in undertakings where a fund of this kind has been set up are
members of the fund; on the other hand, persons not employed
in the undertaking in question cannot be admitted as active
members (Sections 245 and 307 of the German Act; Section 46
of the Austrian Act; Section 54 (3) of the Norwegian Act; Section 26
of the Czechoslovak Act).
Guild Funds
In Central European countries, the guilds were the first to set
up sickness funds, either compulsory or optional. These usually
include both artisans and workers employed by them, in separate
sections 1 . Most of these funds were maintained, even after the
introduction of a general system of workers' insurance ; but whereas
German legislation authorises the formation of new guild funds
under certain conditions (Sections 250-252), the Czechoslovak Act
only recognises such funds as statutory insurers when their membership on 1 January 1924 was at least 4,000 (Section 27). The
general rules for the management of guild funds are roughly
similar to those regulating Employers' Provident Funds.
Special Trade Funds
The third class of Trade Funds includes sickness funds acting
as legal insurers for the stall of large public transport undertakings
and the sickness funds set up in mines. Thus, railway workers
and miners are exclusively afflliated to special trade funds of this
kind, such as the German Mining Funds (Act of 23 June 1923),
the Czechoslovak Mining Funds (Act of 11 July 1922), etc.
1
See German Industrial Code and Austrian Industrial Code of 1859.
— 62 —
TERRITORIAL INSURANCE FUNDS
When persons subject to insurance are members either of a
mutual benefit fund or of a trade fund, they become automatically
and by definition members of the appropriate district insurance
fund. The country is divided into several insurance areas, corresponding to the area covered by a district insurance fund, a
network of funds being thus created.
The simplest form of territorial insurance fund is to be found in
the Norwegian district funds and the Portuguese compulsory mutual
benefit funds. In Central European countries, on the other hand,
funds are sometimes sub-divided, and territorial funds, dealing
more "particularly with the insurance of agricultural wage-earners,
have been set up side by side with the general territorial funds
(e.g. the Landkrankenkassen in several German states, and the
agricultural insurance funds in Austria and Czechoslovakia).
Constitution
Territorial sickness insurance funds are independent public
corporations, possessing various privileges generally reserved for
public administrative organisations.
They are set up under the relevant Act as a result of action by
the authorities ; in Germany, the first steps must be taken by the
municipal unions, or by the superior Insurance Offices (Section 231);
in Norway by the Communes (Section 40); in Portugal by the
Social Insurance Institute (Section 16); and in Austria (Section 12)
and Czechoslovakia (Section 24 (2)) by the subordinate government authorities. The areas for which territorial funds are responsible, and which vary in size (e.g. a district in Norway, a subdistrict in Czechoslovakia, the administrative area of a Court of
First Instance in Austria), are determined in accordance with
existing administrative divisions, so that all portions of the national
territory are included in one or other of the areas assigned to a
territorial fund.
Similar rules apply to the creation of district agricultural funds;
and special measures are sometimes taken to ensure that the coexistence in the same area of two funds, one general and one agricultural, shall not prejudice their proper working (See, for example,
Sections 228-230 of the German Act). As a general rule, neither
general nor agricultural funds are set up if this would result in the
membership of the existing fund falling below 1,000.
, - 63 —
Machinery
The deliberative and executive machinery of district funds
includes representatives of both wage-earners and employers.
In Central European countries, both workers' and employers'
representatives are freely appointed by the insured and by their
employers; thus, a third of the members of the Management
Committees and of the officers of German territorial insurance funds
are appointed by the employers, and two-thirds by the insured
wage earners. All insured persons have a vote, while the number
of votes assigned to employers is determined, in accordance with
the number of wage earners employed by them, who are members
of the fund (Sections 232-233). The same proportion (namely, 1: 2)
exists on the Management Committees and Supervisory Commissions
of Austrian territorial insurance funds (Sections 18 and 34), and
Section 126 of the Hungarian Act provides for an equal number of
representatives of employers and insured.
The proportion prescribed implicitly in the German Act, and
explicitly in Section 34 of the Austrian Act, in which employers and
workers participate in the costs of insurance, on the one hand, and in
representation on the deliberate and executive committees of the
fund on the other, is not maintained in the Czechoslovak Act, Section
59 of which assigns eight representatives to the workers and two to
the employers on the Management Committees of territorial
insurance funds. On the other hand, the Supervisory Commissions
of these bodies, which consist of ten members, are composed of
eight employers' representatives and of no more than two representatives of the insured (Section 64).
The Norwegian district funds are administered by a Management
Committee of nine members, who are not, however, elected by
employers and insured, but are appointed by the municipal authority
by which the district fund was created. Of these nine members,
five are appointed from among the insured persons, two from the
employers, the remaining two being freely selected. Membership
of the Management Committee of a district fund is honorary and,
moreover, constitutes a civic duty which cannot be declined except
for the reasons specified in Sections 43 and 48 of the Act.
The machinery of the Portuguese compulsory mutual benefit
funds consists of a Management Committee and a Supervisory
Commission, composed of persons appointed by the members at
the General Meeting, in which both active and honorary members
have a vote. There are no provisions concerning the number of
— 64 —
representatives to be appointed by honorary members, which is
decided solely by the result of the elections (Section 49).
Membership
Membership of ä territorial msurance fund is automatic, nor is
any application for membership required. Membership dates from
the day when persons begin work in an occupation subject to
compulsory insurance, and neither the fund nor the parties concerned can withhold or refuse membership when it is legally
prescribed.
The territorial insurance fund constitutes the collective insuring
group for all persons subject to compulsory insurance who are
not members of a mutual benefit fund or a trade fund (Sections 234
and 236 of the German Act; Section 13 (1) of the Austrian Act;
Sections 120-121 of the Hungarian Act; Sections 5 and 7 of the
Norwegian Act: Section 3 (1) of the Portuguese Act; and Section 24
(1) of the Czechoslovak Act).
The territorial competence of district funds extends, under a
system of general workers' insurance, to include all wage earners
whose principal place of employment is situated within the area
covered by the fund (German Act, Section 234; Austrian Act,
Section 13; Hungarian Act, Section 120;.Norwegian Act, Section 9;
Czechoslovak Act, Section 24 (1), while the Portuguese system of
National Sickness Insurance includes all persons habitually resident
in the area covered by a compulsory mutual benefit association.
§ 4. — System of Legal Affiliation
MAIN FEATURES
In countries where, prior to the introduction of compulsory
sickness insurance, the mutual benefit movement had not assumed
any considerable development, the compulsory insurance Act liad
to provide for the creation ab initio of collective insurance groups
comprising all persons subj ect to compulsory insurance. Insurance
institutions of this kind, set up as a result of legislation, enjoy a
virtual monopoly of insurance, as no other types of insurance fund
are recognised as legal insurers.
The system of legal affiliation is exemplified in two groups of
compulsory sickness insurance legislation.
The first and by far the most important of these is constituted by
the laws adopted for establishing, or paving the way to the establish-
— 65 —
ment of, a general system of workers' insurance against all physical
risks, under which sickness insurance funds, in addition to their
duties as insurers against illnesses of short duration, also act as
local organisations for every branch of the insurance system
(e.g. Serb-Croat-Slovene and Russian Acts, and certain tendencies
in Polish legislation).
The second group includes legislative systems which restrict the
application of the principle of compulsory insurance to certain
classes of wage earners, more particularly to industrial wage
earners, as, for instance, Latvian and Roumanian legislation. In
this case, the funds responsible for working the compulsory insurance system are organised on an occupational basis and, so far
as their competence extends, automatically include all wage
earners subject to compulsory insurance.
Despite the great difference between single funds in these two
types of legislation, the system of legal affiliation is enforced in
both cases with equal strictness: and all persons subject to compulsory insurance automatically become members of the legally
competent fund.
TERRITORIAL INSURANCE F U N D S
Constitution
The territory of a country is divided into insurance areas, corresponding, in the Serb-Groat-Slovene State, to administrative
sub-districts; in Poland, to administrative districts, and, in Russia,
to areas with a radius of two versts at least from the headquarters of
the competent sickness insurance fund. Each of these areas contains
a sickness fund competent to insure all wage-earners habitually
working within the area. The central administrative bodies responsible for the supervision of workers' insurance (e.g. the Central
Workers' Insurance Institution in the Serb-Croat-Slovene Kingdom,
the Ministry of Labour in Poland, and the Commissariat of Labour
in Russia) are, generally speaking, responsible for setting up
territorial insurance funds.
Machinery
The Management Committees of Polish and Serb-Croat-Slovene
territorial insurance funds include representatives of employers and
insured: but while on the latter employers and workers are represented in equal numbers (Section 125; Serb-Croat-Slovene Act)
on the former, employers' representatives only constitute one-third
of the members (Section 6 8 ; Polish Act).
5
— 66 —
Russian district funds are administered by a committee of
from three to seven members elected by a meeting of the representatives of insured persons who comprise delegates of works council
in the area in proportion to the size of the works, and representatives
of each of the trade unions concerned in the different works (Circular
of 22 June 1922). The departmental authorities confirm the
chairmen of the committees who are elected by the committees
themselves.
Membership
All wage-earners habitually employed in the area of a territorial
insurance fund automatically become members of the fund from
the date when they begin work involving compulsory insurance.
(See Section 142 of the Serb-Croat-Slovene Act and Section 5 (1)
of the Polish Act).
The only exceptions to this territorial principle are in the case
of public transport workers insured by a special employers' benefit
fund (Railway Workers' Fund, Seamen's Fund, etc.) (Sections
153-157 of the Serb-Croat-Slovene Act; Section 1 of the Polish
Act; Circular of 4 March 1922 of the Russian Commissariat for
Social Welfare).
Miners are also exempted in certain cases (See, for example,
Section 158 of the Serb-Croat-Slovene Act).
TRADE FUNDS
An example of a system of compulsory sickness insurance,
organised entirely on the basis of Trade Funds (in this case, Employers' Provident Funds) is found in Latvia.
Constitution
The employers' provident fund is the only type of legal insurer;
all industrial employers, employing more than 500 workers, are
compelled to set up a fund of this kind. In the case of small or
"medium-sized" undertakings, joint funds are set up by the employers and, if necessary, by the authorities (Sections 14-16).
Machinery
The Management Committee of an employers' provident fund
is elected by a General Meeting of the insured or, if the fund includes more than 300 members, by their delegates. The same
applies to the members of the Audit Committee, on which the em-
— 67 —
ployer, or his representative, may sit, though they may not sit
on the Management Committee (Sections 80 and 87).
Membership
All wage-earners employed in an undertaking where a fund has
been set up are members of the sickness fund; membership dates
from the time of their entering employment, if a fund already
exists; otherwise, from the date of the institution of the fund in
the undertaking. Membership ceases one month at the latest after
the person ceases to be employed in the undertaking concerned
(Section 18).
CHAPTER II
CONSTITUTION AND MACHINERY OF VOLUNTARY SICKNESS
INSURANCE INSTITUTIONS
Approved Sickness Insurance Funds
PRELIMINARY
REMARKS
The special regulations applying to sickness insurance funds in
countries where a voluntary system of sickness insurance prevails,
are generally of an optional character: mutual benefit societies are
free to submit to such regulations, or to remain subject to the
common law rules for associations not carried on for profit. But
mutual benefit societies can only obtain State recognition, and
the advantages reserved for approved sickness insurance funds, if
they express their readiness to accept such special regulations,
and if their constitution and rules of management have been
brought into line with the requirements of the law.
CONDITIONS REQUIRED FOR APPROVAL
The conditions required for approval under legislation at the
end of the XlXth century (e.g. French and Belgian legislation),
are different from those in legislation of more recent origin (e.g.
Swedish, Swiss, and Danish legislations).
Generally speaking, the laws of the first groups specify the following conditions only : that the social aims of the institution
should be defined by its constitution and should be confined to
mutual assistance in case of illness or any other occurrence of a
similar character; that regulations shall be adopted defining the
composition of the various organisations of the society and laying
down rules for its management (e.g. contribution rates, benefits
granted to members, procedvire for investing moneys collectively
held); formal application for approval to the authorities (Belgium); or merely the communication of the constitution and rules
to the authorities (France).
_
69 —
Approval, which is virtually subject to the discretion of the
authorities, involving certain advantages for the society approved :
for instance, in addition to the right of obtaining annual grants
or subsidies from the authorities, various measures intended to
encourage a society may be adopted, such as, the grant of legal
personality; measures for facilitating the acquisition by the society
of movable or immovable property; exemption from registration
and stamp duties ; free postage (Belgium) ; State bonus on deposits
(in France, on deposits with the Deposit and Loans Fund). In
Belgium legal recognition is a right in virtue of Section 1 of the
Act of 23 June 1894.
Under the legislative systems of the second group the conditions
required for approval, which are stricter than in France and Belgium, involve as a rule the following: membership open to all
nationals (Switzerland), or to all persons resident in the country
(Denmark, Sweden) without distinction of sex, with or without
minimum and maximum age limits (in Denmark, 14 to 40); a
form of organisation which is territorial (e.g. local and national
funds in Sweden), or occupational, or at once territorial and occupational (e.g. Switzerland and Denmark); a minimum number
of members (100 in Sweden, 200 in Denmark) ; freedom for members
to pass from one fund to another, limited, however, in the interests
of the fund; minimum benefits to which all members of the fund
are entitled. The latter condition, namely, minimum benefits to
which all members of approved funds are entitled (Swedish, Swiss
and Danish legislation), constitutes the fundamental difference
between the two groups.
Approval given in accordance with the legislation referred to
above involves, in addition to certain moral advantages, not only
the power, but also the right to receive grants from the authorities,
the minimum amount of which is specified by law (Section 17 of
the Danish Act; Sections 35-39 of the Swiss Act).
MEMBERSHIP
Membership of a mutual benefit fund is purely voluntary, as
prescribed in Section 14 of the Swedish and Danish Acts, and in
Section 15 of the Swiss Act.
As membership is a private legal act left entirely to the individual's own judgment, members are, as a general rule, free to
resign membership at any time. In the interests of members,
however, the right of a fund to expel members who have been
duly admitted is, in many cases, subject to certain restrictions.
— 70 —
Under the various laws by which approved Sickness Funds are
entitled to periodical subsidies, membership of the fund entails
certain consequences of a positive or negative character, extending
even beyond the relations between the members and the fund;
for an example of positive consequences, see Sections 7-10 of the
Swiss Act concerning the right to transfer from one approved
fund to another; for an example of negative consequences, see the
prohibition in Section 12(1) of the Swedish Act, and in Section
11 (4) of the Danish Act, to belong to more than one approved
fund at a time.
There is this peculiarity in the Danish system, that all members
of a recognised Sickness Insurance Fund are automatically insured
with the State Invalidity Fund against the economic consequences
of premature invalidity. Denmark thus affords the only example,
thanks to the comprehensive character of the Act of 10 May 1915,
of another branch of social insurance (in this case, invalidity insurance) being established on a basic organisation supplied by
the system of free sickness insurance.
PART ITI
SICKNESS INSURANCE BENEFITS
INTRODUCTION
DEVELOPMENT AND GENERAL FEATURES OF THE SYSTEM
Insured workers are when sick entitled to claim from the insurance institution such benefit as is provided for in the statutes of
that institution. The institution's liability to pay benefit begins
as a general rule on the day when the bodily or mental condition
of the insured worker has reached a pitch of abnormality necessitating medical treatment, or the suspension of employment, or
both; in some cases, however, this liability does not arise unless
certain other conditions have been fulfilled, for instance, unless
the worker concerned was a member of the insurance institution
for a minimum period of time before the risk was translated into
reality, or unless he has paid a minimum number of contributions.
The sick worker who fulfils the conditions governing payment
of benefit acquires a definite right to such benefit as is specified
in the statutes of the institution. The kind and extent of assistance
afforded must not fall below the specified legal minimum.
In principle no difference should be made in the contributor's
status as a claimant to benefit whether he became a member of
the insurance institution under compulsory or under voluntary
insurance.
The primary object of the first insurance acts was to furnish
the worker with monetary compensation designed to replace the
wages lost through sickness, and provision for curative treatment
to ensure the recovery of the patient occupied only a relatively
surbordinate place. This state of affairs is evidenced by the circumstance that insurance institutions were left free to grant an
increase in the monetary compensation in lieu of medical treat-
— 72 —
ment, even where no obstacles to the latter arose. Matters changed
when it was realised that sickness insurance was likely to assume
great importance as an instrument for improving the health of
the masses. Intimately and permanently bound up with the life
of the labouring classes, sickness insurance is better adapted than
any other form of social institution to contribute towards the
improvement of public health, not merely by curative, but also
by preventive measures. Henceforward the principal task of sickness insurance was to make suitable medical assistance available
for all the insured workers. Slowly but steadily benefit in kind
has overshadowed compensation in cash, and the essential aim
of every system of sickness insurance has been to ensure as rapid
and as complete a cure as possible for diseases which prophylactic
measures have failed to prevent. Pecuniary compensation which
aims at shielding the patient from the most immediate material
cares only subsists as a supplementary factor side by side with
medical assistance.
Although sickness insurance legislation tends more and more to
take the line that benefit in kind should be the principal form of
assistance afforded, and although this line is almost universally
followed where such insurance is compulsory, the extension of
benefits in kind to members of the insured worker's family has not
yet become the general practice. Considerable progress has, however, been made in that direction, particularly since the war, and
we may anticipate that this tendency will assert itself with increasing force and that the scope of sickness insurance will expand
until it becomes the most extensive organisation for the promotion
of public health.
Part III of this report will deal first of all with money benefits,
and consideration will then be given to benefits in kind, the conditions governing the payment of such benefits, the minimum benefit
prescribed by law, and the additional benefits which may be
granted by insurance institutions so far as their resources permit.
CHAPTER I
BENEFITS IN CASH
§ 1. — Conditions of Benefit
The object of the main form of money benefit, i.e. sickness
compensation, is to provide the patient with the minimum means
of subsistence for the period during which he is precluded by sickness, from earning his ordinary wages. It is payable to an insured
worker as soon as sickness compels him to abandon his ordinary
work. The conditions upon which payment depends are in some
cases more stringent, the insured worker being further required
to show that he has been a member of the insurance institution
for a minimum period of time. Again provision is rarely made for
cases where the suspension of work is of short duration, no compensation being claimable unless disablement for work lasts for
several consecutive days.
The conditions governing payment of money benefit show considerable variation as between the different systems of legislation;
only the most important of these conditions will be considered
here.
PHYSIOLOGICAL CONDITION : INCAPACITY FOR WORK
The essential condition and one generally laid down is that the
insured worker shall be disabled for work as a result of sickness.
Sickness as defined by insurance laws is not identical with sickness as regarded by medical science. In the eyes of sickness
insurance law, sickness is any abnormal mental or bodily condition
which prevents the individual from working at a remunerative
occupation or entails medical treatment, regardless of its œtiological aspect. The determining factor in the eyes of the law is
therefore primarily the extent to which sickness affects the capacity
of an individual suffering therefrom to perform his ordinary work
(see for instance, Section 10 (1 b), of the British Act).
