- 19.
46. The first method which is normally used in commercial health insurance and safeguards the traditional relationship between doctor and patient is applied by social insurance in such countries as Algeria, Belgium, Finland, France and Norway. The second method is used, for example, in Bolivia, Burma, Chile, Colombia, Costa Rica, Ecuador, Greece, Iran, Peru and Turkey. The third method which may be described as somewhere between the first and the second is adopted by social insurance schemes, for example in Austria, Denmark, Federal Republic of Germany, Italy, Japan and the Netherlands.
Qualifying period for medical care
47.
A number of social insurance schemes still require the applicant for medical benefit to satisfy a qualifying period of contributions or employment in order to prove that he belongs to the category of persons for whom protection is intended. There are various different formulas for the qualifying period; for example, sixty hours of employment in the last three months; one contribution month in the last four months; or six contribution months in the last twelve months. Public medical services impose no qualifying period. However, an increasing number of social insurance schemes also require no qualifying period and grant benefit to any person who is actually in insurable employment when the illness is diagnosed. Even where the contingency occurs immediately after he left the employment some schemes provide for a "free insurance period". For example, persons who have been insured for 26 weeks in the last 12 months before becoming unemployed may be treated for the initial period of unemployment (say for three weeks), as though they were still employed, and so are entitled to medical benefit for any morbid condition that begins in that period.
Cash benefits
48.
Cash benefits under social security undertake to replace a part but not all of normal earnings or income of the person protected. This is necessary both to prevent abuse and to avoid excessively high cost. It is also important for any social security scheme to retain some incentive to encourage workers to return to work as soon as they are able to work. Such an incentive cannot be maintained when practically the same amount is available to a worker whether working or not working. There are two types of cash benefit,
i.e.
one is wage related and the other is flat rate.
A benefit formula prescribing a flat rate for all persons protected may not be appropriate where substantial differences in wages prevail. A flat rate benefit may equal Ог exceed the wages of lower paid workers, or it may not be enough to ensure adequate protection for higher paid workers.
49.
The following table indicates rates of cash benefits (periodical payments) provided for in the Social Security (Minimum Standards) Convention, 1952 (No. 102), where they are calculated on the basis of the previous earnings of the beneficiary or his breadwinner.'
Contingency
Sickness
Unemployment
old age
Employment injury:
Standard beneficiary
Man with wife and two children
Man with wife and two children
Man with wife of pensionable age
Percentage
45
45
40
Incapacity for work
Man with wife and two children
50
Invalidity
Survivors
Man with wife and two children
Widow with two children
50
40
1 In the case of
schemes
male
where flat rate benefits are provided, the benefit rates must attain the same percentages of the total wages of an ordinary adult labourer.
E-1195-2B:5