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September 5 – 6, 2005 Vienna | Austria Conference of the European Forum of the Insurance against Accidents at Work and Occupational Diseases “Insurance against accidents at work and occupational diseases in the EU 25” Conference Report Impressum Medieninhaber und Herausgeber: Allgemeine Unfallversicherungsanstalt (AUVA) Adalbert-Stifter-Strasse 65, 1200 Wien, Österreich Redaktion: Dominique Dressler Büro für Internationale Beziehungen und Kongresswesen der AUVA Lektorat: Helga Meister, Johanna Riederer, Mag. Doris Scherling Übersetzungen: Dominique Dressler, Dr. Herbert Kaiser, Mag. Doris Scherling, Mag. Paolo Sturm Grafische Gestaltung, Layout und Satz: Beate Lamisch Bei Bestellungen wenden Sie sich bitte an: Allgemeine Unfallversicherungsanstalt (AUVA) Büro für Internationale Beziehungen und Kongresswesen Adalbert-Stifter-Strasse 65 1200 Wien, Österreich T: +43-1-33111-558 F: +43-1-33111-469 E-Mail: [email protected] Permanent Office in Brussels of the European Forum: c/o Maison européenne de la protection sociale 50, rue d'Arlon Brussels Email: [email protected] www.europeanforum.org Konferenz des Europäischen Forums der Versicherungen gegen Arbeitsunfälle und Berufskrankheiten "Die Versicherung gegen Arbeitsunfälle und Berufskrankheiten in der EU 25" Conférence du Forum européen des assurances contres les accidents du travail et les maladies professionnelles "L'assurance contre les accidents du travail et les maladies professionnelles dans l'UE 25" Conferenza del Forum Europeo contro gli infortuni sul lavoro e le malattie professionali "L'Assicurazione contro gli Infortuni Sul Lavoro e le Malattie Professionali nell'UE 25" 5. – 6. 9. 2005 Wien - Vienne - Viena Table of Contents | Inhaltsverzeichnis Table des matières | Indice Opening remarks – Einführende Worte – Remarques introductives - Parole introduttive .............. Helmut Pichler 11 Current situation and future challenges Aktuelle Situation und Herausforderungen Situation actuelle et défis Situazione attuale e sfide future...................................................... 1 3 11 Occupational injury and disease insurance in the Europe of Fifteen - Overview................................... L’assurance AT-MP dans l’Europe des 15 - Panorama............................................................................ Marie-Chantal Blandin, Gilles Evrard Recent developments in the European Union and insurance against occupational risks.................. Neuere Entwicklungen in der Europäischen Union und die Versicherung gegen Berufsrisiken....... Franz Terwey 19 23 Economic aspects of statutory accident insurance (considering as example the Swiss model)............................................................................................. 27 Wirtschaftliche Aspekte der gesetzlichen Unfallversicherung (dargestellt anhand des Schweizer Modells)......................................................................................... Willi Morger Occupational diseases.............................................................................................................................. Berufskrankheiten.................................................................................................................................... Peter Pils, Dominique Dressler New prevention plans for older employees........................................................................................... "Neue Präventionskonzepte (ältere Arbeitnehmer)"........................................................................... Alfons Grösbrink Trends and patterns of violence-related injuries at schools in Germany............................................. Trends und Strukturen gewaltassoziierter Verletzungen an Schulen in Deutschland........................ Efthimia Dima, MA-Päd., Kurt Scherer, Hartmut Weber-Falkensammer I 37 47 53 59 71 81 85 Table of Contents | Inhaltsverzeichnis Table des matières | Indice Insurance against accidents at work and occupational diseases in agriculture: Specificities and special needs ........................................................................ 87 Bedürfnisse und Besonderheiten der Versicherung gegen Arbeitsunfälle und Berufskrankheiten in der Landwirtschaft.............................................................. Harald Deisler, Hans-Jürgen Sauer 93 Insurance against accidents at work and occupational diseases in the new member countries of the EU Die Unfallversicherung in den neuen EU-Mitgliedsstaaten und in Beitrittskandidatenstaaten L'assurance contre les accidents du travail et les maladies profesionnelles dans les nouveaux pays membres de l'UE et les pays candidats Assicurazione contro gli infortuni sul lavoro e le malattie professionali nei nuovi paesi membri dell'UE e nei paesi candidati............................................................................... 99 101 Unfallversicherungssysteme in den neuen EU-Mitgliedsstaaten im Überblick................................. 107 Accident insurance systems in the new EU member countries – An overview ............................... Bernhard Pabst Insurance against accidents at work and occupational diseases in the Slovak Republic ............... Marek Lendacký 113 Changes planned in compensation for accidents at work and occupational diseases in the Czech Republic...................................................................................... Vít Samek 119 The Regulation and State of Insurance against Accidents at Work and Occupational Diseases in Slovenia................................................................................................ 129 Regelung und Stand auf dem Gebiet der Arbeitsunfall- und Berufskrankheitsversicherung in der Republik Slowenien................................................................. Martin Toth II 135 Table of Contents | Inhaltsverzeichnis Table des matières | Indice 143 Unfallversicherungen in Polen ............................................................................................................ 147 Accident insurance in Poland............................................................................................................... Anna Serafinska Insurance against accidents at work and occupational diseases in Hungary................................... Ferenc Móricz Insurance against accidents at work and occupational diseases in Malta........................................ Frank Micallef Social insurance against accidents at work and occupational diseases in Latvia............................. Jevgeniza Brike 151 169 177 Social insurance against occupational accidents and professional diseases in the Republic of Lithuania................................................................................................................. Vaidotas Kalinauskas Insurance against accidents at work and occupational diseases in Estonia .................................... Evelyn Hallika Insurance against accidents at work and occupational diseases in the Republic of Bulgaria......... National Social Security Institute (NSSI) 183 197 203 Global challenges | Globale Herausforderungen Défis globaux | Sfide globali......................................................... 207 209 Globale Herausforderungen für die Versicherung gegen Arbeitsunfälle und Berufskrankheiten. 215 Global challenges for the insurance against accidents at work and occupational diseases........... Joachim Breuer III Table of Contents | Inhaltsverzeichnis Table des matières | Indice Authors | Autoren | Auteurs | Autori............................................. 223 Conference participants | Tagungsteilnehmer Participants à la conférence | Partecipanti . . ................................... 227 Members of the European Forum Mitglieder des Europäischen Forums Membres du Forum européen Membri del Foro europeo............................................................. 233 History of the European Forum Chronik des Europäischen Forums Histoire du Forum européen La cronistoria del Foro europeo.................................................... IV 237 Ladies and Gentlemen, I have the pleasure of cordially welcoming you to this Conference in my capacity as President of the European Forum of Insurance against Accidents at Work and Occupational Diseases. We have chosen the theme of "The Insurance against Accidents at Work and Occupational Diseases in the EU 25" for our conference and have given us a vast field of action, both from the geographical and the topical point of view. The European Forum has set itself the goal of not only promoting the existence of an independent insurance against accidents at work and occupational diseases, but of also supporting and accompanying the convergence of those systems. The aim is to contribute, in the field of the insurance against occupational risks, to what we could call the Social Europe or the European Social Union. Our efforts must be seen in a world in constant evolution. Since the creation of the Forum in 1992, the economic integration of Europe has greatly intensified. Decisive steps have been taken for the creation of the single market and the national borders have become permeable to trade but also to production factors. And finally, in many member states, the national currency was replaced by the Euro. The entry into the European Union of 10 new member states on May 1, 2004, has led to a significant enlargement of the EU. The membership of those countries with their individual traditions and differing social systems constitutes a special challenge for the already mentioned convergence. The deepening of the links and the exchange of information with the new member states have become main priorities of the Forum. The Conference will provide us with an overview over the insurance systems in the field of occupational risks in the EU 15 and will also present the situation in the new member countries. Country reports from nearly all new member states will provide us with a deeper insight into the individual systems of insurance against occupational risks. The strengthening of the European Union does not only bring about cooperation beyond borders, but also leads to an increased competition. Productivity and cost reduction are the parameters of this "borderless" and often "limitless" competition. Under these circumstances, individual nations will always aim at making the country more attractive to investors. We must acknowledge that this competition puts the social systems under pressure. These developments obviously also affect insurance against occupational risks. The question whether social security would be better administered by private companies is increasingly raised. Private is often automatically seen as more efficient and therefore better. What we need to do is to stress the economic impact and benefits of the insurance against occupational risks and to prove that an insurance based on the solidarity principle is best equipped to meet current and future challenges. The European Union unfortunately is quite receptive to ideas of radical privatisation. In view of this, the representatives of social insurance must learn to make themselves heard and to present their arguments in the right places. The creation of an office of the Forum in Brussels and the nomination of European Commissioners of the Forum are important steps in that direction. Let me briefly mention some of the challenges that we are faced with. The changes in the world of work also lead to new occupational or work related diseases. Financial compensation cannot be the answer. What is much more important is to take the right preventive measures, in order to avoid those diseases or at least to reduce them. Experience has shown that prevention is much more cost efficient than compensation! This leads to another important consideration, the demographic trend. The percentage of older people is increasing in our European societies. In view of this, efforts are made to raise the retirement age and to keep people working longer. This also means that measures need to be taken to insure that people at work remain healthy. The insurances against occupational risks are ideally suited to take up this challenge. The extensive specialised knowledge of the insurance institutions in the field of occupational risks allows them to identify potential risk factors and to define the adequate prevention measures. The presentation on topics such as violence-related injuries in German schools or specific needs of insurance against occupational risks in the agricultural sector will make this evident. Finally, we cannot focus only on Europe, but we need to consider global challenges. We must face the fact that an important part of humankind practically does not benefit from any social cover. Our aim must be to ensure that economic globalisation is accompanied by a globalisation of social security. There is a lot to be done! I wish our conference interesting contributions and much success! Mag. Helmut Pichler President of the European Forum Sehr geehrte Damen und Herren, ich darf Sie als Präsident des Europäischen Forums der Unfallversicherungsträger sehr herzlich zu unserer Konferenz begrüßen. Wir haben uns die "Versicherung gegen Arbeitsunfälle und Berufskrankheiten in der EU der 25" zum Thema gemacht und uns damit sowohl in geographischer wie auch in inhaltlicher Hinsicht viel vorgenommen. Das Europäische Forum hat sich zum Ziel gesetzt, nicht nur für den Bestand eigenständiger Versicherungen gegen Arbeitsunfälle und Berufskrankheiten einzutreten, sondern auch einen Konvergenzprozess dieser Systeme zu fördern und zu begleiten. Mit anderen Worten geht es also darum, im Bereich der Versicherung gegen Berufsschäden einen Beitrag zur Schaffung dessen zu leisten, was man als soziales Europa oder als europäische Sozialunion bezeichnet. Dieses Bemühen vollzieht sich nicht im luftleeren Raum, sondern innerhalb von Rahmenbedingungen, die einem laufenden Wandel unterliegen. Seit der Gründung des Forums im Jahr 1992 hat sich die wirtschaftliche Integration Europas wesentlich intensiviert. Es wurden weitgehende Schritte zur Realisierung des Binnenmarktes gesetzt, und die nationalen Grenzen