Questions of detail which the very summary legal provisions
ignore are governed by jurisprudence, but it would be idle to
attempt to give a representative selection of the issues raised by
— 74 —
the countless individual cases in which medical officers and judges
are called upon to decide as to the validity of claims for compensation. A few of the principal points only can be mentioned.
Any abnormal condition involving the cessation of work confers
a right to compensation, whatever its etiological origin, or whatever the time and place of its inception. It is immaterial whether
this condition is attributable to external agencies or to defects
which are the outcome of normal physical wear and tear; it is
also a matter of indifference whether the disease arose out of
particular conditions of work, or is not traceable to any occupational
cause. Generally speaking, all forms of disease are covered,
even incurable diseases. Nevertheless, diseases wilfully induced
by the claimant are excluded on principle. (See for instance,
Section 95 (2) of the Czechoslovak Act ; Section 47 of the Jugoslav
Act; or, as optional, in Section 182 (2), of the German Act).
On the other hand, sickness within the meaning of the insurance
laws should have reached a degree of severity sufficient to prevent
the worker from continuing to perform his regular work. The
worker is disabled for employment when he is prevented by sickness from continuing to follow his former occupation, or could
only do so at the risk of aggravating his condition. Two points
are of importance: (1) disablement for employment must be
attributable to sickness (cf. for instance, Section 182 (2) of the
German Act ; Section 10 (1 b) of the English Act ; Section 95 (2) of the
Czechoslovak Act; Section 16 (1, A, c) of the Norwegian Act; and
Section 45 (3), of the Jugoslav Act); (2) it suffices if the worker is
disabled from following his ordinary occupation and he cannot be
required to undertake remunerative work in a trade other than his
own. It is immaterial whether incapacity for employment is total or
partial, provided the patient is in fact unable to work without
running the risk of aggravating his condition (see for instance
for Germany: Central Insurance Office Bulletin, 1914, pp. 631, and
1917, p. 642; and, as regards Great Britain: Summary of the Law
and Administration of National Health Insurance, Stationery
Office, 1924, No. 49565, p. 17).
The bare circumstance of disablement for work through sickness
is not in itself sufficient to confer the right to compensation; the
insurance institution must, in addition, be informed in the prescribed manner. To this end the claimant is required to furnish
the insurance institution with a medical certificate x attesting that
the patient is incapable of work for medical reasons, and though
1
As regards the competent medical officer, see p. 102.
— 75 —
the departments of the institution are not compelled to bow to
this medical opinion, they are generally precluded from opposing
it unless they produce medical evidence to the contrary from other
sources.
LEGAL CONDITIONS
On receipt of the medical certificate attesting the contributor's
inability to follow a remunerative occupation, the insurance
institution considers whether the claimant is properly entitled
to benefit, that is to say, whether there are any reasons affecting
him individually which would deprive him of his right to benefit.
It should be noted in this connection that absence abroad generally
involves a limitation of the right to compensation, or even the
loss of such right. A more important restrictive provision,
occurring only in certain laws, however, is the bar on workers who
have only been members of the insurance institution for a short
time, or who have not paid the minimum number of contributions.
Residence outside the District of the Insurance Institution
The insurance institution, which undertakes to carry out the
legal and statutory provisions regarding benefits payable to the
sick worker, is required to possess administrative and supervisory
machinery. It cannot be called upon to pay benefit at any place
at the will of the claimant.
While the question as to where the insurance institution can
properly be required to furnish the claimant with benefit is of
great importance from a national point of view, it will not be discussed here ; it will be sufficient to state that, as a general rule, the
institution is only obliged to serve benefit to claimants resident in
its district. The position of a claimant resident outside the district
of the fund differs, however, according to whether he is living abroad
or in the country.
Residence Abroad
As a general rule the sick worker who is living abroad is not
entitled to benefit. Section 26 (1) of the Norwegian Act, divesting
the sick worker who leaves the country of all right to compensation,
may be quoted as an example. The British Act (Section 19) takes
up the same position, while at the same time leaving the insurance
institution free to continue payment of benefit to any sick contributor who proceeds abroad temporarily and with the consent
of the institution after having been in receipt of benefit at home.
The line taken by the Polish Act (Section 38) is very similar. Here
— 76 —
the sick contributor is only divested of his right to compensation
if he proceeds abroad during his period of sickness and without
the consent of the managing committee of the fund.
The German and Jugoslav Acts draw a much sharper distinction between the case of the sick contributor living abroad at the
term of falling sick and that of a sick contributor proceeding
abroad after such time. In the first case both the German Act
(Section 221) and the Jugoslav Act (Section 61) compel the employer
to allow the worker resident abroad such benefit as is payable
when under the Act. The employer is entitled on his side to the
refund of the extra expense involved from the insurance institution.
The German Act, however, only places the claimant on this
footing whilst his physical condition prevents him from returning
to Germany. In the second case — that of a sick contributor
proceeding abroad during sickness — the right to benefit is suspended; when, however, the insurance fund has consented to the
claimant's proceeding abroad, it is required to continue payment
of benefit, but can compensate the sick contributor by paying a
lump sum equivalent in value to the benefit which it would have
been called upon to serve had he not left the country (German
Code, Sections 216 and 217). The line taken by the Norwegian Act
(Section 23) and Hungarian Act (Section 66) is similar to that
followed by the Jugoslav Act.
Residence in the Home Country outside the District of the Fund
The claim of contributors who fall sick while, resident in the
home country, outside the district of the fund, is usually subject
only to unimportant restrictions. In states possessing a complete
network of sickness insurance institutions organised on district
lines, the claimant can apply to the nearest district fund. This
fund is obliged to assume liability on behalf of, and to reclaim the
monies expended from, the fund properly concerned (see for instance,
monies expended from, the fund properly concerned (see for
instance, Sections 220 and 222 of the German Act, Section 37 of the
Polish Act, Section 34 of the Portuguese Act and Section 28 of the
Norwegian Act; see also, for Russia, Circular of 24 March 1923).
Minimum term of membership (Contributor''s probationary period)
The contributor is not necessarily entitled to full benefit on
the -date of admission to membership of the insurance institution.
Following the lines of private insurance, and with a view to shielding insurance institutions -against the losses to which they would
be liable by admitting to membership persons already suffering
— 77 —
from compensable disorders, the first sickness insurance laws onlyconferred the right to benefit on persons who had fulfilled the obligations of membership for a minimum (probationary) period.
Since then the probationary period has generally speaking been
abolished in compulsory sickness insurance: the contributor can
claim benefit if need be as from the day following, or even on the
day of, his admission to membership and the shortness of his term
of membership or the fact of not having paid his contribution
does not justify a refusal. This is the only feasible method of
procedure seeing that the contributor could not become a member
of the insurance institution on a compulsory basis before taking
up insurable employment, and that he is not immediately to blame
for not paying the contribution 1. In optional insurance, on the
other hand, it is frequently stipulated that the contributor shall
not be entitled to insurance benefit unless he has completed a
probationary period, and has during that period met the financial
obligations towards the insurance institution devolving upon him
by virtue of his membership.
The fact of a probationary period not being required for compulsory contributors is confirmed by a considerable number of express legal provisions, as occurring for instance, in the German Act (Sections
206 and 306), the Jugoslav Act (Section 55), the Czechoslovak Act
(Section 95 (2), and Art. 95, (1), the Polish Act (Section 35 (1),
the Russian Act (Section 175), and Hungarian Act (Section 60).
This practice has not been universally followed however,
several compulsory sickness insurance Acts, such as the British,
Roumanian, Portuguese and Bulgarian Acts, allow no cash benefit
to contributors recently admitted to membership of an insurance
institution. Thus, the British Act (see Section 13 (3) allows no
sickness benefit unless 26 weeks have elapsed since he entered
into insurance and unless 26 weekly contributions have been
paid to the claimant's account. Similarly, the Portuguese Decree
(Section 30) stipulates that eligibility to benefit in cash shall
be conditional on payment of contributions for a period of not
less than six months. The Roumanian Act (Section 116) and the
Bulgarian Act (Section 19) are satisfied with a shorter term of
membership, the first stipulating only for six, and the second
only for eight, weekly contributions.
The voluntary contributor, on the contrary, is frequently required to undergo a probationary period of varying length, and
this is true not merely of free insurance systems, but also of com1
See p. 115-
— 78 —
pulsory systems which allow of voluntary membership. To exem
plify this we may quote as an instance of free sickness insurance
legislation the Danish Act, Section 20 of which lays down that contributors cannot be admitted to benefit unless their membership of
an approved society extends over at least six weeks; and as instances of compulsory sickness insurance legislation, the German
Act, Section 207 of which authorises sickness insurance funds to
require voluntary contributors to undergo a probationary period
of six weeks; the new Czechoslovak Act (Section 251 (3)), which.
authorises the funds to impose a probationary period of at least
four, and at most eight, weeks; and finally, the Polish Act (Section
35 (2) which itself prescribes a minimum probationary period of
four weeks for voluntary members, and admits of this period being
extended to a maximum of six weeks by the statutes of the fund.
The Swiss Act (Section 13 (1)), on the other hand, protects members
of approved sickness insurance societies by stipulating that the
term of membership properly requirable by an approved society as a
condition of payment of benefit shall not exceed three months.
WAITING PERIOD (DÉLAI D'ATTENTE, WARTEFRIST, WARTEZEIT)
Even where the requirements governing the right to sickness
benefit have been fulfilled, the contributor does not become
entitled to such benefit as from the first day of disablement for
employment. In order to prevent abuses and to avoid overburdening insurance institutions with the payment of benefits
for short terms of disablement, which would involve management
expenses quite out of proportion to the advantages accruing
therefrom, contributors are precluded from claiming benefit
unless disablement for work at a remunerative occupation lasts
for several consecutive days (waiting period). Almost every
sickness insurance Act, whether compulsory or free, imposes a
waiting period of this kind on contributors who have been disabled
for employment.
The footing upon which contributors are placed varies, however,
according to whether the waiting period is absolute or relative.
In the first case the claimant is not entitled to benefit until the
waiting period has elapsed, however long disablement may last.
In other words, the financial losses suffered by the contributors
disabled for work in the course of the waiting period are definitely
borne by them. On the other hand, when the waiting period is
only relative, the sick worker whose disablement continues beyond
the minimum prescribed disablement period, becomes entitled
— 79 —
to benefit with retrospective effect as from the first day of disablement. When a relapse occurs within a specified period of time
after the first attack of sickness, the waiting period is generally
not applicable.
The waiting period assumes an absolute character in British,
German, Lithuanian, Polish and Norwegian law. In the first
of the above-mentioned laws the period is three days, in the others
it is two days, that is to say that the worker disabled through
sickness for work at a remunerative occupation, is entitled to
sickness benefit as from the fourth and third day of disablement
respectively (see Section 10 (1, b) of the English Act; Section 182 (2)
of the German Act; Section 49 of the Lithuanian Act; Section 23 (1)
of the Polish Act; Section 19 (1) of the Norwegian Act). According
to the Swiss Act (Section 13 (2)) the absolute waiting period cannot
exceed two days. Insurance institutions are moreover, frequently
authorised by law to curtail the waiting period (for instance under
the British Act, Schedule 3, No. 4, provided that the disposable
surplus is adequate for this purpose, and under Section 57 (2), of
the Lithuanian law), of even to waive it completely (see for instance,
Schedule 3, No. 4, of the British Act, and Section 191 (2), of the
German Code in respect of sickness lasting more than 8 days, etc.)
The waiting period is only relative in the Austrian Act (Section 6
(2)), the Jugoslav Act (Section 45 (3)), and the Danish Act (Section 20 (2)), for instance under which Acts benefit is payable as from
the first day of disablement provided such disablement lasts for
more than three successive days. If the period of disablement is
shorter, the individual concerned is not entitled to benefit ; nevertheless, when disablement extends to the fourth day the contributor
that day becomes entitled to benefit for the three days preceding.
In the Czechoslovak Act (Section 95 (2)) the waiting period
may be absolute or relative, according to the length of period of
disablement. When disablement lasts less than three days benefit
is not payable; when it lasts from 4 to 14 days benefit is payable
as from the fourth day (absolute waiting period), and when disablement extends beyond the fourteenth day, it is payable as from
the third day of disablement (relative waiting period).
In concluding these remarks we may add that as a general rule
the right to sickness benefit is only claimable by insured persons
who have fulfilled all the requirements upon which such right is
conditional. At the same time provision is made for exceptions
of varying importance in favour of former members who fall sick
during a relatively short period after the termination of their
membership of the insurance institution.
— 80 —
The most generous provisions in this connection are contained
in Section 3 of the British Act, where it is stated that insurance
continues to be effective in the case of voluntary or compulsory
contributors for a period of one year reckoned from the cessation of
insurable employment, or the last payment of a voluntary subscription as the case may be. This free year is also capable of being
extended indefinitely in respect of duly notified incapacity commencing within that year. A similar provision, limiting the
period of benefit however, is to be found in the Polish Act (Section 36 (2)) where }t is stated that members of an insurance fund
who relinquish their employment and who were members of the
fund for not less than the six immediately preceding weeks, or for 26
weeks during the 12 preceding months, retain their right to benefit for
the period specified in the statutes of the fund, provided sickness
occurs within the 4 weeks following the cessation of employment.
Other compulsory sickness insurance act only acknowledge
the right to benefit in the case of former members who have fallen
out of employment and are still resident in the country. Thus, the
new Czechoslovak Act (Section 97 (4)) extends sickness benefit to
sick and unemployed workers for a period not exceeding six weeks
following the termination of membership of the fund. The Hungarian
Act (Section 61 (1) and the Jugoslav Act (Section 50 (1)) are
less generous and only extend sickness benefit to unemployed
workers who were insured for not less than six months during the
preceding year, and curtail the period during which benefit is
payable to three weeks (six weeks when the unemployed worker
was insured for a period of 12 months during the two previous
years). The Austrian law (Section 13 (3)) also affords benefit to
unemployed workers who have been disabled for work through
sickness for a maximum period of six weeks following the termination of their membership.
The German law (Section 214) allows benefit under the act to
insured workers who lose their employment and fall sick during the
three weeks following the cessation of work. Nevertheless, only
those persons are entitled to benefit in these circumstances who
were insured for 26 weeks during the preceding year or for 6 weeks
immediately before the cessation of work. When sickness occurs
after a period of three weeks reckoned from the cessation of employment, the unemployed worker still remains entitled to compensation under the Sickness Insurance Act owing to the fact that, as
already mentioned 1 , all unemployed workers must be insured
1
See p. 32.
— 81 —
against sickness by the commune either with the district fund
or with any other fund affording at least equivalent advantages,
and such insurance must be effectedat latest within the three weeks
following the cessation of employment (Order dated 16 February
1924, Section 20 and 24).
§ 2. — Rates and Period of Sickness Benefit
Sickness benefit is payable to workers who fulfil all the requirements prescribed by law and the statutes of the fund. The rate of
benefit and the period during which it is payable are fixed by the
insurance Act; the fund is required to pay such amount for a period
not less than that laid down by law (minimum legal benefit).
Notwithstanding this, the fund may, when resources permit,
pay benefits above the minimum legal rate, and in cases, for a
longer period. This additional benefit, which cannot exceed
the limits prescribed by law, is definitely claimable, on the same
terms as legal benefit, by insured workers who are eligible for.
general and, where applicable, special benefit.
LEGAL SICKNESS BENEFIT
As already pointed out, the object of sickness benefit is to
provide some measure of compensation for the pecuniary loss
«ntailed on the contributor by the cessation of his regular employment. As the amount of such loss varies in proportion to the
rate paid for the work which the insured person has been unable
to perform, the rate of sickness benefit must necessarily be calculated in proportion to the ordinary wages of the claimant (sliding
scale of benefit). With few exceptions, therefore, sickness insurance
laws calculate the rate of benefit according to the contributor's
regular earnings. The only exceptions among compulsory sickness
insurance Acts are the British and Irish Acts which lay down a
fixed scale of benefit for all insured persons, and ignore the question
of average earnings (fixed rate benefit).
Two different kinds of contribution, i.e. contributions at fixed
rates and subscriptions according to a sliding scale accompany
to the system of benefit at fixed rates and that of benefit on the
sliding scale respectively *. The system of fixed benefits affords
great facilities for the administration of the fund. At the same
time, fixed benefits must be calculated in such a manner as
to afford the strict minimum required for subsistence, lest they
1
See p. 109-
— 82 —
should approximate too closely to the lower rates of wages and
impose too heavy a burden on the small wage-earners; but once
reduced to this minimum figure, they are apt to be of small economic value to the better paid members. Benefit on a sliding scale,
on the other hand is somewhat difficult to administer, entailing as
it does the notification and recording of all, or at any rate of a
considerable number of fluctuations in salaries and wages; at the
same time, it affords all members a minimum rate of benefit in
keeping with their ordinary standard of life, and its economic
value is the same for all.
Benefit at Fixed Rates
Under the British and Irish Acts, legal benefit is payable at a
flat rate to all contributors irrespective of their earnings. The rate
varies, however, according to sex, being 15s. a week for men, and
12s. a week for women. This benefit (sickness benefit) is payable
as from the fourth day following disablement for a maximum.
period of twenty-six weeks; if at the end of this period, the contributor is still incapable of work at a remunerative occupation,
disablement benefit at the rate of 7s. 6d. per week, irrespective
of sex, is payable in lieu of sickness benefit. , No benefit is payable
to persons over 70 years of age.
Sickness benefit at full rates is allowed provided that the contributor has been insured and paid the approved society's contributions for at least 104 weeks; if the number of weekly contributions
is less than 104, but not less than 26, benefit is payable at the
reduced weekly rate of 9s. for men and 7s. 6d. for women 1 . (British
Act, Sections 10 and 13).
The appended table summarises the rates of fixed benefit laid
down by the British Act.
TABLE SHOWING RATES OF FIXED
THE BRITISH
Number of
weekly contributions
BENEFIT LAID DOWN BY
ACT
In the event oí incapacity for work at a remunerative
occupation, the rate of weekly sickness (disablement)
benefit, starting from the fourth day, is:
as from the 27th week
For the first 26 weeks
Female
Male
Female
Male
contributors contributors contributors contributors
From 26 to 103.
104 or over
. . .
s.
d.
s.
d.
s.
d.
s.
d.
9
15
0
0
' 7
12
6
0
7
6
. 7
6
1
Contributors who have paid less than 26 weekly contributions are not
eligible for sickness benefit.
— 83 —
Reductions up to 100 per cent, may be made in the weekly
sickness (disablement) benefit on the grounds of arrears of contributions. Under the regulations based upon Section 15 in the
British Act, arrears of contributions, for the second half of 1922
and the first half of 1923 for instance, entail unfortunate consequences on the contributor during the year 1924, unless he discharges such arrears before the expiry of the period of grace,
which usually runs from the end of the month of July until the
end of October or November of the same year (1923). In the event
of the contributor failing to take advantage of the period of grace,
he is liable during the following benefit year to a fixed penalty
proportionate to the amount of arrears in his subscriptions. If the
penalty is paid, the insured worker becomes eligible for full benefit;
such benefit being otherwise reduced or even completely disallowed.
