R029 - Recomendación sobre el seguro de enfermedad, 1927 (núm. 29)

Whereas the maintenance of a healthy and vigorous labour supply is of capital importance not only for the workers themselves, but also for communities which desire to develop their productive capacity; and

Whereas its development is only attainable by constantly and systematically applying provident measures to obviate or make good any loss of the workers' productive efficiency; and

Whereas the best provident measure for these purposes is to establish a system of social insurance which confers clearly defined rights on the persons to whom it applies;

Therefore the General Conference of the International Labour Organisation,

Having adopted Conventions concerning, of the one part, sickness insurance for workers in industry and commerce and domestic servants, and, of the other part, sickness insurance for agricultural workers, which lay down minimum conditions which must be complied with from the beginning by every system of sickness insurance, and

Considering that, in order to put the experience already gained at the disposal of the Members with a view to assisting them in the institution or completion of their sickness insurance services, it is desirable to indicate a number of the general principles which practice shows to be the best calculated to promote a just, effective and appropriate organisation of sickness insurance,

Recommends that each Member should take the following principles and rules into consideration:

I. Scope of Application

1. 1. Sickness insurance should include within its scope, without discrimination as to age or sex, every person who performs work by way of his occupation and under a contract of service or apprenticeship.
2. 2. If, however, it is considered desirable to fix age-limits by reason of the fact that workers above or below such limits are already protected by law or otherwise, such limits should not apply to young persons who cannot normally be considered as dependent upon their family or to workers who have not reached the old-age pension age; and

if exceptions are made in respect of workers whose earnings or income exceed a specified amount, such exceptions should only apply to workers whose earnings or income are such that they may reasonably be expected to make their own provision for sickness.

II. Benefits

A. Cash Benefits

1. 3. In order to secure that an insured person who is rendered incapable of work by sickness may recover his health as early as possible, the cash benefit representing compensation for lost wages should be adequate.

For this purpose the statutory scale of benefit should ordinarily be fixed in relation to the normal wage which is taken into account for the purposes of compulsory insurance, and should be a substantial proportion of such wage, regard being had to family responsibilities; but in countries where the workers have adequate facilities, of which they are accustomed to take advantage to procure for themselves additional benefit by other means, a uniform scale of benefit may be appropriate.

1. 4. The statutory benefit should be paid for at least the first twenty-six weeks of incapacity as from and including the first day for which benefit is payable; nevertheless, the period for which benefit is payable should be increased to one year in cases of serious and chronic illness and for insured persons who will not receive any invalidity benefit on the expiry of their right to sickness benefit.
2. 5. An insurance institution which can show that it is in a sound financial position should be authorised--
   • (a) to increase the statutory scale of benefit up to specified amounts either for all insured persons or for certain groups of the same, in particular insured persons with family responsibilities;
   • (b) to prolong the statutory period during which benefit is payable.
3. 6. In countries where burial expenses are not, customarily or by law, covered by some other insurance, sickness insurance institutions should, on the death of an insured person, pay a benefit in respect of the cost of decent burial; they should also be empowered to pay such a benefit in respect of the burial expenses of the insured person's dependants.

B. Benefits in Kind

1. 7. Treatment by a fully qualified doctor and the supply of proper and sufficient medicines and appliances should be granted to an insured person from the beginning of his illness and for so long as the state of his health requires it; the insured person should be entitled to these benefits free of charge from the beginning of his illness and at least until the expiry of the period prescribed for the grant of sickness benefit.
2. 8. In addition to treatment by a fully qualified doctor and the supply of proper and sufficient medicines and appliances, there should be available for the insured person, as and when local and financial conditions admit, facilities for specialist services, as well as dental treatment, and for treatment in hospital, where his family circumstances necessitate it or his illness requires a mode of treatment which can only be given in hospital.
3. 9. While an insured person is maintained in hospital, the insurance institution should pay to his dependants the whole or a part of the sickness benefit which would have been payable to him had he not been so maintained.
4. 10. With a view to ensuring good conditions for the maintenance in health of the insured person and his family, members of the insured person's family living in his home and dependent upon him should be furnished with medical benefit, as and when it may be possible and practicable to do so.
5. 11. Insurance institutions should be empowered to avail themselves, on equitable conditions, of the services of such doctors as they need.

In urban centres, and within specified geographical limits, an insured person should be entitled to choose a doctor from among those at the disposal of the insurance institution, unless this would involve considerable extra expense to the institution.

C. Sickness Prevention

1. 12. As most diseases can be prevented, an alert policy of prevention is calculated to avert loss of productive efficiency, to render available for other purposes the financial resources which are absorbed by avoidable illness, and to promote the material, intellectual and moral well-being of the community.

Sickness insurance should assist in inculcating the practice of the rules of hygiene among the workers. It should give preventive treatment and grant the same to as large a number of individuals as possible as soon as the premonitory symptoms of disease appear. It should be capable of contributing towards the prevention of the spread of disease and the improvement of the national health, in pursuance of a general policy co-ordinating all the various activities towards these ends.

III. Organisation of Insurance

1. 13. Insurance institutions should be administered, under the supervision of the competent public authority in accordance with the principles of self-government, and shall not be carried on for profit. The insured persons being those who are the most directly interested in the working of the insurance scheme should, through elected representatives, have an important part in the management of the insurance system.
2. 14. A good organisation of medical benefit and, in particular, the efficient provision and utilisation of medical equipment embodying the results of scientific progress can be most easily secured--except in certain special circumstances--by concentrating action on a territorial basis.

IV. Financial Resources

1. 15. The financial resources for the insurance scheme should be provided by contributions from the insured persons and contributions from employers. The provision thus jointly made can be supplemented to advantage by contributions from public funds, especially for the purpose of improving the health of the people.

With a view to securing the stability of the insurance system, reserve funds, appropriate to the peculiar circumstances of the system, should be constituted.

V. Settlement of Disputes

1. 16. With a view to their being settled rapidly and inexpensively, disputes as to benefits between insured persons and insurance institutions should be referred to special tribunals, the members of which include judges or assessors who are specially cognisant of the purposes of insurance and the needs of insured persons.

VI. Exception for Sparsely Populated Territories

1. 17. States which, by reason of the small density of their population or of the inadequacy of the means of communication, cannot organise sickness insurance in certain parts of their territory should--
   • (a) establish in such parts of their territory a sanitary service adequate to the local conditions;
   • (b) examine periodically whether the conditions required for the introduction of compulsory sickness insurance in the parts of their territory previously excepted from the compulsory scheme are fulfilled.

VII. Seamen and Sea Fishermen

1. 18. This Recommendation shall not apply to seamen and sea fishermen.