sind für den Handel aber auch für die Produktionsfaktoren durchlässig geworden. Nicht zuletzt wurde – wenn auch nicht in allen Mitgliedsstaaten – die nationale Währung durch den Euro ersetzt. Mit dem Beitritt von 10 Staaten am 1. Mai 2004 hat die Europäische Union eine wesentliche Erweiterung erfahren. Der Beitritt dieser Staaten mit ihrer individuellen Tradition und unterschiedlichen Ausgestaltung der Sozialsysteme stellt für den angesprochenen Konvergenzprozess eine besondere Herausforderung dar. Die Vertiefung der Verbindungen und der Erfahrungsaustausch mit den neuen Mitgliedstaaten ist daher ein wesentliches Anliegen des Forums. Wir werden einen Überblick sowohl über die Unfallversicherungssysteme in der EU der 15 als auch über die Situation der neuen Mitgliedsländer bekommen. Länderberichte aus fast allen neuen Mitgliedsstaaten werden uns einen vertieften Eindruck über die jeweilige Ausformung der Absicherung gegen berufliche Risken vermitteln. Das Zusammenwachsen Europas steht aber nicht nur im Zeichen grenzüberschreitender Kooperation, sondern bedeutet auch verschärfte Konkurrenz. Produktivität und Kostenminderung sind die Parameter dieses grenzen- und oft auch schrankenlosen Wettbewerbs. Einzelstaatliche Politik ist in diesem Rahmen ständig darum bemüht, das eigene Land für Investitionen attraktiv zu machen und es ist nicht von der Hand zu weisen, dass dieser Standortwettbewerb einen wachsenden Druck auf die Sozialsysteme ausübt. Dies alles betrifft natürlich in hohem Maß auch die Versicherungen gegen Arbeitsunfälle und Berufskrankheiten. Auch wird verstärkt die Frage aufgeworfen, ob nicht auch die soziale Sicherheit besser durch privatwirtschaftlich orientierte Unternehmen wahrgenommen werden könnte. Privat gilt offenkundig automatisch als effizienter und damit als besser. Es kommt daher umso mehr darauf an, auch den wirtschaftlichen Nutzen der Unfallversicherungssysteme herauszuarbeiten und zu belegen, dass eine solidarische Versicherung am besten geeignet ist, sich den Herausforderungen der Gegenwart und Zukunft zu stellen. Die Politik der Europäischen Union hat leider die Tendenz, für radikal privatwirtschaftlich orientierte Bestrebungen durchaus empfänglich zu sein. Daher ist es von besonderer Bedeutung, dass sich auch die Vertreter der sozialen Sicherheit Gehör verschaffen und ihre Argumente an geeigneter Stelle vorbringen können. Die verstärkte Präsenz des Forums durch die Einrichtung eines Büros in Brüssel sowie durch unsere Europabeauftragten ist ein wichtiger Schritt im Sinne dieses Ziels. Lassen Sie mich noch kurz einige der Herausforderungen ansprechen, denen wir uns gegenübersehen und die wir thematisieren wollen. Die Veränderung der Arbeitswelt bringt auch das Auftreten neuer Berufskrankheiten bzw. beruflich bedingter oder doch mitbedingter Erkrankungen mit sich. Es wird nicht ausreichend sein, diesen nur durch finanzielle Entschädigungen zu begegnen. Vielmehr bedarf es geeigneter präventiver Maßnahmen, um das Auftreten solcher Krankheiten erst gar nicht zuzulassen oder doch wenigstens einzudämmen. Hat doch die Erfahrung gezeigt, dass Vorbeugung im Vergleich zur Entschädigung der ungleich kostengünstigere Weg ist. Dies berührt einen weiteren wichtigen Punkt, nämlich die demografische Entwicklung. Unzweifelhaft steigt der Anteil älterer Menschen in unseren europäischen Gesellschaften an. Dies führt zur Forderung, die Menschen müssten länger im Erwerbsleben bleiben, könnten also später in den Ruhestand treten. Eine solche längere Erwerbstätigkeit erfordert freilich auch Maßnahmen zu Erhaltung der Gesundheit der arbeitenden Menschen. Wer sollte berufener sein, als die Versicherungen gegen Arbeitsunfälle und Berufskrankheiten, um sich dieses Problems anzunehmen und so einen Beitrag zum Sozialsystem insgesamt zu leisten. Das hohe Fachwissen, das in den Unfallversicherungsanstalten vorhanden ist, ermöglicht es, spezifischen Gefährdungspotentialen und Präventionserfordernissen adäquat zu begegnen. Die Vorträge über das Thema der gewaltassoziierten Verletzungen an deutschen Schulen und über die Besonderheiten der landwirtschaftlichen Unfallversicherung werden dafür ein Beleg sein. Letztlich dürfen wir unseren Horizont nicht auf Europa alleine beschränken, sondern müssen unseren Blick auch auf die globalen Fragen richten. Es kann uns nicht gleichgültig sein, dass ein großer Teil der Weltbevölkerung praktisch ohne sozialen Schutz auskommen muss. Ziel muss es vielmehr sein, neben der Globalisierung der Wirtschaft auch der Sozialen Sicherheit eine weltumspannende Perspektive zu verleihen. Es gibt also viel zu tun. Ich wünsche unserer Konferenz in diesem Sinne interessante Stunden und viel Erfolg! Mag. Helmut Pichler Präsident des Europäischen Forums Madame, Monsieur, En ma capacité de Président du Forum européen de l'assurance contre les accidents du travail et les maladies professionnelles j'aimerais cordialement vous souhaiter la bienvenue à notre Conférence. Nous avons choisi comme thème "L'assurance contre les accidents du travail et les maladies professionnelles dans l'UE 25" et nous nous sommes ainsi donnés un cadre très vaste autant du point de vue géographique que du point de vue des contenus. Le Forum européen s'est donné comme mission de ne pas seulement promouvoir et défendre une assurance spécifique contre les accidents du travail et les maladies professionnelles mais d'accompagner également le processus de convergence de ces systèmes. Il s'agit donc pour le Forum de contribuer dans son champ d'action à l'Europe sociale ou en d'autres mots à une Union sociale européenne. Ces efforts s'accomplissent avec dans un environnement en constante évolution. Depuis la fondation du Forum en 1992, l'intégration économique de l'Europe s'est fortement intensifiée. Beaucoup d'efforts ont été entrepris pour la création du marché unique et les frontières nationales sont devenues "perméables" autant pour le commerce que pour les facteurs de production. Et, bien entendu, dans nombre des pays de l'UE – même si ce n'est pas dans tous – la monnaie nationale a été remplacée par l'euro. Avec l'adhésion de 10 états à l'Union européenne le 1er mai 2004, l'UE s'est agrandie de façon considérable. L'adhésion de ces états ayant chacun ses traditions et son système de sécurité sociale constitue un défi particulier pour le processus de convergence déjà mentionné. Le renforcement des liens et l'échange d'expériences avec les nouveaux états membres de l'UE est donc devenu un soucis essentiel du Forum. Notre conférence nous présentera un panorama des systèmes d'assurance contre les risques professionnels dans l'UE des 15, et nous informera également sur la situation actuelle dans le domaine de l'assurance ATMP dans les nouveaux pays membres de l'UE. Des rapports nationaux de presque tous les nouveaux pays membres de l'UE nous montrerons quels systèmes de protection contre les risques professionnels existent dans les différents pays. Le processus d'unification de l'Europe est certes placé sous le signe d'une coopération par-delà des frontières, mais il entraîne aussi une concurrence accrue. Productivité et réduction des coûts sont les paramètres de cette concurrence presque illimitée. La politique nationale visera toujours à rendre le pays plus attractif pour des investisseurs. Et on constate que cette concurrence exerce une pression croissante sur les systèmes sociaux. Les systèmes d'assurance contre les risques professionnels ne sont pas épargnés. La question si des systèmes privés ne seraient pas plus à même d'assurer la sécurité sociale est souvent discutée, car certains estiment que le secteur privé est automatiquement garant d'une plus grande efficacité et donc plus performant. Il s'agit d'autant plus de démontrer les bénéfices économiques des systèmes d'assurance ATMP et de prouver qu'une assurance basée sur le principe de la solidarité est la plus indiquée pour se montrer à la hauteur des défis actuels et futurs. La politique de l'UE tend malheureusement à être ouverte à des tendances privilégiant de façon radicale le secteur privé. Il est d'autant plus important que les représentants de la sécurité sociale sachent se faire entendre et sachent présenter leurs arguments. La présence renforcée du Forum grâce à l'ouverture d'un bureau permanent à Bruxelles et grâce aux commissaires européens du Forum est un pas important. J'aimerais encore brièvement aborder quelques uns des défis auxquels nous nous voyons confrontés et qui feront l'objet de notre conférence. Les changements du monde du travail conduisent aussi à de nouvelles maladies professionnelles ou à composante professionnelle. Il ne suffit pas de dédommager les victimes de ces maladies. Il faut plutôt investir dans une prévention ciblée afin de prévenir ou tout au moins réduire ces maladies. L'expérience a montré que la prévention est toujours bien moins onéreuse que la compensation. Cela nous amène à un autre point important, l'évolution démographique. Le pourcentage des personnes âgées dans nos sociétés européennes ne cesse de croître. Ceci signifie que dans tous les pays les personnes travaillent plus longtemps et partent à la retraite plus tard. Si cependant l'activité professionnelle se poursuit jusqu'à un âge plus élevé, il faut aussi prendre des mesures pour que les personnes qui travaillent restent en bonne santé. Et c'est bien aux systèmes d'assurance contre les accidents du travail et les maladies professionnelles d'entreprendre tous les efforts possibles dans ce domaine. La grande expertise dont disposent les institutions d'assurance contre les risques professionnels leur permet de trouver la bonne réponse aux dangers potentiels et de mettre en place les mesures préventives adéquates. Les présentations sur les blessures associées à la violence dans des écoles allemandes et sur les spécificités de l'assurance ATMP dans l'agriculture nous le montreront. Finalement, nous ne pouvons pas nous limiter à l'Europe, mais nous devons être conscients des défis globaux. Nous ne pouvons être indifférents au fait qu'une grande partie du monde ne bénéficie pratiquement pas de couverture sociale. Il faudra qu'en parallèle à la globalisation de l'économie nous développions une perspective mondiale pour la sécurité sociale également. Bien du travail nous attend donc! Je vous souhaite une conférence intéressante et beaucoup de succès! Helmut Pichler Président du Forum européen Signore e Signori, in qualità di presidente del Foro Europeo degli Enti Assicuratori per gli infortuni ho il piacere di porgervi un caloroso benvenuto alla nostra conferenza. Abbiamo scelto a tema del convegno “L’assicurazione contro gli infortuni sul lavoro e le malattie professionali nella UE a 25”, proponendoci pertanto un programma ambizioso sia dal punto di vista geografico che dei contenuti. Il Foro Europeo non persegue solo l’obiettivo di impegnarsi per la promozione di assicurazioni contro gli infortuni sul lavoro e le tecnopatie autonome, ma anche quello di promuovere ed accompagnare un processo di convergenza di tali sistemi. In altri termini, l’obiettivo è apportare un contributo a livello di assicurazioni contro i danni professionali per dare vita a quella che viene chiamata “Europa sociale” o “Unione Europea sociale”. Tale impegno non si attua in uno spazio astratto, bensì entro condizioni quadro soggette ad un’evoluzione permanente. Dalla fondazione del Foro a questa parte, avvenuta nel 1992, l’integrazione economica europea si è fortemente intensificata. Sono stati compiuti passi importanti verso la realizzazione del mercato unico, ed i confini nazionali sono divenuti permeabili agli scambi ma anche ai fattori produttivi. Va ricordata naturalmente anche l’introduzione dell’Euro a sostituzione delle valute nazionali, seppur non attuata in tutti i paesi membri. Con l’adesione di dieci paesi il 1° maggio 2004, l’Unione Europea ha conosciuto un allargamento fondamentale. L’adesione di tali Stati con le loro tradizioni specifiche e varie configurazioni dei sistemi sociali costituisce per il processo di convergenza menzionato poc'anzi una sfida particolarmente importante. L’approfondimento dei contatti e lo scambio di esperienza con i nuovi paesi membri rappresentano pertanto un interesse fondamentale del Foro. La conferenza ci offrirà una panoramica sia dei sistemi di assicurazione contro gli infortuni nell’Unione Europea dei 15 sia della situazione dei nuovi paesi membri. Rapporti nazionali da parte di quasi tutti i nuovi paesi membri ci trasmetteranno un’impressione dettagliata dello sviluppo dell’assicurazione contro i rischi professionali nei diversi paesi. L’integrazione europea, tuttavia, oltre ad esser posta nel segno della cooperazione transfrontaliera, comporta anche un inasprimento della concorrenza. La produttività ed il taglio delle spese sono i parametri di tale concorrenza senza confini e spesso anche senza limiti. Le politiche nazionali sono costantemente impegnate, in questo contesto, a promuovere l’attrattiva del proprio paese per gli investimenti, ed è un fatto che tale concorrenza delle localizzazioni comporti una crescente pressione sui sistemi sociali. Tutto ciò tocca naturalmente da vicino anche le assicurazioni contro gli infortuni sul lavoro e le malattie professionali. Si pone inoltre in maniera più pressante l’interrogativo se anche la sicurezza sociale possa essere promossa meglio mediante imprese private. Il privato, a quanto pare, viene considerato automaticamente più efficiente e pertanto migliore. È quindi tanto più importante enucleare il beneficio anche economico dei sistemi assicurativi contro gli infortuni e dimostrare che un’assicurazione solidale è la più adatta ad affrontare le sfide del presente e del futuro. La politica dell’Unione Europea ha purtroppo la tendenza ad essere fortemente ricettiva rispetto ad orientamenti privatistici radicali. È pertanto di particolare importanza che gli esponenti della previdenza sociale si assicurino l’ascolto che gli spetta presentando le loro argomentazioni nelle sedi più opportune. La rafforzata presenza del Foro grazie all’istituzione di un ufficio a Bruxelles ed al nostro incaricato per l’Europa rappresenta un passo importante per il conseguimento di questo obiettivo. Desidero poi accennare brevemente ad