The amount of the penalty in respect of arrears of contributions
and the rates of sickness benefit (reduced rates of benefit for compulsory members) are shown in the following table:
TABLE
SHOWING THE
RATES OF
"ARREARS
PENALTY"
AND
THE
REDUCED RATES OF SICKNESS (DISABLEMENT) BENEFIT FOR COMPULSORY CONTRIBUTORS
Amount of arrears
Number
penalty
of contributions
(including
weeks
of sickness)
Men
45-47
42-44
39-41
36-38
33-35
30-32
26-29
25 at least
s. d.
1 0
2 0
3 0
4 0
5 0
6 0
7 0
12 0
Women
s.
1
2
3
4
4
5
5
9
d.
0
0
0
0
0
0
0
0
Reduced rates of benefit if
arrears not paid (persons
who have been insured for
i 04 weeks and have paid 10-5
contributions)
Reduced rates of
sickness benefit if
arrears penalty not
paid (persons who
have not been insured for 104 weeks
or have paid less
Disable- than
104 contriment
butions)
benefit
Sickness
benefit
Men
s. d.
14 0
13 0
12 0
11 0
10 0
9 0
8 0
Nil
and
Women Men
women
s.
d.
11 0
10 0
9 0
8 0
8 0
7 0
7 0
Nil
s. d.
7 0
6 6
6 0
5 6
5 0
4 6
4 0
Nil
Men
s.
d.
8 6
8 0
7 6
7 0
6 6
6 0
5 6
Nil
Women
s. d.
7 0
6 6
6 0
5 6
5 0
4 6
4 0
Nil
The reduction is greater in the case of voluntary contributors,
the penalties are heavier and the reduction takes effect when
the number of weekly contributions is below 50, whereas employed
contributors are eligible for benefit when they have paid a minimum
of 48 weekly contributions.
_ 84 —
Benefit according to a Sliding Scale
Sickness Insurance Acts which do not adopt the flat rate system
are more or less guided by the earnings of insured workers, so that
the rate of benefit varies. When therefore the insured worker is
incapacitated for work on account of sickness, he is eligible for
benefit at a rate in keeping with his ordinary standard of life.
To enable the insurance institution to assess the amount of
sickness benefit payable, as soon as the requirements governing
payment have been fulfilled, it is imperative that reliable information as to the figure of earnings upon which to assess such benefit
(basic wage), should be in the possession of the insurance institution at the time when the claimant falls sick. The legal rate of sickness benefit is then equivalent to a certain percentage of the contributor's basic wage, the exact percentage being fixed by law. Such
benefit is payable during the whole period of incapacity for
remunerative work caused by sickness, subject, however, to a
fixed limit which is also laid down by law.
We therefore have to consider in what manner the basic wage is
determined, the amount of sickness benefit in relation to the basic
wage, and the period during which such benefit is payable to the
contributor.
The Basic Wage
Sickness benefit approximates more closely to the ordinary
resources of the sick worker in proportion as the basic wage approaches the figure of his actual earnings. However desirable it may
be to preserve an exact equivalence between sickness benefit and
the contributor's earnings, such an idea has generally to be abandoned owing to the numerous difficulties incidental to the recording of the individual wages of each insured worker: the basic wage
is therefore fixed as an approximate rather than an exact equivalent
of contributor's earnings. This approximate assessment is effected
by sub-dividing salaries into classes and categories.
(a) Basic wage equivalent to actual wages. — Sickness benefit is
in direct ratio to the insured worker's earnings when the basic
wage is equivalent to his actual wages. In that case, sickness
benefit is equivalent to a definite percentage of the wages last
earned by the contributor before the occurrence of sickness. To
enable sickness benefit to be assessed at any moment, the individual
wage register must be kept strictly up to date. It is nowhere laid
down by law that the basic wage is to be at all times equivalent
to his actual wages. At the same time, a number of compulsory
— 85 —
sickness insurance systems allow, benefit to be assessed according
to actual wages, while retaining as alternatives other methods of
assessing the basic wage. The German Act is among the number,
Section 180 (4) authorising sickness insurance funds to take as the
basic wage the actual wages earned in lieu of the average wage of
any class or category of wages, and to apply this system either to
the whole of the contributors or to the contributors employed
in specified undertakings. Although this latitude has been allowed
to all funds, the establishment funds alone avail themselves of it, as
the wage lists drawn up by large undertakings enable them to keep
their wage registers up to date; district funds, on the other hand,
whose membership includes persons earning varying amounts, and
which lack the facilities employed by establishment funds, are not
in a position to take individual wages into account. The Latvian
Act (Sections 49 and 61) also provides for the assessment of benefit
on the basis of actual wages; here, as before, the funds concerned
are the establishment funds which, by their very constitution are in
direct contact with the undertaking and able to consult the wage lists.
(b) Basic wage equivalent to the average of a class or category of
wages. — To avoid the need for recording the earnings of every
contributor, the majority of insurance Acts embodying the principle
of benefit on a sliding scale, have sub-divided wage-earners into a
varying number of classes. Each class of wages includes contributors whose normal wages for a given period do not exceed the
maximum nor fall below the minimum of that particular class
of wages. The fact of classifying wages in this manner relieves
the funds of the necessity of recording individual wages. The
only entries required to keep the registers up to date are those
showing that the insured worker has been transferred to a different class from that in which he was previously included.
The determination of the number of classes of wages plays a
great part in ensuring the efficiency of the insurance system. If
the number of classes prescribed is too small, the same group
includes individuals earning widely different rates of wages, and
paying subscriptions at varying rates; the consequence is that'
those whose average earnings hardly exceeds the minimum of
a particular class are obliged to subscribe at rates out of proportion to their resources, though entitled on the other hand to very
high rates of benefit. An unduly large number of classes, on the contrary, while strictly fair involves the recording of a considerable number of modifications, thus depriving the system of wage classification
of the facilities of administration which are its principal raison d'être.
— 86 —
Moreover, insurance laws which have adopted the system of
assessment of benefit, whilst retaining or discarding other systems,
provide for a varying number of wage classes as may be seen from
the following figures:
Number of
Wage classes
The
The
The
The
The
The
The
The
Portuguese Act
Roumanian Act
Norwegian Act
Bulgarian Act
Austrian Act
Czechoslovak Act
Polish Act
Jugoslav Act
(Section
(Section
(Section
(Section
(Section
(Section
(Section
(Section
35)
127)
14)
11)
7)
12)
20)
21)
3
5
5
6
9
10
14
17
As a general rule, no minimum is laid down for the lowest class
in order to include any contributors not in receipt of wages, or at
any rate, regular wages; the highest class of wages, on the other
hand, only possess a minimum limit, so as to include all contributors
whose wages exceed the maximum of the highest class but one,
A mean rate of wage is fixed for each class, and is very often
equivalent to the arithmetic mean between the maximum and
minimum figures of each particular class; in other cases, it is
equivalent to the minimum figure for that class.
Sickness insurance Acts sometimes empower insurance institutions to substitute occupational categories for classes of wages
(see, for instance, Section 180 (4) of the German Act, and Section 22 (4) of the Jugoslav Act). Each occupational category includes
contributors possessing similar occupational qualifications. The
main criterion for sub-dividing wage-earners in the same trade into
categories is no longer the current wage, but age, in so far as it is
a factor in the assessment of the wage. This system of categories,
while easier to handle than that of wage classification can, nevertheless, be applied with success only to establishment funds.
The Amount of Legal Benefit
Legal benefit amounts to a definite percentage of the contributor's
basic wage, and is equivalent to a varying proportion of his ordinary
earnings. Benefit on a sliding scale is more or less proportioned
to his needs according to the closeness with which it approximates
to his actual earnings.
The proportion of basic wage payable as benefit to sick contributors varies considerably as between different countries, and sometimes even as between different cases under the same system. It
oscillates between 50 per cent, and 100 per cent. To take specific
cases, it is:
— 87 —
50 per
50
50
50
60
60
) 75
66%
66%
cent.
»
»
»
»
»
»
»
»
66%
¡-80
100
»
»
»
in
in
in
in
in
in
in
in
in
Germany
Esthonia
Luxemburg
Roumania
Norway
Poland
Hungary
Latvia
the Kingdom of the Serbs,
Croats and Slovenes
in Czechoslovakia
in Austria.
in Russia 1 .
It would be a matter of considerable difficulty to judge of the
advantages afforded to the community by this or that system of
insurance from the proportion of basic wage paid in the form of
sickness benefit. In the first place, the basic wage itself is arrived
at by processes which in cases differ considerably; and, in the
various systems the legal benefit of the lowest and of the highest
class is fixed at very dissimilar rates. Moreover, legal benefit can be
increased by additional pecuniary allowances to sick contributors.
The percentage of basic wage paid in the form of sickness benefit
is in any case not always uniform within the system.
It is sometimes increased when disability persists beyond a
specified period. This is the case, for instance, under the Hungarian
Act (Section 13) which increases the sickness benefit, calculated at
60 per cent, of the basic wage for the first four weeks to 75 per
cent, of the basic wage as from the fifth week of disablement for
employment.
Furthermore, benefit may be payable at different rates according
to whether the insured workers have family responsibilities or not.
Thus, the Roumanian Act (Section 117) reduces the benefit assessed
at 50 per cent, for fathers of families to 35 per cent, of the basic
wage in the case of workers having no family responsibilities.
Finally, legal benefit may be paid at different rates, being progressively reduced as the rate of wages increases. Thus the Austrian
law (Section 7) assesses benefit at 80 per cent, for the first seven
classes of salaries, at 74 per cent, for the eighth class, and at 66 2 / 3
per cent, of the basic wage for the ninth and last class.
There are, moreover, considerable differences to be observed
between the different systems according as sickness benefit is
payable for each day of disablement or for working days only.
x
It is, however, to be observed that the central social insurance authorities
can, for lack of money, provisionally reduce
the rate of benefit in case of
temporary incapacity, but not below 662/3 per cent, of the basic wage (See
Labour Code, Section 182).
— 88 —
The first method is followed, for instance, by the Jugoslav, Polish,
Austrian, and German Acts, etc., whereas a certain number of
other Acts such as the Norwegian, Roumanian, and Swedish,
adhere to the second. The Czechoslovak Act adopts a compromise
granting sickness benefit for working days and others, but only
when disablement lasts longer than fifteen days.
Period during which Benefit is Payable
Sickness benefit is payable whilst the contributor is disabled
from employment provided he has not been in receipt of benefit
for a period exceeding the legally prescribed maximum. This period
varies between 16 and 52 weeks consecutive or otherwise, being:
90 days in Sweden (in the course of 12 consecutive months)
16 weeks in Roumania
180 days in Switzerland (in the course of 360 consecutive days)
26 weeks in Denmark (in the course of 12 consecutive months)
26 weeks in Germany
26 weeks in Latvia
26 weeks in Norway
26 weeks in the Serb-Croat-Slovene Kingdom
39 weeks in Poland
52 weeks in Austria
52 weeks in Hungary
52 weeks in Portugal
52 weeks in Czechoslovakia.
The legal period during which sick contributors are eligible for
sickness benefit is in any case not always the same for all contributors. Thus, under the Austrian Act, for instance, only such
claimants as were members of the fund during a minimum period
of 30 weeks prior to falling sick, are entitled to the full period of
52 weeks ; all other contributors being ineligible for more than
26 weeks' benefit. Again, the Polish Act introduces variations into
the legal period according to the length of time the fund has been in
existence ; funds which have been in existence for at least three
years are alone required to pay 39 week's benefit, whereas funds
which have been instituted for a shorter period of time are allowed
to pay benefit for 26 weeks only. The Russian Labour Code
prescribes no limit for the duration of temporary incapacity, the
benefit being continued until the contributor regains his health
or is awarded a permanent invalidity pension (Section 180).
The varying length of time during which sickness benefit can
be granted by the insurance institution is no indication of the value
of any one system as compared with others. Better results are
at times achieved by paying benefits at high rates for a short
period than by paying benefits at low rates for longer periods.
— 89 —
There is yet another and still more important reason which renders
futile any attempt at comparison, namely, that the task of sickness
insurance differs substantially according to whether it is supplemented or not by other branches of insurance against bodily risks.
In conclusion, it will be desirable to review in the appended
table the legal provisions governing the legal amount and period
of sickness benefit in a number of sickness insurance systems.
TABLE SHOWING THE LEGAL SCALE AND PERIOD OF SICKNESS BENEFIT
IN A NUMBER OF SICKNESS INSURANCE SYSTEMS
Benefit payable in respect of disablement for r e m u n e r a t i v e work
Name of country
Date
of commencement
D a y s reckoned
Germany
F o u r t h day
Austria
First day if disablement lasts
more t h a n 3 days
Bulgaria
First d a y
Working d a y s
Working or o t h e r
days
Working days
W o r k i n g or o t h e r
days
Working days
and others
Ditto.
Rate
Maximum period
26 weeks i
50% of t h e basic wage
52 weeks ; 26
weeks if t h e
contributor h a s
been a m e m b e r
for less t h a n 30
weeks
9 months
66 %-80 %
wage
basic
12-30 levas per diem
(allowance of 1 leva
per diem per child
under t h e care of contributor)
Minimum 40 ore per
diem
50-66 % % of wages
Male c o n t r i b u t o r s 15s.;
female
contributors
12s. per week. (Reduced r a t e s when less
t h a n 10-4 weekly cont r i b u t i o n s h a v e been
p a i d ; 9s, and 7s. 6d.
respectively.)
75 % of basic wage
(60 % for t h e first 4
weeks)
66 % % of wages
50 y¿ of basic wage
60 % of basic wage
60 % of basic wage
Denmark
F o u r t h day
Esthonia
Great Britain
F o u r t h day
Fourth day
Hungary
Third d a y
Working or other
days
One year
Latvia
Luxemburg
Norway
Poland
F o u r t h day
Third d a y
F o u r t h day
Third d a y
days
days
days
or other
26
26
26
39
Portugal
First day
Working
Working
Working
Working
days
Working
days
or o t h e r
One year i
escudos
0.30-0.10
0.24-0.8
0.15-0.6
Roumania
F o u r t h day
Working d a y s
16 weeks i
Sweden
Fourth day
Switzerland
Third d a y at latest
First day if disablement lasts
more t h a n 3 days
F o u r t h day and
if disablement
lasts more t h a n
15 days from
t h e 3rd day
W o r k i n g or o t h e r
days
W o r k i n g or o t h e r
days
W o r k i n g or o t h e r
days
50 % of t h e basic wage
for fathers of families;
35 % for unmarried
contributors.
Minimum, 0.90 crowns
per diem
Minimum, 1 franc per
diem
66 % % of t h e basic
wage
Serb-Croat-Slovene Kingdom
Czechoslovakia
(new Act)
W o r k i n g d a y s if
disablement
lasts less t h a n
15 d a y s , and
working
and
other d a y s if it
continues
beyond t h a t period
26 weeks i in t h e
course of 1 y e a r
26 weeks
26 weeks 1
of
weeks
weeks i
weeks
weeks
90 d a y s i
180 days
26 weeks i
52 weeks
! according
( tothecate(
gory of
J
wages.
66 % % of basic wage
i After this period has elapsed, the contributor is entitled to a disablement pension.
— 90 —
§ 3. — Additional Sickness Benefit
Most sickness insurance Acts authorise insurance institutions
whose current resources are found to be adequate for the purpose
to allow benefit at higher rates than the legal minimum to contributors disabled for remunerative work. Sickness insurance societies
which carefully husband their resources are thus able to afford
special benefits to their members.
Before it can act on this authority to pay additional benefit,
a sickness insurance fund must first of all show that it is in a sound
financial position. If it fulfil requirements in this connection, and
if additional allowances are included among the benefits, sick
contributors become eligible in a general way for supplementary
benefit. In some cases, however, they are not eligible for such
additional benefit unless they fulfil certain special requirements.
Yet though the claimant fulfil the whole of the prescribed requirements, the fund cannot pay him benefit above the absolute legal
maximum, both in regards to rates, and in regards to period.
CONDITIONS UPON WHICH INSURANCE INSTITUTIONS
ARE.AUTHORISED TO INTRODUCE ADDITIONAL BENEFIT
As a general rule, additional benefit can be allowed by the
statutes of the institution only so long as the means of the latter
permit. This rule is strictly observed in Section 75 of the British
Act, which does not sanction the payment of additional benefit
except as chargeable to a reserve fund exclusively built up from
economies effected during the last five-yearly actuarial period. The
majority of the remaining Acts which allow additional benefit
merely stipulate such additional benefit must not induce insurance
institutions to raise the scale of contributions above maximum
statutory rates. (For instance, 7% P e r cent, of the basic wage
under Section 386 of the German Act, and 5 per cent, of the basic
wage under Section 159 of the Czechoslovak Act).
CONDITIONS GOVERNING PAYMENT
To establish a claim to additional benefit, it suffices, in the
ordinary way, for contributors to fulfil the requirements governing
the payment of the ordinary legal benefit, together with any
conditions proceeding from the very nature of such supplementary benefit. Such a requirement might be, for instance, that
disablement for remunerative work should continue beyond the
— 91 —
legal period during which minimum benefit is payable, whenever
the statutes allow additional benefit in the shape of an extension of the legal period. The British Act stipulates that additional
benefit may only be paid out of sums economised in the course
of the last actuarial period and extends the right to additional
benefit only to contributors who have been members of approved
societies for at least five years, and have consequently contributed
towards the sums thus economised. This five yearly period has
been curtailed to 3 y2 years in the case of contributors who became
members of approved societies during the years 1922 and 1923.
T H E MEASURES OF ADDITIONAL B E N E F I T A F F O R D E D
The insurance institution is not free to fix the measure of additional benefit to be afforded, that is to say, the maximum extent
and nature of such additional benefit must be determined with
due regard to legal provisions.
Allowances granted as additional benefit fall into three classes
according to the social purpose in view in the various forms of
sickness insurance. They are:
(a) Extension of the minimum period during which the legally
prescribed sickness benefit is payable;
(b) Increase of the legally prescribed sickness benefit either in
respect of all contributors or in respect of certain categories only;
(c) Complete or partial dispensation from the waiting period 1 .
Extension of the Period during which Legally
Benefit is Payable
Prescribed
Such extension enables the contributor who has been disabled
from remunerative work to receive sickness benefit for a longer
period of time. The insurance institution may extend the period
during which benefit is payable, either up to the extreme limit
allowed by law, or to any other limit falling between the minimum
and maximum periods.
Thus, under the Jugoslav Act (Section 46 (2)) sickness benefit
may be paid in the form of supplementary benefit for more than
26 weeks, but not for more than one year. The maximum period
allowed by the German Code (Section 187 (2)) is similarly one year,
whilst the Austrian Act (Section 9) authorises the payment of such
benefit for a maximum period of 18 months.
1
See page 79.
— 92 —
Increased Rate of Legal Benefit
Increases in the rate of legal benefit granted as additional
benefit may be effected in a number of different ways:
(a) Increase in the rate of benefit for all beneficiaries, as occurring, for instance, in the British Act (Schedule 3, No. 3), the
German Act (Section 191 (1), the Jugoslav Act (Section 46 (1)),
the Czechoslovak Act (Section 105 (la)), the Latvian Act (Section
49), and the Polish Act (Section 34 (2)).
