1. Health insurance system. Participation of persons protected PERC Summer School 1-3.September 2008. Budapest Judit Czuglerné Ivány

2. International standards 1. ILO – social security (31 Conventions and 23 Recommendations) 2. Council of Europe - European Social Charter (Art. 12.- social security) 3. European Union – social protection system and cross-boarder healthcare

3. European Standards – ESC I. Art. 12. - The right to social security Para 1: (the State undertakes) to establish or maintain a system of social security. = The existense of social security system. Interpretation of this: -the sss must cover certain major risks - the sss must offer effective benefits in the most important branches - the sss must cover a significant percentage of population

4. European Standards – ESC II. - The Expert Committee also takes management methods into accaunt – the system must be managed under the supervision of the public authorities – as well as financing – benefits must be financed collectively.

5. ILO standards I. Three generations of social security standards: 1.) Mainly based on notion of social insurance. They were only applicable to certain categories of workers, coveres a specific contigency and different economic sectors (i.g. C.24. 25.) 2.) After the Second World War – broader concept of social security – minimum level of social security in nine branches of social security(Declaration of Philadelphia, C. 102.) 3.)Higher level of protection in terms of the population and the level of benefits (C.121. 128. 130. 168. 183.)

6. ILO Standards II. The nine branches of social security 1. medical care (C.102. C.130.) 2. sickness benefit (C.102. C.130.) 3.unemployment benefit (C.102. C.168.) 4. old-age benefit (C.102. C.128.) 5. Employment injury benefit (C.102. C.121.) 6.Family benefit (C.102. - ) 7. Maternity benefit (C102. C.183.) 8. Invalidity benefit (C.102. C.128.) 9.Survivors' benefit (C.102. C.128.)

7. Principal elements of social security - it is financed by contributions normally shared between workers and employers, with often some State participation - it requires compulsory participation - contributions are paid into special funds out of wich benefits are paid - surplus funds are invested to earn further income - benefits are guaranteed on the basis of the contribution record without means testing - contributions and benefits are often proportionate to earnings

8. Guiding principals of social security 1. dignity of human being 2. solidarity 3. participation 4. equality

9. Guiding principals of social security 1. dignity of human being 2. solidarity 3. participation 4. equality

10. Solidarity Essence of it is: to establish within a human community a common pot, into wich everyone has to pay according to their means and on which they may draw according to their needs, whithin the limits laid down by the system's administration.

11. Participation It has two different levels: - formation and development of social policy - management (administration) of the social security institutions – it depends on whether the institution providing solidarity is public, private or joint. Who: Persons protected. Characteristics of it: there is no a single form - the organization and provision of social benefits are mainly the responsibility of the public authorities - the structure of the social security scheme often determins the arrangements for its administration

12. ILO standards on participation in health insurance (C 24.102.130.) C.24 – Sickness Insurance (Industry) Convention, 1927. (ratified by 28 countries) Art.6.para 1: Sickness insurance shall be administered by self-governing institutions, which shall be under the administrative and financial supervision of the competent public authority and shall not be carried on with a view of profit. Institutions founded by private initiative must be specially approved by the competent public authority. Art.6.para 2: the insured persons shall participate in the management of the self-govering insurance.

13. C.24. Article 6. para 1.and 2. - interpretation Case of Hungary Problems: - private sickness insurance scheme would be compatible with the principles of the C24.? - involvment of insured persons. ILO answer: -the C. explicitly refers to the possibility os establishing insurance institutions founded by private initiative, however - both public and private institutions shall not be carried on with a view to profit!

14. C 24. Art. 6. - with respect to the participation of the insured persons in the management of insurance institutions also apply to both public and private sickness insurance institutions. Special problem: Art. 6. para 3.: The administration of sickness insurance may, nevertheless, be undertaken directly by the State, where and as long as its administration is rendered difficult or impossible or inappropriate by reason of national conditions, and particularly byorthe insuffiecient development of the employers' or workers' organizations.

15. C. 24. Art.6. Para 3. Problem of Hungary: between 1998 and 2005 there was no participation Government referred to the Art.6.para 3. and the decision of the Constitutional Court on the lack democratic legitimacy of the social partners in cases of public authority powers.

16. C.130. Medical care and sickness benefit (1969) Scope: it revises C.24. AndC.25. (personal scope: broader) Participation: (narrower)Art. 31.: Where the administration is not entrusted to an institution regulated by the public authorities or to a government department responsible to a legislature, the representatives of the persons protected must participate in its management or be associated therewith in a consultative capacity. Employers and representatives of public authorities may participate.

17. C 102. Social Security Minimum Standards (1952) Participation: Art. 71. para 3. and Art.72. para 1 and 2. Special: general responsibility of the State for the proper adminstration of soc ial security institutions and services. The responsibility of the State also covers the provision of benefits – the State must take all the necessary measures to ensure that benefits ara duly provided, irrespective of the method of financing adopted.

18. Points for discussion 1. Role of Trade Unions in the administration or supervision of public or private health insurance 2. Most important elements of health insurance system 3. Private or public or joint health insurance 4.Financing of health insurance 4. One or more health insurance institutions (regional characteristics) 6. Forms and methods of participation 7. Who should participate: social partners, NGOs, persons protected, how to select them? 8. Financing problems of health insurance 9. Privatisation of health insurance

19. Points for discussion 9. Privatisation of health insurance 10. How can social dialogue, both within countries and at the international level, contribute to the extension and improvement of social security? 11. Priorities for trade unions in the field of health insurance and its administration/supervision? 12. Role of PERC