alcune delle sfide di fronte alle quali ci troviamo e che intendiamo affrontare nel convegno. Il cambiamento del mondo del lavoro comporta anche la comparsa di nuove malattie professionali ovvero di patologie originate o co-originate dal lavoro. Non sarà sufficiente affrontare le stesse unicamente con delle indennizzazioni finanziarie. Si rendono piuttosto necessarie delle misure preventive adeguate, onde impedire a priori -o quanto meno arginare- l’insorgenza di tali patologie. L’esperienza ci insegna infatti che rispetto all’indennizzazione, la prevenzione rappresenta la strada incomparabilmente più economica. Questo ci porta ad un ulteriore punto fondamentale: lo sviluppo demografico. La percentuale di anziani nelle nostre società europee è inequivocabilmente in crescita. Ciò comporta la richiesta di un prolungamento della vita attiva dei cittadini, dunque di un aumento dell’età pensionabile. Un simile prolungamento della vita attiva impone però anche delle misure per la salvaguardia della salute dei lavoratori. Chi meglio delle assicurazioni contro gli infortuni sul lavoro e le malattie professionali potrebbe prendersi cura di questo problema, apportando in tal guisa un contributo al sistema sociale nel suo complesso? Il vasto know how di cui dispongono gli Enti Assicuratori consente di far fronte in modo adeguato a specifiche minacce potenziali ed esigenze preventive. Lo dimostreranno gli interventi riguardanti la tematica delle lesioni da violenza nelle scuole tedesche e le specificità dell’assicurazione contro gli infortuni nell’agricoltura. Infine, non dobbiamo limitare il nostro orizzonte solo all’Europa, bensì dobbiamo rivolgere lo sguardo anche alle questioni globali. Non possiamo restare indifferenti di fronte al fatto che una grandissima parte della popolazione mondiale debba praticamente vivere senza alcuna protezione sociale. L’obiettivo deve essere piuttosto quello di conferire, parallelamente alla globalizzazione economica, una prospettiva mondiale anche alla Previdenza Sociale. Come vediamo, ci attende parecchio lavoro. Esprimo pertanto l’auspicio che la nostra conferenza sia del massimo interesse e si svolga con successo. Mag. Helmut Pichler Presidente del Foro Europeo Current situation and future challenges Aktuelle Situation und Herausforderungen Situation actuelle et défis Situazione actuale e sfide -1- Occupational injury and disease insurance in the Europe of Fifteen - Overview Marie-Chantal Blandin Gilles Evrard It is a real challenge presenting in 30 minutes an overview of occupational risk insurance in the Europe of Fifteen, so much could be said on the subject! This paper will therefore inevitably be schematic, no doubt even simplistic, because we shall have to confine ourselves to general issues. Even though it does not show 15 characters, the drawing by itself provides a good illustration of the current situation in the Union of 15. At first sight, the umbrellas – which, you will have realised, symbolise occupational injury and disease insurance – are all different, and it is true that there are differences (sometimes major ones) between the systems in place in our countries. But this first impression should not conceal another reality, no doubt less obvious at first sight, but just as important: our occupational risk insurance systems are dynamic, they have developed and are still progressing, and, like the characters in the drawing they are all moving forward in the same direction. -3- First we shall examine the main differences between the insurance systems prevailing in the Europe of 15. Then we shall see that, beyond these differences, there is indeed a (solid) common base which is the foundation of occupational risk insurance in our countries. Finally, by way of conclusion, we shall examine rapidly, because the following speakers will deal with this in greater depth, some of the challenges currently faced by occupational injury and disease insurance. Main differences We have identified three main differences: - The legal status of the insurance management organisation; - The risk rating systems in force; - The role of the insurer in the area of prevention. 1) Status of the insurance management organisation - In the United Kingdom and Ireland, it is the government itself that manages occupational injury and disease insurance. - But, in most European Union member countries (Austria, Germany, Italy, France, Sweden and Luxembourg), it is the public social security organisations, often placed under state control, that are responsible for this management. It is important to emphasise that these organisations are very often managed by the social partners … or in association with the social partners. - The case of Spain is rather different: insurance there is managed by the Mutuas, non-profit employers' mutual funds, which take part in the social security system. - Finland is the only country in which the management of insurance is entrusted exclusively to private companies. - Finally, the prize for originality goes to Belgium, Portugal and Denmark. In these three countries, occupational health insurance is taken charge of by a public organisation, while in Portugal and Denmark occupational injury insurance is managed by private companies, and in Belgium jointly by a public establishment, employers' mutual funds and approved private insurance companies. These numerous types of status make it easier to understand the other points of divergence between the various national systems. 2) Let us now consider the risk rating systems in force The purpose of an occupational risk rating system is to ensure permanent funding of the expenditures payable by the insurance system, i.e. benefits paid to victims and administrative expenses. Everyone agrees on this point, but the methods adopted by the various countries to apply this principle are diverse. Some countries give priority to an inter-company solidarity approach; this amounts to pooling expenses and distributing them among the contributors without distinction. Others, on the contrary, emphasise more the insurance nature of the contribution; this tends to segment risks and encourage individualisation of premiums. In this context, moreover, the contribution as such is considered as an incentive for prevention. -4- Relative to these two approaches – contradictory in principle – how are the European countries positioned? - Inter-company solidarity at the national level Two countries are adepts of this complete resource pooling system, Austria and Sweden. There is therefore a single rate of contribution for occupational injury and disease risks that applies to all enterprises, irrespective of their business, number of employees and accident rate. - Individualisation of the contribution according to the enterprise's accident rate Contrary to the Austrian and Swedish systems, the French system is that which takes the policy of individualisation furthest. This policy appears on two levels. On the one hand, risk rating is performed for each establishment. This means that each establishment – i.e. each group of people carrying out a given activity, under the same authority and in a certain place – is given notice each year of a contribution rate which is specific to it. Thus two establishments in the same enterprise may have different contribution rates. In addition, the risk rating method applicable varies according to the number of employees in the enterprise. When the customary number of employees is at least equal to 200, it is a real individual rate that is applied. This rate is determined on the basis of the financial data specific to the establishment: value of the risk and total wages paid to staff during the reference period. The clearly stated objective is to make the enterprise pay a cost in relation to the risk to which it subjects its employees, the underlying idea being that in this way the enterprise will have an incentive to apply preventive measures from which it will benefit directly through a reduction in its rate of contribution. For very small establishments (with a workforce of less than 10 employees), collective risk rating is applied. The rate is set at the national level by ministerial order; it is established on the basis of the statistical and financial results of each sector of activity (there have been approximately 800 risk numbers). Finally, for establishments with a workforce in the range between 10 and 199, a combined rate is applied, combining a fraction of the collective rate corresponding to the business activity of the establishment and a fraction of the real individual rate of the establishment calculated as though it were based on real individual risk rating. The closer the workforce comes to 200, the higher the proportion of the specific rate. - Solidarity at the occupational branch level Most countries have opted for a risk rating system which is a compromise between the policy of complete pooling of risks and that of individualisation of the contribution. This is the case in particular in Germany, Italy, Spain … and also in Switzerland. The contribution rates are calculated at the level of occupational branches or by industry sectors, which introduces an initial aspect of differentiation. Sometimes, (and this is the case in Germany in particular), there is a second level of differentiation, to strengthen the role of the contribution as an incentive to prevention. Under this system, each occupational branch determines risk classes for the industrial sectors for which it is responsible, so as to take into account the various risk levels involved in the various industries covered by it. -5- Very schematically, we could say that systems of this type, based on pooled risk rating factors, practise a certain individualisation of contributions to allow for the enterprise's accident rate situation. - The law of the market: This last case is prevalent in a few countries in which the "occupational injuries" risk is managed by private companies. In theory, the companies set premiums according to the level of risk … but in practice the contributions are calculated based on "subjective" criteria having little to do with the number and seriousness of occupational injuries in the enterprise. Fortunately, this is not generally the case! 3) The role of the insurer in the area of prevention With a few exceptions (Denmark, Ireland, Sweden and the United Kingdom), all the organisations responsible for managing occupational injury and disease insurance perform prevention actions; some even emphasise that this is an essential aspect of their task. But the means and the actions taken in this area differ. - In Belgium, Finland, Italy, Spain and Portugal (for occupational diseases): The actions carried out by the insurance organisation are chiefly actions to raise awareness of risks and the means of preventing them: production of posters, brochures, videos, information campaigns and organisation of training sessions. - In Germany, Austria, France and Luxembourg. In other countries, less numerous, but in which the occupational risk insurer is a public organisation, prevention is stated as one of the fundamental roles of insurance. Although, in recent years, they have placed more emphasis on the "advisory" part of their prevention role, the insurance management organisations have more constraining means of action with regard to enterprises: they have often set up bodies of inspectors and controllers which can penalise, in particular financially, those enterprises that do not comply with their recommendations or requirements. They have also established high-level study and research services and centres. The common base The differences identified in the first section should not conceal the fact that there is indeed a common base to all – or nearly all – the occupational injury and disease insurance regimes prevailing in the Union of 15. In our view, this common base is characterised by three features: - "Occupational injuries" insurance is the oldest form of social insurance. - But, despite its age, it has managed to change in all the countries. - With a few rare exceptions, it has kept its specific nature in the social insurance field. -6- 1) The first form of social insurance - From 1884 to 1913, all the countries of the current Union of 15 developed a system of insurance against occupational injuries (with one exception, Greece). Germany was first in 1884, while Portugal was last in 1913. In fact, only Greece has never established occupational injury and disease insurance. It should be mentioned, however, that since 1967 the Netherlands no longer have a specific insurance system for occupational risks. - Occupational injury and disease insurance originated in the often very dangerous conditions that characterised factory work in the 19th century, at a time when the civil liability system was unable to compensate workers who were occupational injury victims, or only with great difficulty. It was under the pressure of labour action and the workers' conflicts at the end of the 19th century that occupational injury insurance was born. Company managers were obliged to subscribe to this system, which radically changed the legal principles of civil liability, by ensuring the victims and their survivors of adequate compensation for the damage sustained, without having to carry out an enquiry to determine whether there had been a fault or negligence on the part of the employer, and without any need to bring the case before the courts. 2) An insurance that is still often specific The advent of other forms of social insurance covering broader populations for more "common" risks (in particular "health" and "invalidity" insurance) did not bring into question the interest in occupational injury and disease insurance; on the contrary, it developed and, except in the Netherlands, it retained its specific nature. This nature is apparent on two levels: - Its funding: Unlike the other forms of social insurance, occupational injury and disease insurance is funded exclusively by the employer. It is because the latter benefits from the activity of his firm that he must take responsibility for the risks inherent in this activity. - Its organisation: In most countries, occupational injury and disease insurance is managed by an organisation whose sphere of action is limited to occupational risks. There are only four exceptions to this situation: the United Kingdom and Ireland, where it is the government that manages the insurance system itself, Sweden, and France. 