(b) Increases granted to beneficiaries having family responsibilities as prescribed, for instance, by the British Act (Schedule 3,
No. 3), the Czechoslovak Act (Section 105 (1 a)), the Austrian Act
(Section 9 (2)) and the German Act (Section 191 (3)).
(c) Increases granted to low paid beneficiaries as prescribed, for
instance, by the Czechoslovak Act (Section 105 (la)), the Austrian
Act (Section 9 (1)), and the German Act (Section 191 (3)).
(d) Increases in cases of protracted sickness as prescribed, for
instance, by the Czechoslovak Act (Section 105 (1 b)) and the
Austrian Act (Section 9 (1)).
Dispensation from the Legal Waiting Period
Such dispensation is either complete, in which case the contributor is entitled to sickness benefit as from the first day of disablement for remunerative work (e.g., the British Act (Schedule 3,
No. 4) and the German Act (Section 191 (2)), or it is partial, the
contributor being eligible for sickness benefit after a shorter time
than the statutory waiting period.
§ 4. — Grants for Funeral Expenses
A number of sickness insurance laws provide for the payment
of an allowance to cover the whole or a part of the funeral expenses
in the case of the decease of a contributor. This allowance is payable
either to the person who bore the funeral expenses or to the near
relatives of the deceased. The payment of this grant is not to be
regarded as expenditure from which an advantage may accrue to
the community; its main object is merely to lighten the burden
of expenditure imposed upon the surviving members of the family
or other individuals or legal persons in consequence of the decease
of the contributor.
Where not assessed at a fixed figure, as, for instance, in article
16 e of the Norwegian Act, and article 121 of the Roumanian
— 93 —
Act, the amount of such funeral grant varies considerably in different
countries. Thus the grant payable under t h e :
Polish Act (Section 32)
amounts to 21 times the basic wage.
Latvian Act (Section 52)
»
20-30
»
»
German Act (Section 201, 204)
»
20-40
»
»
Hungarian Act (Section 50)
»
30-40
»
»
Austrian Act (Section 6, 9)
»
30-45
»
»
Czechoslovak Act (Section 95,105)
»
30-45
»
»
Jugo-slav Act (Section 45, 46)
»
30
»
»
but not exceeding the amount
actually expended.
A funeral grant of an entirely different character is sometimes
made to the contributor for the purpose of meeting expenses in^
curred owing to the decease of the husband or wife as the case
may be, or to t h a t of minor children who are members of the household. Such a grant is provided for as a definite legal benefit by
the Polish Act (Section 33 e), the Russian Labour Code (Section
184), and the Czechoslovak Act (Section 95 (3)), and as a supplementary benefit by the German Act (Section 203 b), and the
Jugoslav Act (Section 46 (5)).
CHAPTER II
BENEFITS IN KIND
§ 1 . — Conditions of Benefit
It has already been pointed out that the successful pursuance
of a genuine policy of public health promotion demands of
insurance institutions that they should treat the provision of
benefits in kind under sickness insurance as a matter of vital
concern. The aim here is less to compensate sick contributors
for the loss of their earnings than to cure them and to enable
them to resume their regular work with full efficiency at the
earliest possible date. This is achieved by providing contributors
with individual medical attendance, at the same time affording
them the full advantages of a medical service organised on
collective lines. But another consideration arises. Prevention
being better than cure, preventive measures, which come of
strict medical supervision and intensive propaganda on hygiene
should protect contributors against disease.
That legislation regards benefits in kind as of paramount
importance is at once apparent from the fact that, in its main
forms, i.e., medical benefit and the supply of drugs, etc., it is
usually accessible to all contributors; that is to say, that the
requirements upon which the provision of such benefit is conditional are less numerous than those prescribed for benefit in
cash.
If the conditions laid down for the payment of benefits in
cash 1 be compared with those governing the provision of benefits
in kind, it will be found that the latter are rarely made to depend
either on any specified term membership (an exception arising,
however, in the case of the Portuguese Decree, which in Section 29
stipulates for a probationary period of three months), or on any
waiting period, the contributor becoming entitled to benefit
in kind regardless of the number of contributions paid to his
account and usually as from the first day of sickness.
1
See p. 73
— 95 —
§ 2. — Medical Benefit and the Supply of Drugs, etc. to Contributors
Compulsory sickness insurance Acts recognise without exception the contributor's right to a varying measure of medical
attendance and drug supply. The status of a contributor as
eligible for benefit remains unaffected whether such benefit is provided by the sickness insurance institution itself (as, for instance,
under the German, Czechoslovak, etc., systems), by an organisation other than the insurance institution (as, for instance, in the
the British system) or by the contributor's employer (as, for
instance, in the Latvian system). Free sickness insurance
Acts, on the other hand, with the exception of the Danish Act,
have been unable, considering the strictly limited resources of
the sickness insurance funds, in the absence of employers'
contributions 1 to compel such insurance funds to provide medical
benefit; and so they leave the funds free to choose between
granting sick contributors the right to cash benefits and that to
benefits in kind. The Swedish and Swiss laws offer examples of
this. But the free funds which, of their own accord, undertake
more extensive liability and afford medical and pharmaceutical
assistance either with or without benefit in cash are constantly
growing in numbers.
The nature, extent, and the period of the contributor's claim
to medical benefit and to the supply of drugs are all determined
by law.
Sick contributors can clearly not expect to receive medical
benefit which would burden the responsible organisation with
expenses out of keeping with the nature and seriousness of the
case; but they are required to adhere to the rules laid down for
the whole body of contributors. However much legislation
may desire insurance contributors to benefit by the advances
of medical science, it cannot do more than ensure that they shall
receive sufficient and suitable medical treatment. The British
system, for instance, stipulates that the sick contributor is to
receive suitable and sufficient treatment from general practitioners. This comprises all proper and necessary medical services
other than those involving the application of special skill and
experience of a degree or kind which general practitioners as a
class cannot reasonably be expected to possess. The German system,
again, (Order 30 October 1923) only stipulates for such medical
1
See p. 117.
— 96 —
assistance as is necessary and prohibits attending physicians from
engaging upon any form of treatment which would involve
expense out of proportion to the nature of the particular case.
The law thus provides the contributor with no more than an
adequate measure of properly skilled medical attendance of
the average kind. Any medical benefit which sickness insurance
funds may grant, over and above such average treatment,
depends in the first place on available resources, and, in the
second, on their ability to organise the medical service 1. It
must be acknowledged that, though possessing equal rights, sick
workers in rural communities and those in the large industrial
centres actually obtain anything but equivalent medical benefit.
The period during which medical benefit is due to the contributor varies considerably as between the different countries.
The British Act, which covers both short and long periods of
sickness, alone places no time limit on the contributor's title to
medical benefit, which is extended to him for as long as he requires
it. Patients who are no longer insured remain entitled to medical
benefit for at least 18 months after relinquishing their insurable
employment. Other sickness insurance Acts fix the minimum
period during which medical benefit is granted at from 16 to 52
weeks, reckoned from the day upon which the patient first
obtained such benefit. This minimum period is practically coextensive, in the various Acts, with that during which the contributor is legally entitled to sickness benefit2. When benefit is
extended beyond the minimum period the same applies to medical
assistance.
Treatment may, at times, have to be abandoned before a
thorough cure has been effected, owing to the fact that the time
limit for medical benefit has been reached. This unfortunate
result is avoided in countries where the patient is entitled to
invalidity insurance benefit after having received the full
measure of his due at the hands of the sickness insurance fund.
Although, as a general rule, invalidity insurance is only
called upon to provide pensions, yet with a view to preventing
permanent invalidity it may, and frequently does, afford medical
assistance at least equivalent to that provided by the sickness
insurance fund (see, for instance, Section 72 of the Jugoslav Aet
and Sections 1269 and 1270 of the German Act).
1
2
See p. 102.
See p. 88.
— 97 —
Assistance in the matter of pharmaceutical supplies usually
comprises the provision of medicines, therapeutic agents, and
at times even small appliances when prescribed by the attending
physician. In this connection, the British Act stipulates that
the contributor shall be provided with a sufficiency of good
quality medicines and therapeutic agents (Section 10 (2). The
wording of the Act is generally interpreted to mean that the
patient is entitled to all medicines requisite for proper medical
treatment, regardless of their price. Ordinary tonics, on the
other hand, which are not generally prescribed as medicines are
not supplied gratis. In a certain- number of other insurance
systems attending physicians are only authorised to prescribe
medicines and therapeutic agents contained in a restrictive
schedule, which excludes any specialities for which cheaper substitutes can be found.
In order to prevent extravagance, prescriptions and chemists'
bills are sometimes subjected to special medical scrutiny. With the
same end in view the German Order of 30 October 1923 (Section 25
and Regulations dated 13 February 1924) stipulates that the
patient shall contribute towards expenditure on drugs, such
contribution varying from 10 to 20 per cent., and being leviable
only in serious cases or emergencies.
§ 3. — Medical Benefit afforded to the Contributor's Family
When the contributor's near relatives, who are members of his
household, are properly entitled to medical benefit, the element
of selfishness which is in evidence when benefit is restricted to
the contributor disappears out of sickness insurance. The extension
of medical benefit to the contributor's family is a definite gain, not
merely to the contributor himself, who is thenceforward relieved
of medical expenses in respect of the other members of the family,
but also, and above all, to those members themselves within
whose reach individual medical attendance is thus placed. Regarded
from a wider standpoint than that of its value to the worker's
family circles, such an extension of benefit ranks first among all
possible measures for promoting the health of large sections of the
population.
Even in states possessing a system of sickness insurance deeply
rooted in social life, the expense incidental to such a measure is
an obstacle to its introduction as a legal obligation of insurance
institutions. But to enable the insurance institutions to operate
7
— 98 —
along these lines they have been authorised to introduce family
medical benefit as an additional benefit if their financial position
is such as to afford them the requisite funds.
Nevertheless, a number of sickness insurance Acts of fairly recent
date, have set financial difficulties at nought, and have conferred
a definite title to medical assistance and to the supply of drugs,.
etc., on members of the contributor's family. A few examples
of this, the latest stage of development towards family medical
benefit, may be given.
The Polish Act (Section 33) grants a right to medical benefit and
to the supply of drugs for a maximum period of 13 weeks to members
of the contributor's family who are entirely dependent upon his
earnings and are members of bis household, being the husband or
wife as the case may be, lineal predecessors, and descendant sisters
or brothers, benefit being granted on the same terms as to the
contributor himself. The Jugoslav Act (Section 45 (5)), the Czechoslovak Act (Section 96) and the Hungarian Act, give a similar
definition of the degrees of relationship involving a title to medical
assistance, and extend the minimum period during which such
benefit can be provided to 26 weeks in the case of the first-named
Act, and to one year in the case of the remaning two. In the same
manner, the Portuguese Decree (Section 29) and the Norwegian Act
(Section 16 (1 b) extend medical benefit and the supply of drugs to
the husband or wife, as the case may be, and to minor children who
are members of the contributor's household, for the same term as
would apply to the contributor himself.
The Danish Act stands out from among free sickness insurance
Acts as making an energetic venture in the field of family medical
assistance. Although organised on the lines of free membership,
Danish funds are required to provide medical assistance not only
to regular members but also to their children below the age of
15 years, and for a period of 26 weeks (Sections 19 and 24).
§ 4. — Institutional Treatment and Additional Benefit in Kind
In defining contributor's right to benefits in kind it is even more
essential than in the case of cash benefits that legislation should
have every regard, not only for financial difficulties, but also for the
compelling circumstances which may preclude insurance institutions
from providing benefit in kind when called upon. That is why the
minimum medical and pharmaceutical assistance guaranteed by
Jaw and obtainable as freely from small rural funds administering
— 99 —
a vast district, with at times inadequate means of communication,
as from the large funds of industrial centres falls shorts of the full
measure of assistance which medical science is in a position to
give.
Insurance institutions possessing sufficient means to afford sick
contributors something beyond the strict legal minimum can,
none the less, grant medical attendance of a kind better adapted
to circumstances than that ordinarily provided by law. For this
purpose insurance Acts frequently offer two-fold facilities to insurance institutions, authorising them (1) to provide in special cases,
some other form of medical attendance (institutional treatment,
thermal hydropathic treatment, etc.) in lieu of the ordinary facilities
for medical attendance at the physician's consulting rooms, or,
at the patient's home where required; and (2) to supplement the
advantages extended to the whole body of contributors, in the shape
of benefits in kind, by the addition of one or several forms of allowances supplementary to the legally prescribed benefit (e.g. dental
treatment, convalescent treatment, etc.).
As in the case of legal benefits, such special forms of medical
benefits and additional benefits in kind may be restricted to
contributors themselves, or they may be extended to the contributor's family.
SPECIAL AND ADDITIONAL FORMS OF BENEFIT IN KIND FOR
CONTRIBUTORS
Special Forms of Medical Benefit
A large number of sickness insurance Acts provide for the
institutional treatment of contributors in lieu of medical attendance
(e.g. Section 184 of the German Act; Section 8 of the Austrian Act;
Section 19 of the Danish Act; Section 41 of the Latvian Act;
Section 28 of the Polish Act; Section 53 of the Jugoslav Act;
and Section 145 of the Czechoslovak Act).
The extent to which sickness insurance institutions take advantage of institutional treatment depends upon the number and standard of the public or private health institutions at their disposal
for the treatment of their members. Public hospitals, and, at
times, private establishments, are required to reserve a certain
number of beds for the sickness insurance funds in their district
and to treat patients sent to them by such funds at cheaper rates
than those charged to other patients. The readiness with which
an insurance society can afford institutional treatment is, of course,
— 100 —
much greater when the society has its own medical establishments ;
in this respect the important district funds which control large
sums, thanks to the number of their members, are in a specially
privileged position, particularly if they are systematically linked
up and work hand in hand with disablement insurance funds.
Whatever material facilities it may command, the sickness
insurance fund is not compelled (except in Denmark) to assume
liability for institutional treatment. But it is required to do so,
so far as its means permit, in the event of contagious diseases or
such as require treatment not otherwise obtainable, or if the
patients' state of health or behaviour necessitates constant supervision. Leaving aside cases of this kind, the provision or refusal
of institutional treatment rests with the competent organs of
the insurance institution which decide whether they consider it
necessary or desirable; as a general rule, however, their decision
is subject to the consent of patients who are householders or are
members of a family household.
Sickness benefit is suspended during institutional treatment with
full maintenance unless a patient has relatives who are wholly
dependent upon his earnings, when an allowance is granted for
the whole period of institutional treatment. In the ordinary way
this allowance is calculated at 50 per cent, of the sickness benefit
otherwise payable were the contributor not undergoing institutional
treatment. Except in the Norwegian Act, the number of relatives
whom he supports is not taken into account. The usual practice
is to pay the allowance to the institutional patient himself; in some
countries, however, benefit is properly payable to the family
(Czechoslovak Act), and in others it may be so paid at the discretion
of the insurance fund (e.g. the German Act, Section 186). The object
of these prescriptions is to prevent patients who are in receipt of
full maintenance in institutions from retaining benefits intended
for their families. (As regards institutional treatment in general,
see, for instance, Section 186 of the German Act ; Section 8 (4) of
the Austrian Act; Section 29 of the Polish Act; Section 148 of the
Czechoslovak Act; and Section 54 (5) of the Jugoslav Act.
Another form of special assistance which is, however, more seldom
granted, is treatment at the contributor's home by a physician
and with the assistance of nurses when institutional treatment,
though desirably, is impracticable and when there are special reasons
why the patient should remain with his family see, for instance,
Section 185 of the German Act; Section 9 (7) of the Austrian Act;
Section 152 of the Czechoslovak Act).
— 101 —
Additional Benefits for Contributors
The contributor's title to benefit in kind can be extended in
various ways by rules of the society as, for instance:
(1) by extending the period during which medical benefit and
the supply of drugs is due (see, for instance, Section 187 (1) of the
German Act; Section 9 (5) of the Austrian Act; Section 34 (2) of
the Polish Act, etc.);
(2) by admitting patients into special medical institutions,
institutions for specific types of treatment, and convalescent homes
(see, for instance, Section 187 (2) of the German Act; Third Schedule, No. 8, of the British Act and Additional Benefit Regulation
1921; Section 34 (2) of the Polish Act; and Section 105 g of the
Czechoslovak Act);
(3) by providing patients with artificial limbs or orthopaedic
appliances which may enhance or restore their earning capacity
(see, for instance, Section 187 (3), of the German Act; Section 34,
(2) of the Polish Act; and Section 105 h of the Czechoslovak Act);
(4) by administering preventive treatment to persons whose
health is endangered (see, for instance, Section 187 (4) of the
German Act);
(5) by affording more extensive treatment than that laid down
as legally claimable, see, for instance, Third Schedule, No. 2, of the
British Act (payment of the whole or a part of the cost of dental
treatment), Additional Benefit Regulations 1921 (refund of optician's and nursing fees).
ADDITIONAL BENEFITS IN KIND AFFORDED TO THE
CONTRIBUTOR'S FAMILY
Under a number of compulsory sickness insurance Acts insurance
institutions are legally authorised, though not compelled, to extend
medical benefit and the provision of drugs to the near relatives
of the contributor. Such are the German Act (Section 205 (1); the
British Act (Third Schedule, No. 1); the Austrian Act (Section 9 a);
the Bulgarian Act, etc.
Certain voluntary sickness insurance laws make similar provision.
Thus in Belgium, for example, the Government grants a special
subsidy to friendly societies which furnish medical benefit and
drugs, for at least two years, to insured persons and their families.
In this manner the insurance institution is enabled by legal
means, yet without legal compulsion, to distribute the beneficial
effects of medical assistance not only over the contributors themselves, but also over the whole of the worker's family.
— 102 —
§ 5. — Organisation of the Medical Service
RESPONSIBILITY FOR ORGANISING THE MEDICAL SERVICE
Insurance Acts under which sick contributors are eligible for
medical assistance specify what individuals or legal persons are to
be responsible for organising the medical service.
As a general rule, this responsibility falls on the insurance institution itself, which is thus called upon to make provision not only
for cash benefits, but for benefits in kind. This is the practice
followed by the majority of insurance Acts in European countries.
There are, however, two other systems which do not require the
insurance institution to organise the medical service.
The system instituted by the British law, for instance, does not
allow this organising work to devolve upon approved societies,
which are merely required to administer benefits in cash. Tue
Act lays down that public corporations, entitled Insurance Committees, shall be formed in each administrative district of the Kingdom, and shall be responsible for the organisation of the medical
service.
On the other hand, in those of the Baltic countries, where a system
of organisation based upon the former Russian Labour Code of
1911, still prevails, responsibility for the medical service rests
primaliry with the employer. The insurance fund has no obligations in that direction, but may itself organise its own medical
service and thereby afford treatment to contributors whose
employers have not made proper medical provision for them.
The task of organisation remains substantially the same whoever the responsible parties may be: it involves, namely, the bringing of proper individual medical attendance within the reach of
all the sick contributors, and supplementing this with the advantages accruing from medical collaboration and medical services
organised upon collective lines.
ORGANISATION OF THE MEDICAL SERVICE
The sickness insurance funds of the continental systems, the
British Insurance Committees, and the employer in the Baltic
countries, are responsible for medical assistance while precluded
from providing such themselves. They are required by law to call
upon physicians and surgeons to attend sick contributors, and,
without collaboration on the part of medical men, the organisers
— 103 —
of medical services are powerless, whatever the funds at their
disposal.
Medical men who agree to treat beneficiaries under insurance Acts
become of their own free will responsible for safeguarding the
interests of the whole body of contributors. It is upon the value
of their professional services that the social efficiency of the insurance system depends.
Appointment of Medical Officers by the Organisers of Medical
Service
Insurance Acts rarely leave sickness insurance funds (insurance
committees, employer) full freedom to organise the medical service
as they choose. In the interests of the whole body of contributors
and at times in that of the medical profession, the law lays down
specific regulations for the appointment of attending medical
officers or only allows the fund to choose between different methods
of appointment.
These different methods of appointment may be classified as
follows, according to the restrictive conditions governing the
approval of medical attendants.
(a) Approval of all medical practitioners making an application.
— Any duly qualified medical practitioner may apply to be included on the panel of approved physicians. The fact of making
such application to the insurance committee entitles the medical
practitioner to administer treatment to sick contributors. The
insurance committee cannot refuse to inscribe the name of a duly
qualified applicant, however great may be the number of medical
men already so inscribed and the application can be refused in
those cases only where the applicant's name has on a previous
occasion been removed from the medical list by order of the
Minister.
(b) Approval of any medical practitioner who is a member of a
specific medical association. —• Any medical practitioner who is a
member of a medical association entrusted by the fund with the
treatment of its members ipso facto becomes an approved medical
attendant.
(c) Approval of all medical practitioners subscribing to the conditions prescribed by the fund. •— The sickness insurance fund enters
into an agreement with a professional medical association to retain
the services of its members. Any medical practitioner, whether a
member of the contracting association or not, who subscribes to
the conditions of this contract is recognised as an approved attend-
— 104 —
ant. In certain cases the number of medical attendants who can
be approved is fixed in proportion to the membership of the fund,
say one medical attendant per thousand members.
(d) Appointment of medical attendants by the insurance fund. —
The fund appoints one or several medical attendants who undertake to treat the members. No medical men other than the appointed
attendants are allowed to administer treatment to members.
The prescriptions governing the appointment of medical officers
by the fund determine at the same time the extent to which the
patient is free to choose his attendant.
Choice of Attendant by the Patient
Although compulsion is applied in the case of sickness insurance
itself, the patient is seldom obliged to accept treatment by a physician in whom he has no faith. Patients very naturally wish to be
treated by doctors of their own choice, and the latter also demand
such freedom of choice to safeguard their own professional and
economic interests. It has not been everywhere obtainable.
Conditions under which medicine is practised vary enormously
according to districts and social grades. They differ both in the
town and country districts, according to the density of population
and according to means of communication. The patient's freedom
to choose á medical attendant, which can easily be respected in the
towns, involves almost insuperable difficulties in country districts,
owing to the long distances which the practitioner would be called
upon to cover and the time required for the purpose.
The patient's freedom of choice is either unlimited or restricted;
in some cases, however, it is non-existent, patients being obliged
to accept treatment by the medical attendant designated by the
fund.
(a) Unlimited freedom of choice means that the patient is free
to choose any medical attendant who has agreed to treat members.
No restrictions can be placed by the fund on his freedom in
this connection. Patients under treatment can nevertheless not
change their medical attendant without adequate reasons.
Freedom of choice is yet never complete in the sense of allowing
the patient to pick his attendant from among all medical men
resident in the neighbourhood, as all of the latter do not place
themselves at the disposal of the sickness insurance fund ; it should,
however, enable the patient to obtain the services of the large
majority of medical practitioners in his town or district.
— 105 —
(b) Limited freedom of choice means that the patient can
choose from two practitioners at least. The sickness insurance
fund may, and will, increase the number of medical practitioners
whose services are available for the patient, but it satisfies legal
requirements if it merely offers the patient the choice of two
medical practicioners.
(c) The patient is not allowed to choose when he is required to
call in one particular medical practitioner designated by the fund
or the employer.
In certain countries the method of appointing medical attendants
is strictly defined by law, that is to say, appointments may only
be made in the legally prescribed manner. According to the method
of appointing medical attendants, the patient is either free to some
extent to choose his own medical attendant, or compelled to accept
treatment by a duly appointed attendant. Thus the British Act
requires Insurance Committees to recognise as an approved medical
attendant any qualified physician who submits an application, and
on the other hand, allows insurance contributors full freedom of
choice from among all medical men who have undertaken to treat
sick contributors. A different method has been followed by the
Polish Act which compels every insurance fund to choose and appoint medical officers (at least two therefore) and allows the patient
to choose from among practitioners appointed. According to the
Portuguese Decree the duties of medical attendant devolve upon
the municipal medical officer of the district in which the patient's
mutual benefit society has its registered offices, so that neither
the fund itself nor the patient are free to choose the medical
attendant.
In other countries, institutions required to organise the medical
service may avail themselves of different methods of appointing
medical attendants. Thus the Czechoslovak, Austrian, Polish and
several other Acts authorise sickness insurance funds to choose and
appoint medical attendants, or by means of a collective agreement
with a professional medical association to secure the services of
any member thereof. The limitations thus placed on the patient's
choice of a doctor varies according to the method of appointment
followed by the fund. The German law adopts a similar method;
at the same time it authorises rural funds administering extensive
districts to compel patients living in the country to accept treatment by such medical attendants as are recognised as the only
medical attendants in specified parts of the fund's district.
— 106 —
T H E W O R K I N G OF THE MEDICAL SERVICE
The regulations concerning the functioning of the medical service
are designed to secure the maximum efficiency in medical work,
while at the same time ensuring t h a t the patient shall not suffer
through excessive rigidity of organisation.
The fund's medical officer is required to treat members conscientiously, and to the best of his professional ability, with a view to
securing as rapid and as complete a cure as possible. In the ordinary
way the patient is required to attend the doctor's consulting rooms
at hours to be specified either by the fund or by the doctor himself; only patients who are unable to move without running the risk
of aggravating their condition are entitled to' apply for medical
attendance at home. Apart from the restrictions which are imposed
in the interests of the whole, body of contributors, the treatment
administered to the patient should not differ from t h a t obtained
b y persons of affluence.
The most skilled and watchful attendance of a single medical
practitioner is not always sufficient to secure a rapid cure. Medical
collaboration is necessarily becoming more and more the general
practice among insurance funds.
But the work of the medical attendant is specially facilitated
b y the development of social medicine on collective lines and its
accompanying institutions, i.e. hospitals, specialised health establishments, nursing homes, convalescent homes and medical
training centres.
There remains one last step to take, that is, the organisation
of a system of positive preventive medicine which would require
members to undergo periodical medical examinations undertaken
with a view to discovering symptoms of serious and avoidable
disorders and to spread knowledge of the rules of hygiene among
the laborious classes.
PART ÍV
RESOURCES OF SICKNESS I N S U R A N C E
INTRODUCTION
THE FINANCING OF SICKNESS INSURANCE
Unlike those branches of insurance which are called upon to
provide long-term benefits — i.e. accident, disability, or old-age
insurance — and which are consequently bound to adopt a financial
system affording the funds requisite for pensions, failing which
members' contributions must be progressively increased until such
time as a balance has been established between incoming and
outgoing beneficiaries, sickness insurance can be content with a
far simpler financial system, which consists in distributing among
all recipients of benefits during each financial period the whole
of the income of the insurance institution during that period.
The total amount of receipts is employed to cover insurance charges
as and when they fall due.
This system of distribution is suitable for any form of sickness
insurance. The amount of annual expenditure is fixed in proportion to the average number of probable days of sickness per contributor per year; to enable this figure to be estimated, all that is
required is that the degree probability of sickness, per member,
during the course of one year and the probable duration of disablement involved in each case shall be known. Of course, the composition of the body of members as to sex and age affects the probability
of diseases among any group of contributors; but, in compulsory
sickness insurance, at any rate, annual insurance liabilities are, as
a matter of fact, practically constant in amount and do not show
any very great variation from one year to another.
— 108 —
The system of distribution has been universally adopted in
compulsory sickness insurance as in voluntary sickness insurance.
The British law alone appears to depart from this practice, stipulating
as it does for the constitution of a reserve value in respect of all
members insuring after reaching 16 years of age, such reserve
value being designed to compensate the insurance institution
for any loss accruing to it owing to the admission of members
over 16 years of age who are not required to pay a supplementary
premium on account of age. As, however, these reserve values are
constituted by a uniform levy on the whole of the contributions,.
irrespective of the age of the contributor, this method obviously
amounts to nothing more than the placing in reserve of amounts
drawn from the general distribution fund.
The financial organisation of sickness insurance having now been
outlined, it remains to be shown from what sources funds required
to work such insurance are drawn. Now here, compulsory sickness
insurance, which is in receipt of assured revenue secured to it by
law, is in a much sounder position than voluntary sickness insurance ;
we shall, therefore, consider separately the financial resources of
compulsory insurance and those of free insurance.
CHAPTER I
FINANCIAL RESOURCES OF COMPULSORY SICKNESS INSURANCE
§ 1.— Insurance Contributions: Contributions at Flat Rates
and on a Sliding Scale
Where sickness benefit is paid at flat rates to all contributors,
there is a corresponding flat rate of contribution, whereas, when
benefit is equivalent to a given percentage of the contributors'
salary or wages, contributions must of necessity be levied on a scale
which increases in proportion to such salary or wages. Such a
method of uniform distribution, though feasible where money
benefit is concerned, is quite inadequate, however, to cover expenses
of benefit in kind: medical attendance, drugs or institutional
treatment, which bear no relation to the economic standing of
the contributor. Hence the need for requiring better-paid members
to contribute sums out of proportion to the liability assumed
towards them by the insurance institution or for calling upon the
community, that is to say, the state or the commune, for financial
support.
CONTRIBUTIONS AT FLAT
RATES
The British Act adopts the system of contributions at flat rates
irrespective of the contributors' wages. Sex is the only factor
affecting the assessment of contribution, the latter being lOd. per
week for male contributors and 9d. per week for female contributors.
CONTRIBUTIONS ON A SLIDING SCALE
The compulsory insurance Acts which provide for payment of
benefit on a sliding scale calculated according to the contributors'
wages likewise adopt a system of contributions graded according
1
See § 3 of this chapter.
— 110to the contributors' financial standing, and this is the only feasible
method of making certain that part of the cost of insuring betterpaid contributors shall not be borne by the lower-paid, the proper
method being rather to call upon the more fortunate members to
contribute towards the expenses involved by insuring the latter.
Sickness benefit being calculated at an exact, or more frequently
at an approximate, percentage of the contributors' wages, contributions are similarly calculated in respect of each contributor.
Thus, according to most compulsory sickness insurance laws, each
insured person's contribution is assessed at a certain percentage
of the mean figure of the wage class in which he is included. The
amount of contribution paid in respect of each member is thus
more or less in keeping with his wages (e.g. Section 385 of the
German Code; Section 23, paragraphs 1 and 2 of the Jugoslav Act;
Section 25 of the Austrian Act; Section 46 of the Polish Act;
Section 15 of the Norwegian Act; Section 159 of the Czechoslovak
Act; etc.).
As a general rule compulsory sickness insurance Acts — with the
exception of the Roumanian and Portuguese Acts — refrain from
specifying what percentage of the mean wage is payable in the
form of contributions by each member.
Frequently, however, a maximum figure is fixed above which
contributors' subscriptions cannot or should not be assessed unless
particular circumstances warrant such assessment for a short
period. In practice, this maximum figure is often taken as the
general average by insurance institutions. As illustrating this, we
may mention that the maximum figure is fixed at :
10 percent of the mean wage by the German Act (Sections 389 and 390)
7
,,
„
,,
„ Jugoslav Act (Section 23 (2)
6
„
,,
„
„ Hungarian Act (Section 24 to 30)
5
„
„
„
,, Czechoslovak Act (Section 159)
4^2 »
»
.>
„ Luxemburg Act (Section 26).
A number of other Acts, while not specifying any maximum,
indicate an average figure for the full leviable rate of contribution
to which insurance institutions are required to adhere. As a general
rule, unless there are special reasons, the rate should never exceed
nor fall below the statutory average figure. Such indications will
be found, for instance, in the Austrian Act (Section 25 (4)), which
gives the figure of 8.3 per cent.; the Polish Act (Section 46 (2)),
giving the figure of 6.5 per cent. ; and the German Act (Section 386),
which specifies 7.5 per cent.
— Ill —
Contributions calculated according to the exact or approximate
amount of the contributors' wages may or may not vary according
to the degree of risk involved. Sickness insurance laws do not,.
usually, refer this matter to a rigid rule, but authorise insurance
institutions to take account of the degree of risk pertaining to
individual contributors when assessing contributions.
Without going into details we shall merely indicate such variations
in contributions as are frequently authorised by insurance Acts in
view of special risks accruing to the whole body of contributors
from the membership of certain individuals or groups of individuals.
The right to modify the contributions, for instance, of members
belonging to certain trades, to be specified by the institutions'
statutes, will be found in the German Act (Section 384 (1)); it
will be found in the Austrian Act (Section 26), as exercisable for
instance in the case of members who have not yet completed their
trade apprenticeship, and in the German Act, again (Section 384 (2)),
its modifications may be made according as members have or have
not family responsibilities whenever the amount of sickness benefit
varies in consequence of such responsibilities.
A considerable number of sickness insurance Acts provide, moreover, for contributions at increased rates to be paid by members
engaged in trades which are particularly dangerous to the workers*
health or which involve particular risks of disease. Such increased
contributions are generally levied in the form of supplementary
premiums designed to make provision against the supplementary
risk due to the nature of the undertaking to which such
contributors are exposed ; see e.g. the German Act (Section 384,
par. 1 and 3); the Austrian Act (Section 27); the Norwegian Act
(Section 31 (3)) ; the Polish Act (Section 59) ; the Jugoslav Act
(Section 23 (6) ).
Whereas in the above-mentioned examples the supplementary
premium required in the case of trades involving special risks of
disease has no other purpose than to provide against the supplementary risk underwritten by the whole body of contributors,
in the new Czechoslovak Act (Section 167) it amounts to a kind
of penalty applied to heads of undertakings whose installation
falls short of the requirements of industrial safety and hygiene, and
this supplementary premium, therefore, ceases to be leviable when
the employer has conformed to the relative regulations. Supplementary premiums to provide against extra risk and penalty
supplementary premiums are payable in their entirety by the
employer.
— 112 —
% 2. — Apportionment of Contributions between the Insured Worker
and his Employer
The wages of labour constitute the wage-earners' income which
must suffice for his maintenance during periods of work as well as
periods of illness. The worker is, however, unable, as a general
rule, with the wages which he employs for the satisfaction of his
immediate needs, to build up an economic reserve which would
allow him to meet the expenditure entailed by sickness and, at the
same time, maintain himself and his family at a time when disablement, consequent upon sickness, deprives him of his earnings.
This is where sickness insurance intervenes, with the object of
affording him the means necessary to restore him to health and to
support his family . Sickness insurance benefit may thus be viewed
in the light of a supplement to the wages of labour which restores
the patient to economic life. The financial resources of sickness
insurance are, therefore, to be regarded as part of the wages of
labour, not available, however, to the wage-earner unless he falls
sick. Such, in precise terms, is the part played in social life by
sickness insurance, which does not distribute that part to those
who earned it but to those who most need it.
The cost of insurance, though it necessarily goes to make up the
cost of production, is nowhere, except under the Russian system,
entirely discharged by the employer and recovered directly by him
as part of the price of goods. On the contrary, the large majority of
workers' insurance Acts divide the contributions either evenly or
unevenly between the insured workers and the employer. A given
amount designed to cover the cost of insurance is, therefore,
added to wages, and the total amount thus obtained is regarded as
the wage actually paid. In point of fact this amount is deducted
at the time of paying the wage and handed over to the insurance
institutions as the workers' contribution.
The requirement that the insured person should pay a portion
of the contribution not only tends to discourage unnecessarily
frequent appeals to the insurance institution, but also acts as
a brake on the increase of contributions which would not be felt,
for some time, at any rate, by the insured contributors in the shape
of an increased deduction from their wages.
Neither the Roumanian nor the Russian Act stipulates for such
apportionment of the contribution between the insured worker
and the employer. The first-named Act (Section 29) provides for
— 113 —
payment of the full contribution by the insured worker, whereas
the Russian Labour Code (Section 178) requires such payment from
the undertaking and debars the latter from making any deduction
from the insured workers' wages.
In other sickness insurance Acts, the apportionment of the
contribution between the insured worker and the employer shows
considerable variation as to the percentages respectively payable.
The portion of the full contribution which is payable by the worker
varies between 40 and 66 2/3 per cent. It is fixed at :
40 per cent, of the total contribution by the
50
,,
„
„
„
„
50
50
50
60
66%
66%
66%
Polish Act (Section 47)
Czechoslovak Act (Section 162 (1))
Jugoslav Act (Section 35 (5))
Hungarian Act (Section 28)
Latvian Act. (Section 62)
Norwegian Act (Section 31)
German Act (Section 381)
Austrian Act (Section 34)
Luxemburg Act (Section 26)
The employers' portion varies inversely (except in the case of the
Norwegian Act (Art. 31), which assesses the employers' contribution
at 10 per cent, only), and the figures are roughly the same, being:
33% per cent, of the total contribution in the
33%
„
„
.,
„
„
33%
„
„
„
„
„
50
„
„
„
„
,,
50
„
„
„
„
,,
50
„
„
„
,,
„
50
,.
„
60
„
„
„
„
„
German Act (Section 381)
Austrian Act (Section 34)
Luxemburg Act (Section 26)
Latvian Act (Section 62)
Hungarian Act (Section 28)
Jugoslav Act (Section 35 (5))
Czechoslovak Act (Sec. 162 (1))
Polish Act (Section 47)
Under the British Act the full weekly rate of contribution, which
is lOd. for male contributors and 9d. for female contributors, is
divided in such a manner that the proportion payable by the
employer amounts to 5d. per week for all members, irrespective
of sex, 5d. per week being deducted from male contributors' wages
and 4d. per week from those of female contributors (Second
Schedule).
The Portuguese Act, which provides for the compulsory insurance
of both wage-earners and persons of independent means, does not
stipulate for any payment on the part of employers. In order to
make certain that the revenue of insurance institutions shall be
sufficient for their needs, it requires, in the first place, that contributors themselves shall pay contributions in proportion to their
— 114 —
income and, in the second place, compels all non-insurable persons
to contribute sums calculated in accordance with the amount of
their income over and above a maximum (900 escudos) specified
by the Act, and to pay a tax similarly calculated according to the
taxpayer's income and the proceeds of which are exclusively
employed for sickness insurance purposes (Sections 4 and 35).
In certain specified cases the insured contributor and the employer may be called upon to pay a percentage of the whole contribution differing from the normal statutory amount.