3) In 100 years, the insurance has changed greatly, along three lines: - The risks covered have become more diverse In the 1920s, legislation extended the insurance to occupational diseases. A list was established to classify the diseases giving entitlement to the specific benefits planned for occupational injury victims. In addition, between 1960 and 1990, depending on the country, a complementary (socalled "open" or "proof") system was introduced. In this way, a disease that does not appear in the list can nevertheless be recognised as work-related, on condition that the victim provide proof of its relation with occupational exposure. -7- Finally, commuting accidents were considered as work accidents as early as 1917 in Germany and 1925 in Austria. For the other countries, this measure was often not introduced until 1945. In Denmark and the United Kingdom, however, commuting accidents are not considered an occupational risk. - The populations protected have become broader Another change concerns the beneficiaries of the insurance. Originally reserved solely for workers in certain particularly dangerous industries, the insurance now covers all employees. Some countries go even further by protecting non-salaried workers such as volunteers, self-employed workers, or even students and school pupils. - The benefits have been improved Finally, over the years, the benefits paid to the victims have improved, now covering not only medical care, lost earnings and permanent disability, but also the physical, social and occupational rehabilitation of the victims. Current issues and challenges Very briefly, and by way of introduction to the papers that will follow, we should like to discuss three issues of debate in most, if not all, our countries: - Drive to cut costs Occupational injury and disease insurance, even though its accounts are, in theory, balanced by nature, does not escape the cost cutting efforts faced in the other branches of the social security system. Because, although the number of occupational injuries declines regularly, the average cost of compensation for an injury (especially healthcare and rehabilitation) also increases regularly. Several paths can be followed to achieve this cost cutting objective. The most radical in this respect is no doubt that taken by the Swedish government in the early 1990s, when it had to make up the deficits of the funds and, to do so, carried out a radical reform of both the recognition system and the system of compensation for occupational risks. But other methods are employed in the various European countries to reduce the cost of occupational injuries and diseases. Reducing the number and seriousness of risks by developing prevention actions is one of the paths taken, especially by the public organisations responsible for managing insurance. It is significant, in this respect, that for about ten years now special emphasis has been placed on actions targeting small and medium-sized enterprises, which very often have no prevention structures and which generate a proportionally larger number of risks. Such actions should, at least in the medium term if not in the short term, help achieve the objective sought. The expected effects of certain measures implemented in some countries to control prescriptions for healthcare, medical treatment and sick leave will no doubt be felt more immediately. - The public organisation/private company issue remains open Many countries regularly debate the advantages and disadvantages of a public system compared with a private system. The promoters of this or that system each have their arguments. It is not our role here to start this debate, but we merely wanted to mention that this question comes up again regularly. - New forms of work and new life styles complicate the situation -8- Over about the last fifteen years, with economic globalisation and the development of new technologies, the working world has undergone changes of such a nature and extent that we have to wonder as to their impact on occupational risk insurance. For example, the considerable growth in services at the expense of industry, the advent of new forms of employment (telecommuting, unstable work, self-employed work), changing production methods (subcontracting, outsourcing, just-in-time production, etc.), the feminisation of numerous industries and population ageing… are all economic and social changes that, in various ways, have or will have consequences for occupational risk insurance. With the tertiarisation of employment and the rapid development of a service economy, the nature of work-related risks is changing: the proportion of traffic accidents and accidents while travelling for work is increasing, and illnesses such as musculoskeletal disorders, psychological disorders and stress-related psychosocial complaints, violence, etc. are developing, sometimes very rapidly, to such an extent that this has been called an epidemic. The growth of unstable work (work under fixed-term contracts and temporary work) is also a problem. The fact that occupational careers more and more often involve work in several companies, with a pace of change that may be fast, is already causing problems for recognition of the job-related nature of certain diseases, especially those appearing much later, such as cancers. A victim whose occupational career has been "fragmented" will undoubtedly have problems in providing proof of his exposure to risk. This is because it will not be easy to gather the traditional means of proof (position data sheet, file established by the company's industrial doctor, testimony by colleagues, etc.), especially if the company has disappeared in the meantime. With the development of the new technologies and the forms of work (such as telecommuting) that they encourage, the boundary between the work sphere and the non-work sphere is becoming increasingly hard to determine. How then can one determine what should be covered and compensated for by occupational injury and disease insurance and what comes under the other forms of social insurance? These are some of the questions that should be answered. Conclusion In the area of occupational risk insurance, there exists no single European model (like for the other forms of social insurance, moreover). Each country has a system that is specific to it, that is the product of its history (political, economic and social), and that is also a reflection of its culture. Nevertheless, today (as in the past), all the national systems have to cope with the same problems and difficulties. We do not doubt that occupational injury and disease insurance will be able to cope with the challenges facing it, and we should once again rejoice in the existence of this European Forum, which enriches our thinking through the discussion it encourages. -9- - 10 - L’assurance AT-MP dans l’Europe des 15 - Panorama Marie-Chantal Blandin Gilles Evrard C'est une vraie gageure que de présenter en 30 minutes un panorama de l'assurance contre les risques professionnels dans l'Europe des 15, tant il y aurait à dire sur le sujet ! Cette communication sera donc nécessairement schématique, sans doute même réductrice, car nous devrons nous en tenir au niveau des généralités. A lui seul, et même s'il ne met pas en scène 15 personnages, le dessin illustre bien la situation actuelle dans l'Union à 15. A première vue, les parapluies –qui, vous l'aurez compris, symbolisent l'assurance contre les accidents du travail-maladies professionnelles– sont tous différents, et c'est vrai qu'il y a des écarts –parfois importants– entre les systèmes en place dans nos pays. Mais cette première impression ne doit pas masquer une autre réalité, sans doute moins évidente au premier regard, mais tout aussi importante : nos systèmes d'assurance contre les risques professionnels sont dynamiques –ils ont évolué et progressent encore– et, comme les personnages du dessin, ils avancent tous dans la même direction. Dans un premier temps, nous aborderons les principales différences qui existent entre les systèmes d'assurance en vigueur dans l'Europe à 15. - 11 - Puis nous verrons qu'au-delà de ces différences, il existe bien un socle commun –solide– qui constitue le fondement de l'assurance contre les risques professionnels dans nos pays. Enfin, en guise de conclusion, nous aborderons rapidement, car les intervenants suivants leur consacreront de plus longs développements, quelques-uns des défis auxquels l'assurance accidents du travail – maladies professionnelles est actuellement confrontée. Les principales différences Nous en avons recensé trois : - le statut juridique de l’organisme gestionnaire de l’assurance, - les systèmes de tarification en vigueur, - le rôle de l’assureur dans le domaine de la prévention. 1) Le statut de l'organisme gestionnaire de l'assurance - Au Royaume-Uni et en Irlande, c'est l'État lui-même qui gère l'assurance contre les accidents du travail – maladies professionnelles. - Mais, dans la plupart des pays composant l'Union européenne (en Autriche, Allemagne, Italie, France, Suède et au Luxembourg), ce sont des organismes publics de sécurité sociale, souvent placés sous le contrôle de l'État, qui sont chargés de cette gestion. Il est important de souligner que ces organismes sont très souvent gérés par les partenaires sociaux … ou en association avec les partenaires sociaux. - Le cas de l'Espagne est un peu différent : l'assurance y est gérée par les Mutuas, mutuelles patronales sans but lucratif, qui collaborent au système de sécurité sociale. - La Finlande est le seul pays où la gestion de l'assurance est confiée uniquement à des compagnies privées. - Enfin, la palme de l'originalité revient à la Belgique, au Portugal et au Danemark : dans ces trois pays en effet, l'assurance contre les maladies professionnelles est prise en charge par un organisme public, alors que l'assurance contre les accidents du travail est gérée au Portugal et au Danemark par des compagnies privées et en Belgique conjointement par un établissement public, des caisses communes patronales et des sociétés privées d'assurance agréées. Cette pluralité de statuts permet de mieux comprendre les autres points de clivage entre les divers systèmes nationaux. 2) Regardons maintenant les systèmes de tarification en vigueur La finalité d'un système de tarification des risques professionnels est de garantir, et ce de façon pérenne, le financement des dépenses à la charge de l'assurance, c'est-à-dire les prestations servies aux victimes et les charges de gestion. Tout le monde s'accorde sur ce point, mais les voies empruntées par les uns et les autres pour mettre en œuvre ce principe sont diversifiées. Certains pays privilégient une logique de solidarité interentreprises; ce qui revient à mutualiser les dépenses et à les répartir de façon non différenciées entre les cotisants. - 12 - D'autres, au contraire, mettent davantage l'accent sur le caractère assurantiel de la cotisation ; ce qui tend à segmenter les risques et à promouvoir une individualisation des primes. Dans ce contexte d'ailleurs, la cotisation est considérée en tant que telle comme une incitation à la prévention. Par rapport à ces deux logiques –opposées dans leur principe– comment se positionnent les pays européens ? - La solidarité interentreprises au niveau national Deux pays sont adeptes de ce système de mutualisation totale : l'Autriche et la Suède. C'est donc un taux de cotisation unique pour le risque AT-MP qui s'applique à toutes les entreprises, quels que soient leur activité, leur effectif et leur sinistralité. - L'individualisation de la cotisation en fonction de la sinistralité de l'entreprise A l'opposé des systèmes autrichiens et suédois, le système français est celui qui pousse le plus loin la logique de l'individualisation. Cette logique se manifeste à deux niveaux. D'une part, la tarification est effectuée par établissement. Cela signifie que chaque établissement – c'est-à-dire chaque groupe de personnes exerçant une activité considérée, sous une même autorité et dans un certain lieu– se voit notifier chaque année un taux de cotisation qui lui est propre. Ainsi deux établissements d'une même entreprise pourront avoir des taux de cotisation différents. D'autre part, le mode de tarification applicable varie en fonction de l'effectif de l'entreprise. Lorsque l'effectif habituel des salariés est au moins égal à 200, c'est un taux individuel réel qui est appliqué. Ce taux est déterminé à partir des éléments financiers propres à l'établissement : valeur du risque et masse des salaires payés au personnel pendant la période de référence. L'objectif clairement affiché est de faire payer à l'entreprise un coût en rapport avec le risque qu'elle fait subir à ses salariés ; l'idée sous-jacente étant que par ce biais l'entreprise sera incitée à mettre en œuvre des mesures de prévention dont elle tirera directement bénéfice grâce à une diminution de son taux de cotisation. Pour les tout petits établissements (dont l'effectif est inférieur à 10 salariés), c'est une tarification collective qui s'applique. Le taux est fixé au niveau national par arrêté ministériel ; il est établi à partir des résultats statistiques et financiers de chaque secteur d'activités (il y a eu environ 800 numéros de risque) Enfin, pour les établissements dont l'effectif est compris entre 10 et 199, c'est un taux mixte qui s'applique, qui combine une fraction du taux collectif correspondant à l'activité professionnelle de l'établissement et une fraction du taux individuel réel de l'établissement calculé comme si celui-ci relevait de la tarification individuelle réelle. Plus l'effectif se rapproche de 200, plus la part de taux propre est importante. - La solidarité au niveau de la branche professionnelle La plupart des pays ont opté pour un système de tarification qui réalise un compromis entre la logique de la mutualisation intégrale des risques et celle de l'individualisation de la cotisation. C'est notamment le cas en Allemagne, en Italie, en Espagne … en Suisse également. Les taux de cotisation sont calculés au niveau des branches professionnelles ou par secteurs d'activités ; ce qui introduit un premier élément de différenciation. - 13 - Parfois, –c'est notamment le cas en Allemagne– intervient un deuxième niveau de différenciation, pour renforcer le caractère d'incitation à la prévention que doit avoir la cotisation. Ainsi, chaque branche professionnelle détermine des classes de risque pour les secteurs industriels dont elle est responsable, afin de tenir compte des différents niveaux de risque que revêtent les diverses activités regroupées en son sein En étant très schématique, nous pourrions dire que les systèmes de ce type, réalisent, sur la base d'éléments de tarification mutualisés, une certaine individualisation des cotisations pour tenir compte de la situation de l'entreprise en matière de sinistralité. - La loi du marché : Dernier cas de figure, elle prévaut dans quelques pays où le risque "accidents de travail" est géré par des compagnies privées. En théorie, les compagnies fixent les primes en fonction du niveau de risque … mais, dans les faits, le calcul des cotisations est réalisé sur la base de critères « subjectifs » n'ayant pas grand-chose à voir avec le nombre et la gravité des accidents du travail de l'entreprise. Ce n'est heureusement pas le cas général ! 