Thus the percentage payable by the employer is sometimes
higher in respect of low-paid workers. The British Act (Second
Schedule) may be quoted as an example. Here the employer's
contribution is raised from 5d. to 6d. for all insured workers of
the age of 18 or upwards whose daily wage is more than 3s. but less
than 4s., and the insured worker's contribution is reduced in conse-.
quence to 4d. and 3d. respectively.
Insurance Acts almost without exception require employers to
pay the whole of the contribution in respect of all workers who
are not in receipt of wages, or do not receive payment in cash
(e.g. the Norwegian Act (Section 32 (2)), the Polish Act (Section 47
(2)), the Roumanian Act (Section 129), the Czechoslovak Act
(Section 162 (2)), etc.). The British Act imposes the same obligation
on employers in respect of every insured person whose daily wage
does not exceed 3s.
§ 3. — State Subsidies
Although all sickness insurance Acts agree in calling upon the
parties concerned — insured workers and employers — to provide
the major part of the funds for the working of the insurance system,
they in no way exclude the financial assistance of the community
(state, district, commune). The provision of such financial
assistance is not the general practice, however, and where it
does occur it assumes various shapes.
A few examples will serve to show in what manner financial
support is given to compulsory sickness insurance by means of
subsidies from public funds.
Insurance institutions sometimes receive state subsidies in the
shape of lump sums intended either to cover initial establishment
charges, or to provide the insurance institution with the machinery
required to enable it to carry on its work (e.g. the Czechoslovak
law, Section 257 •— subsidies for the erection of hospitals).
— 115 —
State support is still greater when financial assistance takes the
form of periodical payments calculated according to the cost of
insurance. It is particularly extensive under the British law
(Section 4), which makes the state liable for two-ninths of the
total expenditure on sickness and disablement insurance. In
Norway the state accepts liability for two-tenths and the communes
for one-tenth of expenditure on sickness insurance (Norwegian
Act, Section 31).
It frequently happens, moreover, that the State or the commune
undertake to discharge the liabilities of insured workers who are
temporarily prevented from paying their subscriptions (during
military service, for instance).
In addition to this, there exists a further and very common
form of state support, the state undertaking to discharge part of
the cost of insurance, that is to say, accepting liability for the whole
or a part of the expenditure entailed by the working of the insurance
system. When the state only defrays the expenditure of the governmental services entrusted with the supervision of the insurance
institutions, there can be no question of state financial support.
§ 4. — The Levying of Contributions: Deduction at source
To give effect to the principle of compulsory insurance, it is
essential that contributions should be regularly collected. The only
effective method of levying such contributions is that of deduction
at source, according to which the employer is responsible for the
payment of the whole contribution and is left to recoup himself
for such proportion as falls to the share of the worker by deducting
it from the wages of the latter when paying him. Compulsory
sickness Acts without exception call upon the employer to pay
the whole of the subscription.
It will suffice to quote as examples the British Act (Section 7) and
the German Act (Sections 393 and 394), which prescribe the method
of previous deduction as the general system of levying contributions
and compel the insured contributors to consent to the deduction
from their salary of such portion as falls to their share.
As regards the actual payment of the full contribution, two
different methods are available: payment in cash or payment of
the contribution by affixing to the contributor's insurance book
insurance stamps, the proceeds of which are credited to the insurance institutions. The stamp system, which is met with, in an
— 116 —
ever increasing number of instances, is tending to become the
general method of levying contributions; it can only be applied,
however, if the insured contributors are classified according to
wages, stamps of different values standing for the equivalent
amount of contribution which corresponds to a particular wages
class and is due for a specified period — usually one week. The
system of prior deduction has numerous advantages, the main one
being spontaneous payment of the contribution by the employer.
The insurance institution is not obliged to collect contributions,
but merely awaits their payment, being able to check arrears of
contributions with ease by scrutinising insurance books.
CHAPTER II
RESOURCES OF FREE SICKNESS INSURANCE
Members' Contributions and State Subsidy
To meet insurance liabilities, the system of free sickness insurance
relies, theoretically speaking, solely upon the insured members'
contributions ; the employer's share of the contribution is lacking.
Members' contributions must suffice to cover the costs of insurance,
less such expenditure as is defrayed by the state or the commune.
Even the system of deduction at source, which consists in making
the employer responsible for the payment of the member's contribution, leaving the former to recoup himself for the expenditure on
behalf of the insured worker by deducting it from his wages, cannot
be introduced into the system of free sickness insurance, as the
law establishes no connection between the insurance institution on
the one hand and the employer on the other.
Under the system of subsidised sickness insurance, however, the
community, that is the state or the commune, usually provides a
larger measure of financial support than under the system of
compulsory sickness insurance. The extent and manner of this
assistance diner considerably as between various countries.
The financial obligations undertaken by the community towards
insurance institutions in certain countries possessing a system of
subsidised sickness insurance may be indicated by means of a
few examples.
In Switzerland the Confederation allows the funds a yearly
subsidy of from three to 5 francs per member, according to sex
and according to whether the fund affords or does not afford a
minimum both of benefits in cash and of benefits in kind of proper
quality. In mountainous countries where communication is difficult and where the population is sparse, the Confederation allows
the funds a supplementary yearly subsidy not exceeding 7 francs
per member. In these districts the Confederation further allows
subsidies to institutions with a view to reducing treatment fees
— 118 —
(Sections 35 and 37). Moreover, exceptional subsidies are granted to
funds whose resources are inadequate to meet insurance liabilities.
The Danish Act grants all recognised sickness funds an allowance to be paid by the State Treasury and amounting, for each
member of such fund, to 3 crowns per year plus one-quarter of the
moneys expended by the fund on medical treatment, home treatment, drugs, and maintenance of patients in convalescent homes
(Section 13).
The Swedish law also provides for a fixed allowance in cash
amounting to 2 crowns per year per member of a recognised sickness
fund. In addition to this, the state assumes liability for approximately one-quarter of the benefits in cash and in kind actually
afforded to members (Section 16).
In Belgium, a friendly society receives a monthly subsidy of
50 centimes per person aged between 14 and 55 and 25 centimes
per person aged below 14 or over 55. A further subsidy is payable,
the amount of which depends on the amount of the contributions
(see also p. 108).
In France, approved friendly societies receive from the State
subsidies amounting to 12 per cent, of money expended on assisting
members and their families in case of sickness, on providing them
with a preventive and curative treatment, and on helping the
invalid and incurable (Decree of 25 March 1921).
APPENDIX
LIST OF PRINCIPAL LEGAL TEXTS
Used in the Report on Sickness Insurance
ABBREVIATIONS
International Publications : B.B. = Bulletin of the International Labour
Office, Basle (1902-1919). L.S. = Legislative Series of the International
Labour Office, Geneva (since 1920).
•For other abbreviations see the foot-notes given with the list of texts for
each country.
AUSTRALIA
Commonwealth
An Act to provide for payment of maternitv allowances.
10 October 1912.
No. 8 of 1912.
New South Wales
An Act to consolidate the Acts relating to friendly societies. No. 46, 1912.
Assented to 26 November 1912. As amended by the Acts: No. 1, 1913;
14, 1913; 56, 1916; 38, 1920; 26, 1922.
Queensland
An Act to consolidate and amend the law relating to friendly societies.
No. 13. Assented to 29 October 1913. Amended by Act No. 30 of 1924.
South Australia
An Act to consolidate certain Acts relating to friendly societies. Assented
to 20 November 1919, No. 1387.
An Act to further amend the Friendly Societies Act, 1919, and for other
purposes. Assented to 7 December 1921, No. 1483.
Victoria
An Act to consolidate the law relating to provident societies.
6 September 1915.
No. 2712.
Western Australia
An Act to consolidate and amend the law relating to friendly societies.
Assented to 22 December 1923. No. 48 of 1923.
— 120 —
AUSTRIA i
GENERAL
LEGISLATION
Act of 30 March 1888 respecting workers' sickness insurance, new text
promulgated by the Order of 20 November 1922. [Gesetz vom 30. März 1888
über die Krankenversicherung der Arbeiter, in der Fassung der Verordnung
vom 20. November 1922 betr. den Text des Gesetzes über die Krankenversicherung der Arbeiter.] B . G . B . 1922, No. 859.
Sickness Insurance Act Amendment Acts, Nos. XVI1-XXI. [XVIIXXI. Novellen zum Krankenversicherungsgesetz.]
No. XVII,
3 February 1923. B.G.B. 1923, No. 73.
No. XVIII, 21 June 1923. B . G . B . 1923, No. 342.
No. XIX,
26 September 1923. B . G . B . 1923, No. 539.
No. XX,
27 March 1924. B . G . B . 1924, No. 90.
No. XXI,
30 June 1924. B . G . B . 1924, No. 214.
SPECIAL LEGISLATION
Civil Servants
Act of 13 July 1920 respecting the sickness insurance of civil servants.
[Gesetz über Krankenversicherung der Staatsbediensteten vom 30. Juli 1920.]
B . G . B . 1920, No. 311.
BELGIUM •
Act of 23 June 1894 to amend the Act of 3 April 1851 respecting mutual
benefit societies. [Loi du 23 juin 1894 portant revision de la loi du 3 avril
1851 sur les sociétés mutualistes.]
Act of 19 March 1898 amending the Act of 23 June 1894 respecting mutual
benefit societies (Conditions under which Government subsidies are granted).
[Loi du 19 mars 1898 apportant des modifications à la loi du 23 juin 1894
sur les sociétés mutualistes (Conditions d'attribution des subsides gouvernementaux).]
Act of 5 May 1912 to provide subsidies for invalidity mutual funds. [Loi
du 5 mai 1912 accordant des primes aux caisses mutualistes d'invalidité.]
R . T . 1912, p. 578.
Act of 6 August 1923 to authorise the fusion of approved mutual benefit
societies and federations thereof. [Loi du 6 août 1923 autorisant les sociétés
et les fédérations mutualistes reconnues à fusionner.]
R . T . 1923, p. 1738.
Act of 26 December 1923 to regulate the investment of funds of approved
mutual societies (Amendment of Section 18 of the Act of 23 June 1894).
[Loi du 26 décembre 1923 réglant le placement des fonds des sociétés mutualistes
reconnues (Substitution de l'art. 18 de la loi du 23 juin 1894).] Moniteur
belge du 11 janvier 1924, p. 133.
Ministerial Circulars of 20 February 1920 and 31 December 1922 respecting
State subsidies to societies which organise medical and drug services. [Circulaires ministérielles du 20 février 1920 et du 31 décembre 1922 (subventions
de l'Etat aux sociétés organisant le service médico-pharmaceutique).]
BULGARIA
8
Act of 7 April 1918 respecting the sickness and accident insurance of
workers and employees. — D- V., 1918, broj. 132.
Act of 6 March 1924 respecting the general organisation of social insurance
— Official Gazette, 1924, No. 289; L.S. 1924, Bulg. 1.
1
2
3
Abbreviations;
Abbreviations;
Abbreviations:
B.G.B. = Bundesgesetzblatt.
R.T. = Revue du Travail.
D. V. = Drzaven Vestnik.
— Í21 —
Ukase No. 26 of 25 June 1924, issuing regulations under the Act of 6 March
1924respécting*the general r «rganisátion of social insurance. — Official Gazette,
1924, No. 69.
CHILE »
Act No. 3185 of 8 January 1917 respecting nursing rooms. [Lei de salas
Cunas. El 8 de enero de 1917. No. 3185.]
Act No. 4054 of 8 September 1924 providing for compulsory insurance
against sickness, invalidity and industrial accidents. [Lei mini 4054, que
declara obligatorio el seguro de enfermedades, invalidez y accidentes del
trabajo. El 8 de septiembre de 1924.] D.O. 1924, No. 13987, p. 2291.
CZECHOSLOVAKIA
2
Former Austrian Territory
GENERAL LEGISLATION
Act of 30 March 1888 respecting workers' sickness insurance. [Gesetz
vom 30. März 1888 über die Krankenversicherung der Arbeiter.] R . G . B .
1888, No. 33.
Act of 20 September 1917 amending the Sickness Insurance Act. [Gesetz
vom 20. September 1917 betr. Aenderungen des Krankenversicherungsgesetzes.] R . G . B . 1917, No. 457.
Act of 15 May 1919 to amend the Sickness Insurance Act. [Zákon ze dne
15. kvêtna 1919 jimz se mëni predpisy zákona o nemocenském pojistëni
dëlnikû.] S.Z.N. 1919, No. 268.
Act of 22 December 1920 to amend the Sickness Insurance Act. [Zákon
ze dne 22. prosince 1920, kterym se mení nekterá ustano vení zákonñ o pojistëni
dëlnikû pro pfípad nemoci.] S.Z.N. 1920, No. 689.
Act of 22 December 1921 to prolong the operations of the Act of 22 December
1920 and to amend the Sickness Insurance Act. [Zákon ze dne 22. prosince
1921 o prodlouzení püsobnosti zákona za dne 22. prosince 1920, a o zmënë
zákona o nemocenském pojistëni dëlnikû.] S.Z.N. 1921, No. 489.
Act of 21 December 1922 to prolong certain provisions respecting sickness
insurance, amended by the Acts of 4 July 1923 and 21 December 1923.
[Zákon ze dne 21. prosince 1922, kterym se prodluzuje pûsobnost nëkterych
právnich predpisû v oboru nemocenského pojistëni dëlnikû se zmënami
stanovenymi zákony ze dne 4. cervence a 21. prosince 1923.]
S.Z.N. 1922,
No. 397, and 1923 Nos. 144 and 248.
SPECIAL LEGISLATION
Miners
Act of 11 July 1922 respecting insurance undertaken by miners' benefit
funds. [Zákon ze dne 11. ëervence 1922, o pojiStêni u bánskvch bratrskych
pokladen.] S.Z.N. 1922, No. 23.
Former Hungarian Territory
GENERAL LEGISLATION
Act No. XIX of 6 April 1907 respecting the sickness and accident insurance
of persons employed in industrial and commercial occupations. [XIX. törvenyczikk az ipari és kereskedelnii alkalmazottaknak betegség es baleset
esetére való biztositasáról. 1907, évi aprilis hó 6-án.] O.T. 9 April 1907;
B.B. 1907, p. 269.
1
2
Abbreviations; D.O. = Diario Oficia].
Abbreviations; R.G.B. = Reichsgesetzblatt. S.Z.N. = Sbirka Zakonu i Naridzeni.
O. T. = Orszâgos Torvénytar.
— 122 —
Order of 23 September 1919 respecting the creation of a workers' insurance
institution for Slovakia and^the extension of workers' insurance to Slovakia.
[Naíízení vlády republiky Ceskoslovenské ze dne 23. zárí 1919 o zrízení
Zemské úfadovny pro délnické pojisténí na Slovensku v Bratislava a rozsírení
püsobnosti zákonü o dëlnickém pojiStení na Slovensku.] S.Z.N. 1919,
No. 516.
Order of 21 January 1921 respecting provisions regulating sickness insurance
in Slovakia and Sub-Carpathian Russia. [Nafizeni ze dne 21. ledna 1921,
kterym se upravují predpisy o nemocenském pojisténí na Slovensku a v
Podkarpatské Rusi.]. S.Z.N. 1921, No. 26.
Orderof 27 January 1922 respecting provisions regulating sickness insurance
in Slovakia and Sub-Carpathian Russia. [Nafizeni ze dne 27. ledna 1922,
kterym se upravují predpisy o nemocenském pojisténí na Slovensku a v
Podkarpatské Rusi.] S. Z. N. 1922, No. 20.
Order of 14 July 1922 amending and completing the provisions respecting
sickness and accident insurance. [Nafizeni ze dne 14. ßervence 1922, kterym
se mení a doplnüjí ustanovení o úrazovém a nemocenském pojisténí délníku.]
S.Z.N. 1922, No. 199.
Order of 30 December 1922, amended by the Orders of 19 July 1923 and
29 December 1923, prolonging the operation of provisions regulating sickness
insurance in Slovakia and Sub-Carpathian Russia. [Naíízení ze dne 30.
prosince 1922 se zmënami stanoven^mi narízenim ze dne 19. iervence a
29. prosince 1923 jimz se prodluzuje pusobnost nékterych právních prëdpisu
o nemocenském pojisténí.] S.Z.N. 1922, No. 398, and 1923, Nos. 145 and 249.
SPECIAL LEGISLATION
Agriculture
Act No. XVI of 3 July 1900 respecting the Benefit Fund for agricultural
workers and farm servants. [XVI. torvényczikk a gazdasági munkás-és
cselédsegélypénztárról. 1900. évi Julius hó 3-án.] O.T., 7 July 1900.
Act No. XIV of 26 June 1902 to supplement Act No. XVI of 3 July 1900
respecting the Benefit Fund for agricultural workers and farm servants.
[ XIV. torvényczikk a gazdasági munkas-és cselédsegélypénztárról szóló
1900: XVI. t.-cz. kiegészitésérol. 1902. évi Junius hó 26-án.] O.T., 29 June
1902.
Act No. VIII of 24 February 1912 to supplement Acts No. XVI of 1900
and No. XIV of 1902 respecting the Benefit Fund for agricultural workers
and farm servants. [VIII. torvényczikk az Országos Gasdasági Munkás-és
Cselédsegélyzópénztárról szóló 1900 :"XVI. és 1902 : XIV. t.-c. -ek kiegészitésérol.
1912. évi februar hó 24-án.] O.T., 28 February 1912.
Act No. XX of 28 June 1913 respecting the State Fund for agricultural
workers and respecting the legal regulations in force concerning the accident
insurance and sickness relief of farm servants and workers employed in agricultural undertakings in connection with machinery. [XX. torvényczikk az
Országos Gazdasági Munkáspénztárról és a gazdasági cselédék, valamint a
gazdasági gépmunkások baleset esetére való biztositása és betegség esetében
való ellátása tekintetében irányadó törvenyes rendelkezésékrol. 1913. évi,
Junius hó 28-án.] O.T., 2 July 1913.
Orders of the Minister in charge of Slovakia dated 23 August 1919, 24 July
1920 and 5 April 1921. [Naíízení ministra s plnou mocí pro správu Slovehska
z. 23. srpna 1919, 24. Êervence 1920 a 5. dubna 1921.]
DENMARK t
Act of 29 April 1913 relating to work in factories, etc. and the public inspection of the same. [Lov om Arbejde i Fabrikker m. v. samt det offentliges
Tilsyn dermed. Den 29de april 1913.] B.B. 1913, p. 324.
i Abbreviations;
L = Lovtidende.
S.F. = Social Forsorg.
— 123 —
Act of 10 May 1915 respecting approved sick funds. [Lov ora anerkendte
Sygekasser. Den 10 Maj 1915.] L. 1915, No. 144.
Act of 18 January 1918 relating to the provisional amendment of the Act
No. 144 of 10 May 1915 respecting approved sick funds. [Lov om midlertidig
Forandring i Lov Nr. 144 af 10 Maj 1915 om anerkendte Sygekasser. Den
18 Januar 1918.] L. 1918, No. 21.
Notification by the Minister of the Interior of Act No. 144 of 10 May 1915
concerning approved sick funds, as amended by the Act of 6 May 1921.
Dated 20 June 1921. [Indenrigsministeriets Bekendtgorelse af 20 Juni 1921
af Lov Nr. 144 af 10 Maj 1915 om anerkendte Sygekasser, saaledes som denne
er ändret i Honhold til Lov af 6 Maj 1921.] L.S. 1921 (1) Den. 2.
Notification in pursuance of the Act of 20 June 1921 relating to approved
sick funds. Dated 28 November 1923. [Bekendtgorelse fra Indenrigsministeriet om de Indtägts- og Formueforhold m. m. der som Regel betinger
Optagelse (Forbliven) som ubemidlet nydende Medlem i en anerkendt Sygekasse. Den 28 November 1923.] S.F. 1924, No. 1, p. 13.
Notification of the Ministry of Social Affairs respecting the income and
property limits for full members without means of approved sick funds.
Dated 11 September 1924. [Bekendtgorelse fra Socialministeriet angaaende
Indtägtsog- Formuegränserne for ubemidelde nydende Medlemmer af
anerkendte Sygekasser. 11 September 1924.] S.F. 1924, No. 8, p. 205.
ESTHONIA
(Russian) Act of 23 June-6 July 1912 respecting workmen's sickness insurance. B.B 1913, p. 129. Amended by the Acts of 18 June 1917 and 3 February 1920.
FINLAND i
Order of 2 September 1897 respecting mutual benefit funds.
työntekijäin apukassoista. 2.9.1897.] S.A. 1897.
[Asetus
FRANCE 2
GENERAL LEGISLATION
Act of 1 April 1898 respecting mutual benefit societies. [Loi du 1 e r avril
1898 relative aux sociétés de secours mutuels.] B.L. 1898, No. 1954, p. 1056.
Act of 31 March 1903 fixing the general budget of expenditure and revenue
for the financial year 1903 (Section 61). [Loi du 31 mars 1903 portant fixation du budget général des dépenses et des recettes de l'exercice 1903 (art. 61).]
B . L . 1903, No. 2461, p. 2053.
Act of 2 July 1904 amending the first paragraph of Section 16 of the Act
of 1 April 1898 respecting mutual benefit societies. [Loi due r 2 juillet 1904
modifiant le premier paragraphe de l'article 16 de la loi du 1 avril 1898 sur
les sociétés de secours mutuels.] B.L. 1905, No. 2587, p. 161.
Act of 5 December 1908 authorising certain exceptions to the Act of 1 April
1898 in favour of mutual benefit societies set up in the army and enavy.
[Loi
du 5 décembre 1908 autorisant certaines dérogations à la loi du 1 r avril 1898
en faveur des sociétés de secours mutuels constituées dans les armées de terre
et de mer.] B.L. 1908, No. 3014, p. 3165.
Act of 1 April 1914, rendering the duties of a member of the Superior
Council for Mutual Benefit Societies incompatible with those of a director
of an association which procures
special advantages for a certain category
of its members. [Loi du 1 e r avril 1914 établissant une incompatibilité entre
i2 Abbreviations;
Abbreviations;
rançaise.
f
S.A. = Suomen Asetuskokoelma.
B.L. = Bulletin des lois. J.O. = Journal officiel de la République
— 124 —
les fonctions de membres du conseil supérieur des sociétés de secours mutuels
et celles de directeur ou d'administrateur d'une société créant au profit d'une
catégorie de ses membres des avantages particuliers.] B.L. 1914, No. 127,
p. 878.
Act of 15 August 1923 amending the Act of 1 April 1898 respecting mutual
benefit societies. [Loi du 15 août 1923 modifiant la loi du 1 e r avril 1898
concernant les sociétés de secours mutuels.] J . O . 1923, p. 8238; errata,
p. 10280.
Order of 25 March 1921 regulating the grant of subsidies to approved
mutual benefit societies, approved federations of mutual benefit societies.
and miners' benefit societies. [Arrêté du 25 mars 1921 réglementant l'allocation des subventions aux sociétés de secours mutuels approuvées, aux unions
approuvées de sociétés de secours mutuels et aux sociétés de secours des
ouvriers mineurs.] J . O . 1921, No. 115, p. 5104.
Decree of 31 March 1923 fixing the rate of interest to be allowed by the
Deposit Fund on the funds of mutual benefit societies during the year 1923.
[Décret du 31 mars 1923 fixant le taux de l'intérêt servi par la Caisse des
dépôts sur les fonds des sociétés de secours mutuels pour l'année 1923.] J . O .
1923, No. 93, p. 3459.
Decree of 15 April 1924, issued by the Minister of Labour and Health,
respecting the independent funds of mutual benefit societies. [Décret du
15 avril 1924 du ministre du Travail et de l'Hygiène relatif aux caisses autonomes des sociétés de secours mutuels.] J . O . 1924, No. 113, p. 3735.
GERMANY *
G E N E R A L LEGISLATION
Order of 16 February 1924 respecting the assistance of the unemployed.
[Verordnung über die Erwerbslosenfürsorge und die Aufbringung der Mittel
für die Erwerbslosenfürsorge, nach der Bekanntmachung der neuen Fassungen
vom 16. Februar 1924.] R . G . B . 1924, Part I, p. 127, 380.
Directions of the Federal Committee of Medical Practitioners and Sickness
Funds, dated 12 May 1924, concerning the drawing-up of contracts with
medical practitioners. [Richtlinien des Reichsausschusses für Aerzte und
Krankenkassen für den allgemeinen Inhalt der Arztverträge, vom 12. Mai
1924.] Reichsarbeitsblatt, 1924, p. 205.
Notification of the new text of the Federal Insurance Code of 15 December
1924. [Bekanntmachung der neuen Fassung der Reichsversicherungsordnung vom 15. Dezember 1924.] R . G . B . 1924, Part I, p. 779; L. S. 1924,
Ger. 10.
Order of 10 January 1925 respecting limits of annual income and annual
earnings in sickness insurance. [Verordnung vom 10. Januar 1925 über die
Verdienst- und Einkommensgrenze in der Krankenversicherung.] R . G . B .
1925, Part I, p. 2.
SPECIAL LEGISLATION
Miners
Act of 23 June 1923 respecting miners' insurance. [Reichsknappschaftsgesetz vom 23. Juni 1923.] R . G . B . 1923, Part I, p. 431.
GREAT BRITAIN 2
An Act to consolidate the enactments relating to National Health insurance.
7 August 1924. (14 and 15 Geo. V, c. 38.) — L.S. 1924, G.B. 6.
The National Health Insurance (Arrears) Amendment Regulations, 1924,
dated 30 October 1924, made by the National Health Insurance Joint Committee under the National Health Insurance Acts, 1911 to 1924.— S.R. andO.
1924, No. 1242.
i Abbreviations;
2 Abbreviations ;
R..G.B. = Reichsgesetzblatt.
S.R. & O. = Statutory Rules and Orders.
— 125 —
The National Health Insurance (Valuation) Regulations, 1924, dated
18 November 1924, made by the National Health Insurance Joint Committee
under Sections 36, 38 and 83 of the National Insurance Act, 1911 (1 and 2
Geo. V, c. 55). — S.R. and O. 1924, No. 1316.
The National Health Insurance (Joint Committee) Regulations, 1924,
dated 18 November 1924, made by the National Health Insurance Joint
Committee under Subsections 3 and" 4 of Section 88 of the National Health
Insurance Act, 1924 (14 and 15 Geo. V, c. 38). — S.R. and 0.1924, No. 1315.
The National Health Insurance (Exempt persons) regulations, 1924, dated
30 December 1924, made by the National Health Insurance Joint Committee,
the Minister of Health and the Scottish Board of Health under the National
Health Insurance Act, 1924 (14 and 15 Geo. V, c. 38). — S.R. and O. 1924,
No. 1501.
The National Health Insurance (Exempt persons) amendment regulations,
1924, dated 30 December 1924, made by the National Health Insurance Joint
Committee, the Minister of Health and the Scottish Board of Health acting
jointly under the National Health Insurance Acts, 1911 to 1924. — S.R. a n d 0 .
1924, No. 1517.
The National Health Insurance (Seamen's Medical Benefit) Regulations,
1924, dated 22 December 1924, made by the Minister of Health under Sections
63 (5) and 24 of the National Health Insurance Act, 1924 (14 ann 15 Geo. V,
c. 38). — S.R. and O. 1924. No. 1461.
The National Health Insurance (Reserve and Transfer Values) Regulations,
1924, dated 23 December 1924, made by the National Health Insurance
Committee under the National Health Insurance Act, 1924 (14 and 15 Geo. V,
c. 38). — S.R. and O. 1924, No. 1468.
The National Health Insurance (Investment account) Regulations, 1924,
dated 16 December 1924, made by the Treasury under Section 70 (1) of the
National Health Insurance Act 1924 (14 and 15 Geo. V, c. 38) as to sums paid
over to the National Debt Commissioners for investment. — S.R. and 0.1924,
No. 1459.
The National Health Insurance (Medical Benefit) consolidated regulations
1924, dated 17 December 1924, made by the Minister of Health under the
National Health Insurance Act 1924 (14 and 15 Geo. V, c. 38) and under Section 1 (1) of the National Health Insurance (Cost of medical benefit) 1924,
(14 and 15 Geo. V, c. 10) relating to the administration of medical benefit. —
S.R. and O. 1924, No. 1433.
The National Health Insurance (Deposit Contributors) Amendment Regulations, No. 2, 1924, dated 18 December 1924, made by the National Health
Insurance Joint Committee, the Minister of Health and the Scottish Board
of Health acting jointly under the National Health Insurance Acts, 1911 to
1924. — S.R. and O. 1924, No. 1483.
The National Health Insurance (Collection of Contributions) Regulations,
1924, dated 24 December 1924, made by the National Health Insurance
Joint Committee and the Minister of Health acting jointly under the National
Health Insurance Act 1924 (14 and 15 Geo. V, c. 38). — S.R. and 0.1924,
No. 1500.
The National Health Insurance (Mercantile Marine) (Collection of Contributions) regulations, 1924, dated 23 December 1924, made by the National
Health Insurance Joint Committee, the Minister of Health, the Scottish
Board of Health and the Minister of Labour for Northern Ireland acting
jointly under Section 8 of the National Health Insurance Act, 1924 (14 and
15 Geo. V, c. 38). — S.R, and O. 1924, No. 1507.
GREECE l
Act No. 2868 of 16 July 1922, respecting the compulsory insurance- of
wage-earning and salaried employees. — E.'K. 1922, No. 119, p. 554; L.S.
1922, Gr. 3.
' Abbreviations;
E.K. = Ephémeris tes Kybernéséos.
— 126 —
Legislative Decree of 19 November 1923, to amend and supplement Act
No. 2868 respecting the compulsory insurance of wage-earning and salaried
employees. — E.K. No. 345, 28.11.23, p. 2493; L.S. 1923, Gr. 6.
Royal Decree of 8 December 1923 to consolidate the provisions of Act
No. 2868 and of the Legislative Decree of 19 November 1923, to amend and
supplement the said Act. — E . K . No. 373, 21.12.23, p. 2690.
HUNGARY i
GENERAL LEGISLATION
Act No. XIX of 6 April 1907 respecting the sickness and accident insurance
of persons employed in industrial and commercial occupations. [XIX törvényczikk az ipari es kereskedelmi alkalmazottaknak betegség es baleset
esetére való biztositasáról. 1907. évi apriljs hó 6-án.] O.T., 9 April 1907;
B.B. 1907, p. 247.
S P E C I A L LEGISLATION
Agriculture
Act No. XVI of 3 July 1900 respecting the Benefit Fund for agricultural
workers and farm servants. [XVI. torvényczikk a gazdasági munkás-és
cselédsegélypénztárról. 1900. évi Julius hó 3-án.] O.T., 7 July 1900.
Act No. XIV of 26 June 1902 to supplement Act No. XVI of 3 July 1900
respecting the Benefit Fund for agricultural workers and farm servants.
[XIV. torvényczikk a gazdasági munkás és cselédsegélypénztárról szóló 1900:
XVI. t.-cz. kiegészitéséról. 1902. évi Junius hó 26-án.] O.T., 29 June
1902.
Act No. VIII of 24 February 1912 to supplement Acts No. XVI of 1900
and No. XIV of 1902 respecting the Benefit Fund for agricultural workers
and farm servants. [VIII. torvényczikk az Országos Gazadasági Munkás és
Cselédsegélyzopénztárról szóló 1900: XVI. és 1902: XIV. t. -c. -ek kiegészitéséról. 1902. évi februar hó 24-án.] O.T., 28 February 1912.
Act No. XX of 28 June 1913 respecting the State Fund for agricultural
workers and respecting the legal regulations in force concerning the accidents
insurance and sickness relief of farm servants and workers employed in agricultural undertakings in connection with machinery. [XX. torvényczikk
az Országos Gazdasági Munkáspéneztérról és a gazdasági cselédék, valamint
a gazdaségi gépmunkások baleset esetére való biztositása es betegseg esetében
valo ellátása tekkintetében iranyadó torvényes rendelkezésékrol. 1913. évi
Junius hó 28-án.] O.T., 2-July 1913.
IRISH FREE STATE'
An Act to provide for insurance against loss of health and for the prevention
and cure of sickness and for insurance against unemployment, and for purposes
incidental thereto. 16 December 1911. (1 and 2 Geo. V, c. 55.)
An Act to amend Parts I and III of the National Insurance Act, 1911.
15 August 1913. (3 and 4 Geo V, c. 37.)
An Act to amend Part I of the National Insurance Act, 1911, 16 March
1915. (5 Geo. V, c. 29.)
An Act to amend the Acts relating to National Health Insurance. 6 February 1918. (7 and 8 Geo. V, c. 62.)
An Act to alter the rate of remuneration for the purposes of exception from
insurance under the National Insurance (Health) Acts 1911 to 1918 and for
purposes in connection therewith. 15 August 1919. (9 and 10 Geo. V, c, 36.)
An Act to amend the Acts relating to National Health Insurance.. 20 May
1920. (10 and 11 Geo. V, c. 10.)
1
Abbreviations;
2 Abbreviations;
O.T. = Országos Tôrvénytas.
S.R. & O. = Statutory Rules and Orders.
— 127 —
An Act to amend and adapt the National Health Insurance Acts, 1911 to
1921, No. 20 of 1923. Dated 26 June 1923. — L.S. 1923, I . F . S . 1.
The National Health Insurance 'Arrears) Amendment Regulations (No. 2),
1924.
Regulations, dated 21 June 1924, made by the Irish Insurance Commissioners, with the concurrence of the Minister for Local Government and
Public Health, amending the National Health Insurance (Irish Migratory
Labourers Benefits) Regulations, 1918.
Regulations, dated 21 June 1924, made by the Irish Insurance Commissioners, with the concurrence of the Minister for Local Government and
Public Health under Sectio'n 35 (2) of the National Insurance Act, 1911
(1 and 2 Geo, V, c. 55). — S.R. and O. 1924, No. 18.
An Act to establish a medical certification Fund under the control and
management of the Irish Insurance Commissioners, and for that purpose
and also for other purposes to amend and extend the National Health Insurance Acts, 1911 to 1923. Dated 28 July 1924. (No. 30 of 1924.) — L.S.
1924, I . F . S . 2.
Regulations, dated 21 August 1924, made by the Irish Insurance Commissioners, with the concurrence of the Minister for Local Government and
Public Health further amending the National Health Insurance (Insurance
Committees) Consolidated Regulations (Ireland), 1916. — S.R. and O., 1924,
No. 21.
ITALY i
Act No. 3818 of 15 April 1886 respecting the constitution of mutual benefit
societies. [Legge 15 aprile 1886, n. 3818 (s. 3a), che approva ]a costituzione
legale délie società di mutuo soccorso.] Codici e Leggi usuali d' Italia (Prof.
Franchi), Vol. I I : Leggi usuali, parte terza (N-S).
Act No. 520 of the 17 July 1910 relating to the institution of a maternity
fund. [Legge del 17 luglio 1910, n. 520 relativa alla instituzione di una
Cassa di maternità.] G.U. 1910, No. 181, 3 August 1910; B . U . L . 1910,
XIII, p. 1311; 1910, XIV, p. 731; B.B. 1912, p. 28.
Regulations approved by Royal Decree No. 1382 of 26 November 1911,
under the Maternity Fund Act, No. 520, of 17 July 1910. [Regolamento
approvato con Regio decreto n. 1382, 26 novembre 1911 per 1' esecuzione
della legge 17 luglio 1910, n. 520 sulla Cassa di maternità.] B . U . L . , 1912,
XVII, p. 246.
Royal Decree No. 23 of 4 January 1920 establishing rules for the grant
by the State of subsidies to mutual benefit societies. [Regio decreto 4 gennaio 1920, n. 23 contenente norme per la concessione di sussidi da parte dello
Stato a società di mutuo soccorso.] B . L . 1920, II, 121.
Act No. 471 of 6 April 1922 ratifying draft conventions adopted by the
Washington Session of the International Labour' Conference. [Legge 6 aprile
1922, n. 471, concernante la ratifica dei progetti di convenzione adottati
dalla sessione di Washington della Conferenza internazionale del lavoro.]
G.U., 1922, No. 91, p. 895.
Legislative Decree No. 237 of il January 1923, relating to provisional
regulations of the National Maternity Fund. [Regio Decreto-Legge 11 gennaio 1923, n. 237, che reca provvedimenti temporanei per la Cassa nazionale
di maternità.] G.U., 20 February 1923, No. 42, p. 1113.
Decree No. 2157, of 24 September 1923 approving the codified text of the
Act respecting the Maternity Fund. [Regio Decreto 24 settembre 1923,
n. 2157: recante approvazione del testo único di legge sulla cassa di maternité.] G.U., 22 October 1923, No. 248, p. 6474; B . U . L . , 1923, 11/53; L . S .
1923, It. 3.
1
Abbreviations; B.L. = Bollettino del Lavoro. B.U.L. = Boiletino dell' Ufflcio del
Lavoro. G.U. = Gazzetta Uflicialel
— 128 —
JAPAN
Act No. 70 of 22 April 1922, relating to Health Insurance. — Kampo,
No. 2914, 22 April 1922; L . S . 1922, Jap. 3.
LATVIA
Sickness Insurance Code for workers and employees, issued by the Codification Section of the Ministry of Justice, 1922. [Noteikumi par strâdnieku
un citu algotu darbinieku nodrosinasanu slimibas gadijumos. Tieslietu
ministrijas kodifikacijas nodalas 1922, gada izdevums.] L.S. 1922, Lat. 2.
LITHUANIA i
(Russian) Act of 23 June — 6 July 1912 respecting workmen's sickness
insurance. — I.L.C.; B.B. 1913, p. 129.
Memel Territory2
Order of 18 November 1922 respecting the reorganisation of social insurance
in the Memel Territory. [Paliepimas kaslink Pertaisymocsociolinio Isipirkimo
Klaipedos Kraczten. 18. Nowemberio 1922.] K. K. W. Z., 1922, p. 1193.
Order of 28 December 1923 to amend the Order of 18 November 1922
respecting the reorganisation of social insurance in the Memel Territory.