3) Le rôle de l'assureur en matière de prévention A quelques exceptions près (au Danemark, en Irlande, en Suède et au Royaume Uni), tous les organismes chargés de gérer l'assurance contre les accidents du travail et les maladies professionnelles réalisent des actions de prévention ; certains soulignent même qu'il s'agit là d'un aspect essentiel de leur mission. Mais en ce domaine, moyens et réalisations diffèrent. - En Belgique, Finlande, Italie, Espagne et au Portugal (pour les MP) : Ce sont essentiellement des actions de sensibilisation sur les risques et les moyens de les prévenir qui sont réalisées par l'organisme assureur : élaboration d'affiches, de brochures, de vidéogrammes, campagnes d’information et organisation de sessions de formation. - En Allemagne, Autriche, France et au Luxembourg. Dans d'autres pays, moins nombreux, mais dans lesquels l'assureur contre les risques professionnels est un organisme public, la prévention est affichée comme l'une des missions fondamentales de l'assurance. Même si, depuis quelques années, ils mettent davantage l'accent sur le volet "conseil" de leur mission de prévention, les organismes gestionnaires de l'assurance disposent de moyens d'intervention plus contraignants auprès des entreprises : ils ont souvent constitué des corps d'inspecteurs ou de contrôleurs qui ont la possibilité de sanctionner, notamment au plan financier, les entreprises qui ne respectent pas leurs ou leurs préconisations ou leurs prescriptions. Ils se sont également dotés de services ou de centres d'études et de recherche de haut niveau. - 14 - Le socle commun Les différences recensées dans la première partie ne sauraient masquer le fait qu'il existe bien un socle commun à tous –ou presque tous– les régimes d'assurance accidents du travail-maladies professionnelles en vigueur dans l'Union à 15. De notre point de vue, ce socle commun se caractérise par 3 éléments : - l'assurance "accidents du travail" est la plus ancienne des assurances sociales ; - mais en dépit de son âge, elle a su, dans tous les pays, évoluer ; - à quelques rares exceptions près, elle a conservé sa spécificité dans le champ des assurances sociales. 1) La première des assurances sociales - De 1884 à 1913, tous les pays de l’actuelle Union à 15 se dotent d’une assurance contre les accidents de travail (à une exception près : la Grèce). L’Allemagne a été la première en 1884, le Portugal fermera la marche en 1913. En fait, seule la Grèce n'a jamais mis en place d'assurance AT-MP. Il faut toutefois mentionner que depuis 1967, les Pays-Bas n'ont plus d'assurance spécifique pour les risques professionnels. - L'assurance AT-MP tire son origine des conditions, souvent très dangereuses, qui caractérisaient le travail en usine au 19ème siècle, alors que le système de responsabilité civile ne permettait pas –ou très difficilement– d'indemniser les travailleurs victimes d'accidents du travail. C'est sous la pression de l'action sociale et des luttes ouvrières de la fin du 19ème siècle que naquit l'assurance contre les accidents du travail. Souscrite obligatoirement par le chef d'entreprise, elle a bouleversé les principes juridiques de la responsabilité civile, en garantissant aux victimes et à leurs survivants une réparation adéquate du préjudice subi, sans qu'il soit nécessaire de mener une enquête pour déterminer s'il y a eu faute ou négligence de la part de l'employeur et sans qu'il soit nécessaire de saisir les tribunaux. 2) Une assurance encore souvent spécifique L'apparition d’autres assurances sociales couvrant des populations plus larges pour des risques plus "communs" (en particulier les assurances "maladie" ou "invalidité") n’a pas remis en cause l’intérêt de l'assurance AT-MP ; au contraire elle s'est développée et a, à l'exception des Pays-Bas, conservé sa spécificité. Celle-ci se manifeste à deux niveaux : - Par son financement : A la différence des autres assurances sociales, le financement de l'assurance AT-MP est à la charge exclusive de l'employeur. C'est parce que celui-ci tire des bénéfices de l'activité de son entreprise qu'il doit assumer les risques inhérents à cette activité. - Par son organisation : Dans la plupart des pays, l’assurance AT-MP est gérée par un organisme dont le champ d’action se limite aux risques professionnels. Il n'y a que 4 exceptions à ce constat : le Royaume Uni et l'Irlande, où c'est l'État qui gère lui-même l'assurance, la Suède et la France. - 15 - 3) En 100 ans, l'assurance a beaucoup évolué ; et ce en trois directions : - Les risques couverts se sont diversifiés Dans les années 1920, la législation étend l'assurance aux maladies professionnelles. Une liste est établie pour répertorier les maladies ouvrant droit aux prestations spécifiques prévues pour les victimes d'accidents du travail. Par ailleurs, entre 1960 et 1990 selon les pays, un système complémentaire (dit "ouvert" ou "de preuve") est mis en place. Ainsi, une maladie qui ne figure pas sur la liste peut néanmoins être reconnue comme professionnelle, à condition que la victime apporte la preuve de son lien avec l'exposition professionnelle. Enfin, les accidents de trajet sont assimilés à des accidents de travail, dès 1917 en Allemagne et 1925 en Autriche. Pour les autres pays, il faudra souvent attendre 1945. Cependant, au Danemark et au Royaume-Uni, l'accident de trajet n'est pas considéré comme un risque professionnel. - Les populations protégées se sont élargies Une autre évolution concerne les bénéficiaires de l'assurance. Réservée à l’origine aux seuls ouvriers de certaines industries particulièrement dangereuses, l’assurance couvre aujourd’hui tous les salariés. Certains pays vont même plus loin en protégeant des non salariés tels que les bénévoles, les travailleurs indépendants, voire les étudiants et les élèves. - Les prestations ont été améliorées Enfin, au fil des années, les prestations versées aux victimes se sont améliorées, couvrant aujourd'hui non seulement les soins, la perte de salaire et l'incapacité permanente mais aussi la réadaptation fonctionnelle, sociale et professionnelle des victimes. Les débats et les défis actuels Très brièvement, et en guise d'introduction aux exposés qui vont suivre, nous aimerions évoquer trois questions qui font l'objet de débats, sinon dans tous nos pays, du moins dans la plupart d'entre eux : - La recherche d’économies L’assurance accidents du travail – maladies professionnelles, même si ses comptes sont, en principe, par nature équilibrés, n’échappe à la recherche d’économies que connaissent les autres branches de la sécurité sociale. Car, si le nombre d’accidents du travail diminue régulièrement, le coût moyen d’indemnisation d’un accident (soins et réhabilitation notamment) augmente, lui aussi, régulièrement. Plusieurs voies peuvent être suivies pour atteindre cet objectif d’économies. La plus radicale à cet égard est certainement celle qu’a empruntée l’État suédois dans le début des années 1990, lorsqu’il a dû combler le déficit des caisses et a, pour ce faire, réformé en profondeur tant le système de reconnaissance que celui d’indemnisation des risques professionnels. Mais d’autres méthodes sont mises en œuvre dans les différents pays européens, pour diminuer le coût des accidents du travail et des maladies professionnelles. Agir sur le nombre et la gravité des risques, grâce au développement des actions de prévention, est l’une des voies suivies, surtout par les organismes publics chargés de gérer l’assurance. Il est significatif à cet égard que depuis une dizaine d’années, un accent tout particulier ait été mis sur les actions en direction des petites et moyennes entreprises qui, très souvent, ne disposent pas de structures de prévention et qui, - 16 - proportionnellement, génèrent plus de risques. De telles actions devraient, sinon à court terme, du moins à moyen terme, contribuer à l’objectif recherché. Plus immédiats sans doute seront les effets escomptés de certaines mesures mises en œuvre dans certains pays et portant sur le contrôle des prescriptions en matière de soins, traitements et d’arrêts de travail. - le débat organisme public/compagnie privée reste ouvert Nombreux sont les pays qui débattent régulièrement des avantages et des inconvénients d’un système public par rapport à un système privé. Les promoteurs de tel ou tel système ont chacun leurs arguments. Il ne nous appartient pas, ici, de lancer ce débat, mais nous voulions seulement mentionner que cette question resurgit régulièrement. - les nouvelles formes de travail et les nouveaux modes de vie compliquent la donne. Depuis une quinzaine d’années, le monde du travail connaît, en lien avec la mondialisation des économies et le développement des nouvelles technologies, des changements de nature et d’ampleur telles que l’on doit se poser la question de leur impact sur l’assurance contre les risques professionnels. En effet, le développement considérable des services au détriment de l’industrie, l’apparition de nouvelles formes d’emploi (télétravail, travail précaire, travail indépendant), la modification des modes de production (sous-traitance, externalisation, flux tendus…), la féminisation de nombreuses activités et le vieillissement de la population… sont autant de mutations économiques et sociales qui ont ou auront, à différents égards, des incidences sur l’assurance contre les risques professionnels. Avec la tertiarisation des emplois et l’essor d’une économie de services, la nature des risques liés au travail change : le poids des accidents de circulation et de mission s’accroît et des pathologies comme les troubles musculo-squelettiques, les troubles psychologiques et les affections psychosociales en relation avec le stress, la violence… apparaissent, parfois très rapidement, au point que l’on a pu parler d’épidémie. Le développement du travail précaire –contrat à durée déterminée et travail intérimaire– pose, lui aussi, problème. Le fait que les carrières professionnelles se déroulent de plus en plus souvent au sein de plusieurs entreprises, avec un rythme de changement pouvant être rapide, est déjà une source de difficultés pour la reconnaissance du caractère professionnel de certaines maladies, notamment pour celles à apparition retardée comme les cancers. Une victime à la carrière professionnelle « éclatée » aura très certainement des difficultés à apporter la preuve de son exposition au risque. En effet, les moyens traditionnels de preuve : fiche de poste, dossier établi par le médecin du travail de l’entreprise, témoignages de collègues… ne seront pas évidents à réunir, a fortiori si l’entreprise a entre temps disparu. Avec le développement des nouvelles technologies et des formes de travail qu’elles favorisent – comme le télétravail–, la limite entre l’univers professionnel et l’univers non professionnel devient de plus en plus difficile à cerner. Comment alors faire la part des choses entre ce qui doit être pris en compte et indemnisé par l’assurance AT-MP et ce qui relève des autres assurances sociales ? Telles sont quelques unes des questions auxquelles il conviendra de répondre. - 17 - Conclusion Dans le domaine de l'assurance contre les risques professionnels, il n'existe pas –comme d'ailleurs pour les autres assurances sociales– un modèle unique européen. Chaque pays dispose d'un système qui lui est propre, qui est le fruit de son histoire –politique, économique et sociale– et qui est également le reflet de sa culture. Néanmoins tous les systèmes nationaux ont, aujourd'hui –comme hier–, à affronter les mêmes problèmes, les mêmes difficultés. Nous ne doutons pas que l'assurance accidents du travail – maladies professionnelles saura relever les défis auxquels elle est confrontée et nous devons, encore une fois, nous réjouir de l'existence de ce Forum européen, qui enrichit nos réflexions par les échanges qu'il favorise. - 18 - - 19 - Recent developments in the European Union and insurance against occupational risks Franz Terwey 1. Social security in the “post-national constellation“ Public social and health systems occupy a central place in the social systems of our countries. By traditional standards they presuppose the existence of a political community with the attributes of a state, and geographic and political borders that form the “framework for national solidarity”. In the last ten years or more, however, we have increasingly been confronted with legislative and material influences that originate wholly or partly outside our national territories. The “post-national change” includes, above all, the rapidly progressing integration of markets at an international level, with the result that national governments are faced with mounting difficulties when trying to control developments strategically and operationally, not only in respect of the flow of capital and services but also in terms of the labour market. This is compounded by the increasing “internationalisation” and globalisation of health and safety risks which is due to open borders and increasing mobility and tends to raise the cost of social security. Especially in the European Union influences make themselves felt that are largely outside the control of national governments – such as the replacement of national economies by the Single Market and resulting subordination of national players to European (transnational) rules governing economic activity and competition. Another case in point is the integration of many member states into a common monetary policy in the interest of stability, on account of which the governments of the participating countries have dispensed with instruments that were essential to their national autonomy, in particular with a view to the material aspects of their future social health and social policies. 2. A hidden liberalisation debate The risks inherent in these developments for the role and functioning of social security systems are great. More and more frequently the debate on the future of Europe is reduced to a purely market-oriented and commercial view of all aspects of social life. The main objective pursued appears to be the radical opening of markets for all sorts of tasks so far in the hands of public enterprises. This paves the way for those who wish, for their own benefit, to liberalise and ultimately privatise social security irrespective of whether or not such actions would be likely to generate added value, or even at the expense of additional financial burdens to be borne by those affected. Traditionally, public social and health systems have never been seen as an entrepreneurial activity guided by purely economic considerations. Nevertheless, the dynamism of “European entrepreneurial action”, which is not only promoted by European legislation but also called for by the European Court of Justice, tends to take hold of all aspects of the public sector, including activities inherent in the exercise of governmental power. - 19 - This tendency to develop the law in such a way as to favour a greater measure of market orientation is aided and abetted by interpretations of the law that extend it to more and more specialised aspects of Single Market and Competition legislation, currently for the most part in the law on public contract awarding processes, subsidies and the liberalisation of services. This trend is confirmed and accelerated by the current debate on the future of services of general economic interest. In this context the Commission has developed a concept for “social and health services of general interest” (social services) in which it claims that it would in principle be possible to have all social services placed in the hands of commercial enterprises that would be engaged in all-European or even global competition without sacrificing any of the social policy objectives. As regards social security this would mean that statutory insurance would be replaced by the obligation to take out private insurance. However, social security and public health are no marketable commodities that could at best be saddled with the obligation to assume responsibilities for public welfare: they are the very expression and symbol of public welfare and the common good. A market-oriented concept of social services would inevitable erode the “social policy objectives”, and any democratic control over such matters would ultimately be lost. This is not merely a question of organisation, it is one of the contents and scope of social protection guaranteed by the public authorities. As regards social policy objectives, the choice of the means to be used to this end is on no account neutral. 3. The Single Market Programme, social benchmarking and “streamlining” In addition, as the completion of the European Single Market Programme progresses, national borders within the EU have not only lost their importance for the flow of capital and services, but their legal and economic function is also increasingly eroded in the field of public social protection, since “employment biographies” are increasingly becoming “transnational” and people, both in their capacity as insured persons and as patients, tend to make increasing use of transnational services and money benefits available from statutory social institutions. This development tends to increasingly undermine the “social security territoriality” still required by the national legislations in the member countries, and exercises mounting pressure on their social systems: costs and benefits of social security instruments and procedures become more and more directly comparable, and the beneficiaries can ask searching questions of the political institutions in their country concerning higher costs or deficits in the availability and performance of such services. It is only consistent with these developments that the transnational benchmarking procedures increasingly used at EU level aim at promoting competition and convergence in the field of public social protection. Benchmarking – often disguised as an ”open coordination method” – formally respects the national jurisdiction of member states in that no open pressure is exerted on the member states to opt for specific solutions. The use of the “open coordination method” forces national governments on the other hand to constantly document the operation of their social systems and to have them assessed in the light of supranationaly agreed objectives, guidelines and indicators. In practice this means that they have to constantly justify themselves with regard to the results of transnational comparisons. This has a “soft-law” effect that will in the long run result in increasing uniformity and standardisation of the systems. - 20 - In principle, benchmarking social security systems is to be welcomed. What is problematic, however, is that at least in the near future the comparability of data will leave a lot to be desired on account of severe methodological problems due to the systematic differences between the various systems that have evolved from different traditions. What is more, social security must not be merely seen as a burden on public budgets: it is an integral part of the “European Model of Society and Social Welfare”, which is based on solidarity. The “financial sustainability” of social security systems is therefore not and end in itself: it is to be seen in the light of “social sustainability” for the present and future generations. This is why such aspects as level and quality of support, accessibility, equal treatment, and the need to balance social and individual risks must all be taken into account in the final reckoning. The European Commission is, incidentally, planning to tighten and intensify benchmarking procedures in the various fields of social security. The object of this “streamlining” is to increasingly harmonise the member states’ social protection policies with the basic European economic policy principles and the European employment strategy. In this context the indicators to be used in the comparison of systems are to be reduced to just a few parameters. This streamlining process therefore threatens to relegate concern for a high level of social protection and public health to second place behind economic and employment policies. In the interest of safeguarding the member states’ jurisdiction in the field of social protection a balance must be sought between social policy, fiscal and employment aspects. One prerequisite is that the players in the field of social protection and in particular the self-governing bodies are given a voice in the debate. 4. Pressure of economic players endangers social policy objectives Social security benefits are overwhelmingly paid from tax revenues or social insurance contributions and not “paid for” by the beneficiary in question. This reflects the special responsibility the public authorities have to attain the social-policy objectives of social insurance. This means, however, that the overall prerequisites are such that a market-oriented product design and pricing policy is impossible. Organising social insurance “in the Single Market” would also be impossible without a fundamental change in the social objectives sought; indeed, it would be tantamount to dispensing with any control over social-policy objectives. If social insurance were indeed to be organised under competitive conditions while respecting all its components and social-policy objectives, it would be indispensable to create an artificial, strictly regulated environment and drastically reduce entrepreneurial freedom of action while at the same time keeping the system flexible enough to allow whatever democratically legitimated social-policy objectives are to be implemented. It would be hard to see any concrete advantages such a system would bring for all those concerned. It is therefore hardly helpful if social insurance remains at the focus of a discussion on European law which is controlled by the interests of specific groups at a time when fundamental political decisions are at stake. Even if the European Court tends to curb such attempts in some cases, it does not do so with sufficient clarity to remove any doubt once and for all. On the contrary, the social insurance institutions’ scope of action confirmed by its decisions in individual cases are often called into question by other decisions, which clearly favour privatisation and competition. In view of the constant pressure on the part of business and its players, this situation is likely to prevail also in future. This means, on the other hand, that the - 21 - rules governing jurisdiction as embodied in Articles 137, 152 and 295 of the EC Treaty are being gradually eroded. What is therefore needed is – European Economic Law notwithstanding - a readjustment of the borderlines in European law between “market-related”, “economic” and “entrepreneurial” activities on the one hand and that scope of such activities, on the other, which must be reserved to the member states on account of their social relevance and their non-profit character. It is therefore essential to reject the recent tendency in European jurisprudence to derive from the EC Treaty an obligation to organise along marketeconomy lines, and thus to privatise, activities that have so far been in the hands of public institutions and undertaken in the general interest of the public. 5. Challenges for national players There can be no doubt that decisions on the structure and organisation of social security systems will primarily have to remain reserved to the individual countries and cannot be left to the European Union. Likewise, it cannot be denied that Europe’s power concentration, as reflected in its economic concentration and deregulation policies, has reached dimensions that threaten to gradually deprive the individual states of their sovereignty with regard to their social and health policies. At the same time the member states are fettered by the common monetary policies, as the budgetary discipline imposed on them restricts their scope of action in social matters. In view of these general conditions, it is becoming more and more difficult for the individual countries to pursue foresightful – yet interrelated - social and health policies. In the absence of broad competences and border-crossing cooperation among the players there is, however, little hope for success. What will also be necessary is to pursue one’s own interests more and more in a larger – European – context. If policymakers fail in this respect, important values such as social justice, solidarity and general access to highquality social services and benefits will be at stake. The realisation of a “European Social Union”, though still rejected in many quarters, would appear to be an essential medium-term necessity if we want to prevent social insurance to be dismantled in the Single European Market. Side by side with is financial and economic policy dimension, Europe is in urgent need of supportive social and societal policies and a social mindset. Otherwise, it will hardly be possible to preserve and keep alive the guiding principle of a broad, publicly administered, generally accessible system of social protection on a European scale. Coping with this exceedingly difficult task is probably one of the greatest historic challenges for all those who feel they bear responsibility for the common future of humanity. The administrators of social insurance systems, their self-governing bodies and indeed all health-care institutions will have to make it one of their principal tasks to assert their active role in this process. In the long run it will be necessary to strive for politically organising division of labour across borders, not only at the strategic but increasingly also on an operative level. - 22 - Neuere Entwicklungen in der Europäischen Union und die Versicherung gegen Berufsrisiken Franz Terwey 1. Sozialversicherung in der „postnationalen Konstellation“ Die öffentlichen Sozial- und Gesundheitssysteme sind ein zentraler Bezugspunkt unserer nationalen Gesellschaftsordnungen. Sie setzen nach traditionellem Verständnis ein politisches Gemeinwesen mit staatlicher Verfasstheit sowie die Existenz geographisch-politischer Grenzen als „Nationalen Solidaritätsrahmen“ voraus. Seit etwas mehr als einem Jahrzehnt jedoch müssen wir uns immer häufiger mit rechtlichen und tatsächlichen Einflüssen befassen, die ihren Ursprung ganz oder teilweise außerhalb des auf ein Staatsgebiet begrenzten Territoriums haben. Zu diesem „postnationalen Wandel“ zählt vor allem die rasch voranschreitende internationale Marktvernetzung, die dazu führt, dass sich für die einzelstaatlichen Regierungen die strategisch-operative Beherrschung des realen Geschehens nicht nur mit Blick auf das Kapital und den Dienstleistungsverkehr, sondern auch im Arbeitsmarkt zunehmend schwierig gestaltet. Hinzu kommt die aufgrund wachsender Grenzöffnung und Mobilität verstärkt zu beobachtende „Internationalisierung“ bzw. Globalisierung von Gesundheits- und Sicherheitsrisiken, die sich kostentreibend auf den Sozialschutz auswirkt. Speziell in der Europäischen Union wirken weitere Einflüsse, die der einzelstaatlichen Steuerung weitestgehend entzogen sind, wie etwa Ablösung der ehedem nationalen „Volkswirtschaften“ durch einen Gemeinsamen Binnenmarkt sowie die hiermit einhergehende Unterwerfung nationaler Akteure unter eine Europäische (transnationale) Wirtschafts- und Wettbewerbsordnung. Auch die stabilitätspolitische Einbindung vieler Mitgliedstaaten in eine Gemeinsame Währungsordnung gehört hierher. Durch sie haben die Regierungen der teilnehmenden Länder sich wesentlicher Instrumente nationaler Autonomie begeben, nicht zuletzt mit Blick auf die künftige materielle Gestaltung ihrer Sozial- und Gesundheitspolitik. 