[Paliepimas pakeisti Paliepima apie socialu Apdraudima,(Isipirkimo) Klaipedos Kraszte Pakeitima isz 18. Nowemberio"1922 (Waldz. Zin. Pusl. 1193).
28. Decemberi 1923.] É . K . W . Z . No. 133, 31 December 1923, pusl. 1104;
L . S . 1923, Lith. 1, A.
Order of 28 December 1923 respecting the protection in case of sickness,
of persons employed in agriculture. [Paliepimas kaslink Laukininkystej
pasidarbuojancziu, Darbèmëju jiems apsirgus Uzrupinimo. 28. Decemberi
1923.] K . K . W . Z . , No. 133, 31 December 1923, pusl. 1105; L.S. 1923,
Lith. 1, B.
Order of 10 January 1924 to amend the Order of 18 November 1922 respecting the reorganisation of social insurance in the Memel Territory. [Paliepimas
pakeisti Paliepimo apie socialu Apdraudima Klaipèdos Kraszte Pakeitima isz
18. Nowemberio 1922 (Waldz.'Zin. Pusl. 1193) 10 Januar 1924.]
LUXEMBURG
3
Act of 31 July 1901 relating to the insurance of workmen against sickness.
[Loi du 31 juillet 1901 concernant l'assurance des ouvriers contre les maladies.]
Act of 21 April 1908 to supplement and amend the Acts relating to the
compulsory insurance of workmen against accidents and sickness. [Loi du
21 avril 1908 complétant et modifiant la législation concernant l'assurance
obligatoire des ouvriers contre les accidents et les maladies.] M. 1908, No. 25 ;
B.B. 1908, p. 109.
Act of 9 February 1918 to amend the Act of 31 July 1901 relating to the
insurance of workmen against sickness. [Loi du 9 février 1918 portant
modification de la loi du 31 juillet 1901 concernant l'assurance obligatoire
des ouvriers contre les maladies.] M., 9 Februarv 1918, p. 178; P.L., 1918,
p. 161.
1
a
8
Abbreviations; I . L . C . =„Industrial Labour Code, 1913 edition.
Abbreviations; K . K . W . Z . = Klaipèdos Krassto Waldzios Zinios.
Abbreviations; M. = Mémorial du Grand-Duoliê de Luxembourg.
nomie luxembourgeoise.
P.L. = Pasi-
— 129 —
Act of 8 March 1919 to supplement Section 31 of the Act of 31 July 1901,
relating to the insurance of workmen against sickness. [Loi du 8 mars 1919
complétant l'art. 31 de la loi du 31 juillet 1901 concernant l'assurance obligatoire des ouvriers contre les maladies.] M., 13 March 1919, p. 257; P.L.,
1919, p. 318.
Ministerial Order of 14 July 1921 to amend the daily wage rates adopted
for the hand workers respecting sickness insurance. [Arrêté ministériel du
14 juillet 1921 portant modification des taux du salaire quotidien usité des
manouvriers ordinaires en matière d'assurance-maladie.] M., 27 July 1921,
p. 835; P.L., 1921, p. 129.
NETHERLANDS >
Act of 5 June 1913 respecting the administration of workmen's sickness
insurance (Labour Councils Act.) Amended by the Acts of 11 April 1919,
and 27 September 1920. [Wet van den 5den Juni 1913, tot regeling der arbeidersziekteverzekering (Radenwet).] S., 1913, No. 203; 1919, No. 165; 1920,
No. 754.
Act of 5 June 1913 relating to workmen's sickness insurance. [Wet van
den 5den Juni 1913 tot regeling der arbeidersziekteverzekering (Ziektewet).]
S., 1913, No. 204. (Not yet in operation.)
NEW ZEALAND
Friendly Societies Act, 1909 (as amended 1911, 1914, 1915).
An Act to encourage the making of provision against destitution arising
from old age, sickness, widowhood, and orphanage (No. 41). 21 November
1910.
National Provident Fund Act, 1910.
An Act to amend the National Provident Fund Act, 1910 (No. 26, 31 October 1910).
National Provident Fund (Amendment) Act (No. 34, 1914).
NORWAY 2
Act of 6 August 1915 respecting sickness insurance. [Lov om sykeforsikring. 6 August 1915.] N.L. 1915, p. 633; B.B. 1916, p. 236.
Act of 15 June 1917 to amend and supplement the Act respecting sickness
insurance of 6 August 1915. [Lov av 15 Juni 1917 om forandring i og tillaeg
til lov om sykeforsikring av 6 August 1915.] N.L., 1917, p. 350; L . S .
1920, Nor. 3 bis.
Provisional Act supplementing the benefits to persons entitled to sickness
benefit and family allowances in pursuance of the Sickness Insurance Act
of 6 August 1915 and the supplementary Act of 15 June 1917. [Midlertidig
lov av 23 Juli 1918 om tillägsunderstottelse for sykepenge og familiebidragsberettigede ifolge lov om sykeforsikring av 6 August 1915 med tillaegsbv av
15 Juni 1917.] L.S., 1920, Nor. 3 bin.
Act of 10 December 1920 to amend and supplement the Act respecting
sickness insurance of 6 August 1915, together with the supplementary Acts
of 15 June 1917 and 23 July 1918. [Lov av 10 desember 1920 om forandringer
i og tillegg til lov om sykeforsikring av 6 August 1915 med tilleggslover av
15 juni 1917 og 23 juli 1918.] L.S., 1920, Nor. 3.
1
2
Abbreviations;
Abbreviations;
S. = Staatsblad.
N.L. = Norsk Lcrvtidende.
— 130 —
Act of 16 February 1923 to amend the Sickness Insurance Act of 6 August
1915, together with the supplementary Acts. [Lov om forandringer i lov
om. sykeforsikring av 6 august 1915 med tillegslover. Den 16 februar 1923.]
N.L., 1923, No. 7, p. 66; L.S., 1923, Nor, 3.
PERU
Act of 25 November 1918 to regulate the employment of women and children.
[Ley que reglamenta el trabajo de las mujeres y de los niños. 25 de noviembre
de 1918.] Boletín del Instituto de reformas sociales, 1919, p. 659; B.B.
1919, p. 186.
POLAND i
Act. of 19 May 1920 respecting compulsory sickness insurance. [Ustawa
z dnia 19 maja 1920 roku o obowiazkowem ubezpieczeniu na wypadek choroby.
Nr. 272.] D.U. 1920, No. 44, poz. 272, str. 723.-L.S. 1920, Pol. 3.
Act of 6 July 1923 to amend Sections 103, 104 and 105 of the Act of 19 May
1920 respecting compulsory sickness insurance. [Ustawa z dnia 6 lipca 1923
r. w przedmiocie zmiany artykulow 103, 104 i 105 ustawy z dnia 19 maja
1920 r. o obowiazkowem ubezpieczeniu na wypadek choroby.] Dz. U . R . P .
Nr. 44, poz. 272). D.U., 1923, No. 75, poz. 589, str. 875; L.S. 1923, Pol. 3, B.
Decree of the Minister of Finance issued in agreement with the Minister of
Labour and Social Welfare respecting the conversion into Polish currency
(zloty) of the pecuniary benefits mentioned in the Act of 19 May 1920 respecting compulsory sickness insurance. Dated 30 June 1924. [Rozporzadzenie
Ministra Skarbu z dnia 30 czerwca 1924 r. wydane w porozumieniu z Ministrem
Pracy i Opieki Spolecznej w sprawie przerachowania na zlote kwot pienieznych,
wyrazonych w ustawie z dnia 19 maja 1920 r. o obowiazkowem ubezpieczeniu
na wypadek choroby.] D.U., 1924, No. 58, poz. 591, str. 858.
PORTUGAL 2
Decree No. 5636 of 10 May 1919 respecting the institution of compulsory
sickness insurance. [Decreto n. 5636, organizando o seguro social obrigatorio na doença. 10 de maio de 1919.] D. G., 1st series, No. 98, 8th suppl.,
10 May 1919.'
ROUMANIA »
Act of 25 January 1912 respecting the organisation of handicrafts minor
credit institutions, and workmen's insurance. [Lege pentru organizarea
meseriilor, creditului si assigurarilor muncitoresti.] M.O., 27 January 1912,
No. 236; B . B . 1913; p. 53.
Acts of 26 April and 31 May 1913 to amend and supplement the Act of
25 January 1912. [Legi pentru modificarea si adàugirea unor dispozitiuni
din legea pentru organizarea meseriilor, creditului si asigurárílor muncitoresti.]
M.G., 28 April , 5 June 1913.
'
' '
Act of 2 July 1924 to amend and supplement provisionally certain provisions of the social insurance laws for the territory of Roumania. [Lege pentru
modificarea si complectarea provizorie a unor dispozitiuni din legile asigurárílor
sociale din cuprinsul României.] M.O., 4 July 1924, No. 143, p. 7613;
L"'S. 1924, Rou.
! . .
1
2
Abbreviations;
Abbreviations;
» Abbreviations;
D.U. = Dziennik TJstaw.
D.G. == Diario do Governo.
M.O. = Monitorul Oficial.
— 131 —
RUSSIA i
Labour Cede of Ihe Russian Federative Socialist Soviet Republic, 1922
edition, chapter 17. — C.L. 1922, No. 71; L.S. 1922, Russ. I.
Civil Code of the Russian Federative Socialist Soviet Republic, Sections
412-415. — C.L. 1922, No. 71.
Circular of 22 February 1922 of the P . S . I . C . respecting the organisation
of territorial insurance funds. — B . P . S . I . C . 1922, No. 5:
Circular of 15 March 1922 of the P . S . I . C . issuing regulations for transport
workers' insurance funds. — B . P . S . I . C . 1922, No. 8.
Circular of 25 March 1922 of the P . S . I .C. issuing regulations for the transport workers' insurance section of the Social Insurance Board. — B . P . S . J . C .
1922, No. 10.
Order of 6 June 1922 of the C.P.C. issuing regulations concerning the
Central Social Insurance Board. — Izvestia, 11 June 1922.
Regulations of 11 July 1922 for the social insurance boards for the governments. — B . P . S . I . C . , 1922, No. 27.
Decree of 21 December 1922 of the All-Russian Central Executive Committee and the C. P . C., to transfer social insurance questions from the P . S . I . C
to the P . L . C . — C.L. 1922, No. 81.
Order of 23 January 1923 of the C.P.C. respecting medical boards. —
C.L. 1923, No. 4.
Instructions no. 125/29, issued on 24 March 1923 by the P . L . C , respecting the payment by one insurance fund of benefit for temporary loss of working capacity to members of another fund. •— I.Q. 1923, No. 14.
Decree of 2 April 1923 of the C.P.C. concerning employers' liability for
contraventions of the social insurance laws. — C.L. 1923, No. 27.
Order of 12 April 1923 of the All-Russian Central Executive Committee
and the C.P.C. respecting the scale of insurance contributions for persons
employed for remuneration. — C.L. 1923, No. 31.
Circular and Instructions of 12 June 1923 of the P . L . C . respecting supervision, of the payment of insurance contributions. — I.Q. 1923, No. 23.
Circular of 21 June 1923 of the P . L . C . respecting the insurance of seasonal
and temporary workers. — I.Q. 1923, No. 26.
Regulations of 21 July 1923 of the P . L . C . respecting insurance offices
and authorised representatives of insurance funds. — I.Q. 1923, No. 34.
Circular of 14 September 1923 of the P . L . C . of the Ü . S . S . R . , respecting
the insurance of apprentices in small-scale industry, industrial arts and
handicrafts, and in industrial co-operative societies. •— I . Q . 1923, No. 38.
Order of 3 January 1924, of the P . L . C . of the U . S . S . R . , issuing rules for
assistance to disabled workers whose incapacity for work is due to an industrial
accident, and also to members of the families of wage-earning and salaried
employees whose death is the result of an accident. —- B . P . L . C . 1924, No. 1.
Regulations of 15 January 1924 respecting the Social Insurance Fund,
approved by the P . L . C . and the People's Commissariat of Finance of the
U . S . S . R . , and by the People's Commissariat of Justice of the Russian
Federative Socialist Soviet Republic, — B . P . L . C . 1924, Nos. 6-7.
Order of 8 February 1924, of the Central Executive Committee and the
C . P . C , to alter the scale of insurance contributions for institutions appearing in State and local budgets. — Izvestia, 10 February 1924.
Order of 15 June 1924, of the P . L . C of the U . S . S . R . , respecting the rates
of pensions and benefit for social insurance purposes. —B.P.L.C. 1924, No. 27.
i Abbreviations; C.P.O. = Council of People's Commissaries. P.L.C. = People's
Labour Commissariat. P . S . I . C . = People's Social Insurance Commissariat. U . S . S . R . =
Union of Soviet Socialist Republics. C.L. = Collection of Laws. B . P . S . I . C . = Bulletin of People's Social Insurance Commissariat. B . P . L . C . — Bulletin of People's Labour
Commissariat. I.Q. = Insurance Questions.
— 132 —
Instructions of 30 June 1924, of the People's Transport Commissariat of
the U.S.S.R., concerning the calculation and payment of insurance contributions for railway workers. — B . P . L . C . 1924, No. 39.
Order No. 249, issued on 26 July 1924 by the P . L . C , respecting the
maximum amount of benefit for temporary loss of working capacity. —•
B . P . L . C . 1924, No. 31.
Order of 26 July 1924, of the P . L . C . of the U.S.S.R., respecting the
payment of pensions to disabled workers travelling outside the territory of
thè U . S . S . R . — B . P . L . C . 1924, No. 31.
Order of 7 August 1924, of the P . L . C . of the U . S . S . R . , concerning the
insurance of disabled persons employed for remuneration.
SERB-CROAT-SLOVENE
KINGDOM
Act respecting workers' insurance. Dated 14 May 1922. [Zakon o osiguranju radnika.] Radnicka Zastita, 1922, Broj 5-6; L.S. 1922, S.C.S. 2.
SPAIN 1
Act of 30 June 1887 respecting friendly societies. [Ley de 30 junio 1887
sobre mutualidades.]
Act of 13 March 1900 respecting the employment of women. [Ley de
13 marzo 1900 sobre el trabajo de las mujeres.]
Act of 8 January 1907 to amend Section 9 of the Act of 13 March 190O
relating to the employment of women. [Ley reformando el art. 9 de la ley
de 13 marzo 1900 en lo relativo al trabajo de las mujeres, 8 de enero de 1907.]
B . I . R . S . III, p. 561-562; B . B . 1907, p. 220.
Decree of 21 August 1923 amending Section 9 of the Act of 13 March 1900
respecting the employment of women and children, as amended
by the Act
of 8 January 1907. [Real decreto reformando el articulo 9o de la ley de
13 de marzo de 1900 sobre el trabajo de las mujeres y los niños. 21 de agosto
1923.] G.M., 23 de agosto de 1923, No. 235; p. 811; L.S. 1923, Sp. 4.
SWEDEN *
Act of 4 July 1910 respecting sick funds. [Lag om sjukkassor. 4 Juli
1910.] S.F., 1910, p. 77.
Royal Order of 30 June 1913 respecting State subsidies to maternity funds.
[K.Maj:ts. nâdiga kungörelse angâende statsbidrag ät sjukkassor, som
meddela moderskapshjälp. 30 Juni 1913.] S.F., 1913, No. 136.
Royal Order of 11 October 1920 respecting State subsidies to sickness
funds. [K.Maj:ts. nâdiga kungörelse angâende statsbidrag àt sjukkassor.
11 Oktober 1920.] Sveriges Rikes Lag, et. Utgiven av H. Westring, B. 586 B. 587.
SWITZERLAND 3
FEDERAL
LEGISLATION
Federal Act of 13 June 1911 respecting sickness and accident insurance.
[Loi fédérale du 13 juin 1911 sur l'assurance en cas de maladie et d'accidents.]
R . L . F . 1911, vol. XXVIII, No. 9, p. 351. B.B. 1912, p. 191.
i Abbreviations; B.I.R.S. = Boletín del Instituto de Reformas sociales. G.M. =
ûaceta de Madrid.
2 Abbreviations; S.F. = Svensk Forîattningssamling.
s
Abbreviations: R.L.F. = Recueil des lois fédérales.
— 133 —
Sickness Insurance Order No. I of 7 July 1913 fixing the rules to be followed
in according recognition to sickness funds and in auditing of their accounts.
[Ordonnance I sur l'assurance-maladie, fixant les règles à suivre pour la reconnaissance des caisses-maladie et la clôture de leurs comptes. Du 7 juillet
1913.] R . L . F . 1913, p. 239.
Sickness Insurance Order No. II of 30 December 1913 fixing the rules to
be followed in calculating the amount of Federal subsidies. [Ordonnance II
sur l'assurance-maladie, fixant les règles à suivre pour le calcul des subsides
fédéraux. Du 30 décembre 1913.] R . L . F . 1914, p. 5.
CANTONAL LEGISLATION
Compulsory Insurance
Appenzell (Outer Rhoden)
Act of 30 April 1916, amended by the Act of 30 April 1922 respecting
sickness insurance. [Gesetz betr. die Krankenversicherung vom 30. April
1916, abgeändert am 30. April 1922.]
Appenzell (Inner Rhoden)
Decree of 29 November 1920 respecting sickness insurance.
über die Krankenversicherung vom 29. November 1920.]
[Verordnung
Basle-Town
Act of 12 March 1914 respecting public sickness insurance funds. [Gesetz
vom 12. März 1914 betr. die öffentlichen Krankenkassen.]
Act of 19 November 1914 respecting compulsory sickness insurance. [Gesetz vom 19. November 1914 betr. obligatorische Krankenversicherung.]
Fribourg
Act of 20 December 1919 respecting sickness insurance and school children's
insurance. [Gesetz vom 20. Dezember 1919 betr. Errichtung einer Krankenversicherung und einer Schüler-Ersparniskasse für die Primarschulen.]
Geneva
Act of 11 November 1919, amended on 29 June 1921, respecting compulsory
sickness insurance for school children. [Loi du 11 novembre 1919, modifiée
le 29 juin 1921, sur l'assurance scolaire obligatoire en cas de maladie.]
St. Gall
Act of 28 May 1914, amended on 28 November 1919, respecting compulsory
sickness insurance and communal sickness insurance funds. [Gesetz vom
28. Mai 1914, mit Nachtragsgesetz vom 28. November 1919, über die obligatorische Krankenversicherung und die Gemeinden-Krankenkassen.]
Vaud
Act of 31 August 1916, amended by that of 28 November 1918, respecting
the creation of a fund for insuring children against sickness in the Canton
of Vaud. [Loi du 31 août 1916, modifiée par celle du 28 novembre 1918,
concernant la création d'une caisse cantonale vaudoise d'assurance infantile
en cas de maladie.]
Order of 29 September 1920 rendering sickness insurance compulsory in
the case of children attending primary schools. [Arrêté du 29 septembre
1920 rendant obligatoire l'assurance infantile en cas de maladie pour les enfants
fréquentant les écoles primaires.]
Zug
Act of 23 October 1916 respecting compulsory sickness and accident insurance. [Gesetz vom 23. Oktober 1916 betreffend die Einführung der obligatorischen Kranken- und Unfallversicherung.]