2. Eine verdeckte Liberalisierungsdebatte Die in dieser Entwicklung liegenden Risiken für die Rolle und das Funktionieren der Sozialversicherung sind groß: Immer häufiger ist zu beobachten, dass die Debatte um die Zukunft Europas sich fast ausschließlich auf eine rein marktorientierte bzw. wirtschaftliche Betrachtung aller Bereiche des gesellschaftlichen Lebens reduziert. Eines der Hauptanliegen dieser Debatte scheint dabei die radikale Marktöffnung sämtlicher bisher in öffentlicher Regie erledigter Aufgaben zu sein. Damit wird zugleich Versuchen interessierter Kreise der Weg bereitet, die Sozialversicherung unabhängig von einem eventuellen Mehrwert – oder sogar unter Inkaufnahme zusätzlicher Belastungen für die Betroffenen – zu liberalisieren und letztlich zu privatisieren. Die Organisation eines öffentlichen Sozial- und Gesundheitsschutzes ist traditionell niemals als wirtschaftlich-unternehmerische Aktivität betrachtet worden. Dennoch erfasst die nicht zuletzt auch vom Europäischen Gerichtshof geförderte Dynamik eines europarechtlichen Verständnisses vom „unternehmerischen Handeln“ prinzipiell sämtliche öffentliche Sektoren – bis hin zu hoheitlichen Tätigkeiten. Diese „Linie“ einer marktorientierten Rechtsentwicklung wird flankiert durch entsprechende rechtsschöpfende Ausdehnungen von Spezialgebieten des europäischen Binnenmarkt- und Wettbewerbsrechts. Hierbei handelt es - 23 - sich zur Zeit vor allem um Entwicklungen auf den Feldern des Rechts der öffentlichen Auftragsvergabe, des Beihilferechts und der Dienstleistungsfreiheit. Bestätigt und beschleunigt wird dieser Trend durch die aktuelle Debatte über die Zukunft der Daseinsvorsorge. In diesem Zusammenhang wurde von der Kommission ein Konzept für „soziale und gesundheitliche Dienstleistungen von allgemeinem Interesse“ (social services) entwickelt, welches behauptet, bei voller Berücksichtigung der Ziele der Sozialpolitik ließen sich prinzipiell alle sozialen Leistungen von kommerziellen Unternehmen in einem europaweiten bzw. globalen Wettbewerb erbringen. Bezogen auf die Sozialversicherung würde dies bedeuten, die Pflichtversicherung durch eine Versicherungspflicht zu ersetzen. Die Sozialversicherung und die öffentliche Gesundheit sind jedoch keine am Markt handelbaren Wirtschaftsgüter, denen - wenn überhaupt - Gemeinwohlverpflichtungen auferlegt werden, sondern sie sind selbst Ausdruck und Sinnbild des Gemeinwohls. Das marktorientierte Konzept sozialer Dienste würde zu einer Erosion der „Ziele der Sozialpolitik“ beitragen, verbunden mit einem Verlust an demokratischen Steuerungsmöglichkeiten. Es geht daher nicht nur um die Art und Weise der Organisation, sondern letztlich um den Inhalt und Umfang des öffentlich gewährleisteten Sozialschutzes. Denn die Wahl der einzusetzenden Mittel ist im Hinblick auf die verfolgten Ziele der Sozialpolitik keineswegs neutral. 3. Binnenmarktprogramm, soziales Benchmarking und „Streamlining“ Hinzu kommt, dass aufgrund der fortschreitenden Vollendung des Europäischen Binnenmarktprogramms nationale (einzelstaatliche) Grenzen in der EU nicht nur für das Kapital und den Dienstleistungssektor ihre Bedeutung verloren haben, sie büßen ihre juristische und ökonomische Funktion immer mehr auch im Bereich des öffentlichen Sozialschutzes ein, weil die Menschen zunehmend „transnationale Beschäftigungsbiographien“ entwickeln und – als Versicherte und Patienten – Dienste und Geldleistungen der gesetzlichen Sozialkassen grenzüberschreitend nachfragen. Durch diese Entwicklung wird die von den Mitgliedstaaten heute noch gesetzlich angeordnete „sozialrechtliche Territorialität“ faktisch mehr und mehr unterlaufen. Diese „Entgrenzungswirkung“ übt einen wachsenden Druck auf die einzelstaatlichen Sozialordnungen aus: Kosten und Nutzen der Instrumente und Verfahren sozialer Sicherheit werden immer mehr direkt vergleichbar, höhere Kosten oder mangelnde Verfügbarkeit und Performanz der Versorgung werden politisch erklärungsbedürftig. Konsequenterweise zielen die von der EU-Ebene in zunehmendem Maße eingesetzten transnationalen „Benchmarking-Verfahren“ klar auf Wettbewerb und Konvergenz im öffentlichen Sozialschutz Europas. Das Benchmarking – mit der etwas verharmlosenden Bezeichnung „Offene Methode der Koordinierung“ – respektiert zwar formal die nationale Gestaltungshoheit der Mitgliedstaaten, indem vordergründig keinerlei rechtlichen Zwang zu bestimmten Systemlösungen ausübt wird. Andererseits verpflichtet die Anwendung der Offenen Methode der Koordinierung die einzelstaatlichen Regierungen jedoch dazu, die Gestaltung ihrer Sozialsysteme permanent zu dokumentieren und sie an supranational vereinbarten Zielen, Leitlinien und Indikatoren messen zu lassen. Dies bewirkt faktisch einen transnationalen Rechtfertigungszwang durch öffentliche Vergleiche und entfaltet so eine gewisse „soft-law-Wirkung", die langfristig zu wachsender Angleichung und Standardisierung der Einzelsysteme führt. Die Durchführung eines Benchmarking von Systemen der sozialen Sicherheit ist grundsätzlich zu begrüßen. Problematisch ist allerdings, dass zumindest für die nähere Zukunft gravierende methodische Probleme in der Vergleichbarkeit der Daten bestehen, die nicht zuletzt auf historisch gewachsene Systemunterschiede zurückzuführen sind. Sozialschutz darf im übrigen nicht nur als Belastung der öffentlichen Haushalte verstanden werden, sondern ist ein ureigener Bestandteil des auf Solidarität basierenden „Europäischen Sozial- und Gesellschaftsmodells“. - 24 - Die „finanzielle Nachhaltigkeit“ der Systeme sozialer Sicherheit ist deshalb auch kein „Ziel an sich“, sondern muss im Lichte des Ziels einer „sozialen Nachhaltigkeit“ für die Menschen und Generationen betrachtet werden. Deshalb müssen auch Aspekte des Versorgungsniveaus und der Qualität sowie der Zugänglichkeit, der Gleichbehandlung und des sozialen und individuellen (Risiko-) Ausgleichs umfassend in die Bewertung einbezogen werden. Die Europäische Kommission plant im Übrigen eine Straffung bzw. Intensivierung der BenchmarkingVerfahren in den einzelnen Bereichen sozialer Sicherheit. Das Ziel dieses so genannten „StreamliningProzess“ ist es, künftig die Sozialschutzpolitiken der Mitgliedstaaten besser mit den Grundzügen der europäischen Wirtschaftspolitik und der europäischen Beschäftigungsstrategie abzustimmen, wobei gleichzeitig die zum Systemvergleich herangezogenen Indikatoren auf nur sehr wenige Messgrößen reduziert werden sollen. Der Streamlining-Prozess birgt mithin die Gefahr, dass das Anliegen eines hohen Sozialschutz- und Gesundheitsniveaus gegenüber der Wirtschafts- und Beschäftigungspolitik nur nachrangig betrachtet wird. Soll die Gestaltungskompetenz der Mitgliedstaaten im Sozialschutzbereich nicht völlig ausgehöhlt werden, muss ein ausgewogenes Verhältnis zwischen sozialpolitischen, fiskalischen und beschäftigungspolitischen Aspekten sichergestellt sein. Hierzu gehört es, dass die Akteure des Sozialschutzes, insbesondere die Selbstverwaltungen, unmittelbar in die Debatte einbezogen werden. 4. Druck der Wirtschaftsakteure bringt sozialpolitische Ziele in Gefahr Die Leistungen der Sozialversicherung werden ganz überwiegend aus Steuern oder Sozialabgaben finanziert und nicht vom Nutzer im konkreten Fall „bezahlt“. Dies ist Ausdruck der besonderen öffentlichen Verantwortung für das Erreichen der mit der Sozialversicherung verbundenen sozialpolitischen Ziele. Damit entfallen aber zugleich eindeutig die entscheidenden Rahmenbedingungen für eine am Markt orientierte Produktgestaltung und Preisfindung. Eine Organisation der Sozialversicherung „im Binnenmarkt“ wäre ohne fundamentale Mutation der jeweils verfolgten sozialen Ziele nicht möglich; vielmehr wäre dies weitgehend gleichbedeutend mit einem Verzicht auf die Steuerung der sozialpolitischen Ziele. Wollte man dagegen tatsächlich die Sozialversicherung „im Wettbewerb“ unter voller Wahrung aller ihrer Elemente und sozialpolitischen Ziele organisieren, so müsste ein künstliches, äußerst stark reguliertes Umfeld unter extremer Reduzierung unternehmerischer Freiheiten geschaffen werden, welches überdies flexibel genug sein müsste, jederzeit einen demokratisch legitimierten Wandel sozialpolitischer Ziele in die Praxis umzusetzen. Welche konkreten Vorteile ein solches System für die Beteiligten haben sollte, ist nicht ersichtlich. Es ist deshalb wenig zufriedenstellend, wenn die Sozialversicherung sich ständig im Zentrum einer interessengeleiteten europarechtlichen Debatte befindet, in der es in Wirklichkeit um grundlegende politische Entscheidungen geht. Auch wenn der Europäische Gerichtshof von Fall zu Fall derartigen Vorstößen Grenzen setzt, so geschieht dies nicht immer mit der Klarheit, die wünschenswert wäre, um weiteren Zweifeln von vornherein vorzubeugen, im Gegenteil: In Einzelfallentscheidungen bestätigte Handlungsspielräume der Sozialversicherung werden durch grundsätzlich privatisierungs- und wettbewerbsorientierte Entscheidungen in anderen Fällen wieder in Frage gestellt. Dies ist angesichts des anhaltenden Drucks aus der Wirtschaftssphäre und ihren Akteuren auch in Zukunft zu erwarten. Damit aber wird die Kompetenzordnung des EG-Vertrags, wie sie vor allem in den Art. 137, 152 und 295 zum Ausdruck kommt, sukzessive außer Kraft gesetzt. Erforderlich ist daher eine Neujustierung des europarechtlichen Verständnisses der Grenzen zwischen „marktbezogenen“, „wirtschaftlichen“ bzw. “unternehmerischen“ Aktivitäten – unter unbestrittener Gel- - 25 - tung europäischen Wirtschaftsrechts – einerseits und dem Bereich solcher Aktivitäten andererseits, der – wegen seines allgemeinen gesellschaftlichen Bezuges und der Abwesenheit kommerzieller Gewinnerzielung – dem ausschließlichen Gestaltungsermessen der Mitgliedstaaten unterliegen muss. Demgegenüber ist der neuen Tendenz in der Rechtsprechung, aus dem EG-Vertrag eine Verpflichtung zur marktkonformen Organisation und damit zur Privatisierung bisher in öffentlicher Regie und im Allgemeininteresse erbrachter Leistungen abzuleiten, eine eindeutige Absage zu erteilen. 5. Herausforderungen für die nationalen Akteure Fest steht, dass auch künftig strukturelle Gestaltungsentscheidungen für die Systeme sozialer Sicherheit vorrangig auf einzelstaatlicher Ebene gefällt werden müssen und nicht durch die EU. Andererseits ist nicht zu leugnen, dass Europa mit seiner wirtschaftspolitischen Konzentrations- und Deregulierungspolitik eine Machtdimension erreicht hat, die für die nationale Sozial- und Gesundheitspolitik einen schleichenden Souveränitätsverlust bewirkt. Zugleich befinden sich die Mitgliedstaaten im festen Griff der gemeinsamen Währungspolitik – die ihnen insofern abverlangte strenge Haushaltsdisziplin verengt die Spielräume für soziale Gestaltung. Unter diesen Rahmenbedingungen eine vorausschauende nationale – und dennoch europäisch vernetzte – Sozial- und Gesundheitspolitik zu betreiben, wird folglich immer schwieriger. Ohne breit angelegte Europakompetenz, ohne grenzüberschreitende Kooperation der Akteure kann dies kaum gelingen. Auch wird man die eigenen Anliegen mehr und mehr in einen größeren, eben europäischen, Bezugsrahmen einbringen müssen. Versagt die Politik an dieser Stelle, dann stehen so wichtige Werte wie soziale Gerechtigkeit, Solidarität und Breitenzugänglichkeit zu sozialen Dienstleistungen von hoher Qualität auf dem Spiel. Die Verwirklichung der Idee einer „Europäischen Sozialunion“, wiewohl von vielen heute noch abgelehnt, dürfte deshalb mittelfristig zu einer Notwendigkeit dafür werden, dass die Sozialversicherung vor einem „Abbau“ im Binnenmarkt geschützt wird. Europa benötigt neben seiner finanz- und wirtschaftspolitischen Dimension dringend eine gesellschafts- und sozialpolitische Flankierung bzw. eine soziale Verfasstheit. Ohne einen solchen Rahmen wird es künftig kaum mehr möglich sein, die Leitidee eines umfassenden, öffentlich verantworteten und allgemein zugänglichen Sozialschutzes im europäischen Maßstab zu bewahren. Die Bewältigung dieser außerordentlich schwierigen Aufgabe stellt wohl eine der größten historischen Herausforderungen für alle diejenigen Akteure dar, die zur Zukunftsgestaltung der Gemeinschaft berufen sind. Auch die Verantwortlichen in den Sozialversicherungen und ihren Selbstverwaltungen sowie in den Einrichtungen der gesundheitlichen Versorgung werden eine ihrer Hauptaufgaben darin sehen müssen, diesen Prozess aktiv zu begleiten. Denn langfristig wird auch im Sozialschutz und im Gesundheitssektor eine grenzüberschreitende Arbeitsteilung politisch zu organisieren sein – nicht nur in strategischer, sondern zunehmend auch in operativer Hinsicht. - 26 - Economic aspects of statutory accident insurance (considering as example the Swiss model) Willi Morger Österreich - Schweiz was sich liebt, das neckt sich! 1. Introduction Our President, Helmut Pichler, has asked me to deal with the economic aspects of statutory accident insurance in our conference. By training I am a jurist and not an economist; therefore I ask for the indulgence of the economists present. Nowadays, a good performance or the personal conviction that you render a good performance is not good enough by half. In our fast-moving time there is no flair left for centuries-old solutions when economy is concerned. Only the best is good enough. Benchmarking helps us to compare with the best. Helmut Pichler knew, of course, that Switzerland qualifies perfectly for a comparison between various public and private insurance carriers. For economists it is clear that private enterprises always work best. Jurists do not simply believe in theories, they require proof. A study at the University St. Gallen, commissioned by the Swiss government with regard to the revision of the accident insurance regulation, went further into this question. The study was conducted by Professor Franz Jaeger. It is a scientific work and not a remittance work started by Suva or private insurance companies. Before I am going to present to you the results of the Jaeger-study, I would like to shortly reintroduce the Swiss system to you again. - 27 - 2. The Swiss accident insurance system Sozialversicherungssystem Alters- und Hinterlassenenversicherung Ergänzungsleistungen Unfallversicherung (UV) Invalidenversicherung Arbeitslosenversicherung Militärversicherung Erwerbsersatzordnung Familienzulagen Landwirtschaft Mutterschaftsversicherung Krankenversicherung Berufliche Vorsorge Statutory accident insurance is a branch of Switzerland's social insurance system. Together with the other forms of social insurance coverage it forms the social security network. The social security system has developed historically. With its 11 insurance branches it has reached a considerable standard. Since it has developed over a period of decades, however, it is highly complex and lacks a certain amount of cohesion. A joint legal basis was created to define and convey common terms such as 'accident', 'invalidity', etc, in a uniform way and to better coordinate benefits. This federal legislation covering a general part of social insurance (ATSG) became effective on January 1, 2003. On July 1, 2005, the management of the Swiss military insurance was transferred to Suva. I was in charge of this project. An accident can result not only in compensation claims against the accident insurance company but also against other insurance branches such as survivors' insurance, invalidity insurance or company pension fund. Versicherte Personen Obligatorisch ArbeitnehmerInnen Arbeitslose Freiwillig Selbständigerwerbende - 28 - The accident insurance is an insurance of workers. It is compulsory for all employees working in Switzerland. Unemployed people in Switzerland are entitled to the same accident insurance protection as employees provided that and for as long as they are claiming unemployment benefits. Self-employed persons have the possibility to insure themselves on a voluntary basis under the same conditions. Housewives, children, retired persons, schoolchildren and students, therefore, are exempted from the compulsory accident insurance. Versicherte Risiken Unfälle Berufsunfälle Nichtberufsunfälle Wegunfälle = Nichtberufsunfälle Berufskrankheiten Listensystem Generalklausel Compulsory accident insurance offers coverage against accidents at work and occupational diseases. A special feature of the Swiss insurance system is the Non-Occupational Accident Insurance. Employees who work at least 8 hours a week for the same employer are also insured against leisure time accidents, in other words around the clock, both at home and abroad. Commuting accidents are considered as non-occupational accidents (exception: For part-time workers who are only insured against accidents at work they pass for accidents at work). I do not want to go into detail with the benefits but rather with the implementation of compulsory accident insurance. Versicherungsträger Die Unfallversicherung wird durchgeführt durch: Schweizerische Unfallversicherungsanstalt (Suva) andere Versicherer Private Versicherungseinrichtungen Öffentliche Unfallversicherungskassen Anerkannte Krankenkassen Ersatzkasse - 29 - In Switzerland we have a system of multiple insurance carriers. This means that the implementation of accident insurance is divided up among several insurance carriers, listed in the law: - the Swiss National Accident Insurance Fund (Suva) - Other insurance carriers, including - o private insurance organisations o public accident insurance funds o recognised health funds substitute public health insurance fund. At present, about 40 insurance companies are registered: Suva, private accident insurer, two public accident insurance funds and the substitute public health insurance fund. The substitute public health insurance fund provides coverage for employees in those companies who are not insured under Suva's remit and whose employers have failed to take out insurance as stipulated by the accident insurance law. The substitute health insurance fund, therefore, has been created as a safety net. Tätigkeitsbereiche Suva-Bereich Sekundärer Sektor Industrie Handwerk Baugewerbe Nicht Suva-Bereich Primärer Sektor Land- und Forstwirtschaft Bergbau Fischerei Tertiärer Sektor Dienstleistung Gastgewerbe Banken Kleingewerbe Versicherungen The areas of activity divided between Suva and the other insurance companies are laid down by the accident insurance law. - Article 66 of the law lists the companies and administrations whose employees are compulsorily insured with Suva. The mandatory and conclusive list covers companies in industry, trade and specific categories of business establishments by branch of industry. These are largely enterprises with a high risk level that were already assigned to Suva under the old law. - The market area of the other insurance companies is stipulated negatively with a general clause: people who are not insured under Suva's remit are insured by other insurance carriers. This avoids a no-man's-land. This sector mainly covers those industries that provide services only (banks, insurance companies, catering establishments), numerous craft industries and agricultural establishments. - This legal allocation, which, of course, does not eliminate the so called grey area, results in the following market allocation: - 30 - Marktaufteilung Anzahl Vollbeschäftigte 49% Anzahl versicherte Betriebe 51% UVG Versicherer 75% Suva 25% UVG Versicherer Suva About half of the employed in Switzerland, approximately 1.8 million, are covered by Suva. A quarter of all enterprises are covered by Suva. Suva's market share is decreasing continually. This economic trend which is developing to the disadvantage of Suva right now was most probably ignored by the legislator. One of the main tasks, therefore, of the recently initiated revision of the accident insurance regulations will be to scrutinise Suva's future positioning and to determine it for the future. Zukunft Suva? Veränderung Wirtschaftsstrukturen Privatisierung Teilmonopol 100% 3,48 Mio. 3.42 Mio. 59,0 % 2,02 Mio. 51,8 % 1.80 Mio. 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Vollbeschäftigte übrige Versicherer UVG Vollbeschäftigte Suva The economic development will – in the medium and long term – constitute an essential menace for Suva. The significance and right of Suva decreases with a diminishing market volume. An enterprise which cannot grow any more has to face problems with the financing of new investments. So much is clear: the status quo of Suva's market allocation which the legislator intended to protect with the reshaping of Suva's field of activity is not guaranteed any more today. - 31 - Deregulation of Suva's partial monopoly would solve the problem of the declining number of persons insured. Suva would no longer be tied to the shrinking secondary sector and would have the opportunity to maintain or even expand its insurance portfolio. However, the downside of this kind of liberalization would be a loss of solidarity within the risk groups. As a consequence, companies insured with Suva would have to pay higher premiums than today. And by no means would it be a foregone conclusion that Suva could continue to exist in a free market; an expensive restructuring would be necessary. A Suva with private law support could act more flexibly and better meet its customers' requirements. It would be free in the choice of the products it offers and it could also become involved in private enterprise. On the other hand, it would entail a loss of Suva's sovereignty in occupational safety. It would lose its legitimacy as the implementing body in occupational safety and would thus lose one of its strengths, namely the combination of prevention, insurance and rehabilitation. Suva's business management has taken an in-depth look at the different alternatives. It is of the opinion that the current solution for enterprises and employees offers considerable advantages. Efforts are now directed at maintaining Suva as a financially independent, non-profit organisation under public law. We see the future of Suva in a top-quality range of prevention, insurance and rehabilitation. Based on these core skills, business areas are to be expanded and new services to be offered in the public interest. Case management for other insurance companies, electronic advisory and coordination services, services for the health care sector (e.g. medical tariffs, statistics) and services relating to capital investment by institutions under public law will be given prominence. In this way, the decline in the number of insurees can be compensated for and the future of Suva assured in its current role in the healthcare sector. And it was fort his reason that the military insurance was integrated into the Suva system with almost unanimous approval of parliament. To be ready and prepared for future discussions on the organisation of the accident insurance, the federal government a cost-benefit analysis of accident insurance from the University St. Gallen. - 32 - 3. Results of the Jaeger-Study The objective of the study was to clarify the benefits and drawbacks of a complete liberalization of the Swiss accident insurance market as well as a privatization of Suva in comparison to the status quo. An important part of the empirical analysis was the comparison of the relationship between output and input of the various insurance carriers. This relationship indicates which percentage of the premiums an insurer collects in a fiscal year is spent again on insurance benefits. The remaining input which is not spent on insurance benefits is predominantly used for administration costs of the carrier as well as for the financing of the capital. The higher the percentage of the output (insurance benefits), the lower, therefore, the costs of administration and capital which arise when rendering a certain amount of insurance benefits. The insured person, therefore, prefers a high output-input relationship. As a non-profit organisation Suva cannot make profits in the long run and therefore passes on cost advantages to the insurees. The input-output relationship to a certain extent also is an efficiency measure. Suva - die effizienteste Unfallversicherung 94.9% 100% Prämien und Kapitalerträge Kosten- und Nutzenanalyse von Professor Franz Jaeger, Universität St. Gallen: als Leistung zurück an die Versicherten 83.2% 79.2% Private UVGVersicherer Krankenkassen SuvaVersicherte Professor Jaeger came to the following conclusion: Compared to private insurance companies, Suva passes on a greater percentage of its income to the insurees in the form of insurance benefits. It stands to reason that Suva has a higher output-input-relationship simply because, among other things, it only needs little capital of its own due to the monopoly, does not have to pay interest on it and, moreover, does not have hardly any acquisition costs. In the study at hand there is no evidence to suggest that possible disadvantages in efficiency of Suva might nullify these advantages. At the oral presentation of the final report Professor Jaeger could (or, maybe, rather had to – for he was a known liberalizer) report that Suva had been administrated very well, obviously also economically. He could not find any inefficiency. For him, Suva was an exceptional case. A reorganization or privatization would not lead to any definite effect. Yet, theoretically, at least, he holds true that competitive economy is better in fact. To sum up the study of the University St. Gallen: on the one hand, it gave positive proof of the efficiency of Suva as enterprise and, on the other hand, it showed that its organization as non-profit institution under public law with its mix of prevention, insurance and rehabilitation is an overall sophisticated and elaborate system. In the following, I would, therefore, like to show successful examples of prevention, insurance and rehabilitation. - 33 - 4. Effective prevention 4.1 Example occupational safety The storms "Viviane" (1990) and "Lothar" (2000) wreaked great havoc in our country and cost the lives of many. As you can see in the illustration, Wirkungsvolle Prävention im Forst Sturmholz (Mio. m3) Tödlich Verunfallte 16 14 12 10 8 6 4 2 0 16 14 12 10 8 6 4 2 0 "Viviane" 1990 Privatpersonen "Lothar" 2000 "Viviane" 1990 "Lothar" 2000 MA Forstbetriebe the forestry industries under Suva's care are significantly better protected than private individuals who are not covered by Suva. The high fatality rate (also for Suva) as a consequence of "Viviane" resulted in a clear intensification of prevention measures which for Suva lead to a clear decrease of the fatality risk in the case of "Lothar", a storm which was considerably stronger than "Viviane". At the same time, the number of private individuals who suffered a fatal accident during clean-up operations after the storm remained nearly the same. Forstunfälle je 1000 Vollbeschäftigte Arbeitssicherheit im Forst: Trendwende dank Kampagne 450 400 SuvaPro-Kampagne „Wald – Sicherheit ist machbar“ 350 300 250 200 150 100 50 0 1985 1990 1995 2000 2005 Also the above illustration is proof of the positive trend which was started in the companies covered by Suva as a consequence of the storm "Viviane". - 34 - 4.2 Leisure time safety Erfolgreiche Velohelm- Kampagne Entwicklung der Velounfälle und Kopf-/Schädelverletzungen seit 1987 (Start Velohelm-Kampagne) 180% 160% 140% 120% 100% 80% 60% 40% 20% 19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 0% alle Velounfälle Anteil Kopf-/Schädelverletzungen More and more people in Switzerland are taking the bike. As first insurance carrier in Switzerland, Suva campaigned for the bike helmet and could thus, despite the rising number of bike accidents, reduce the percentage of head and cranium injuries considerably and continually. Gegen 40% der Sportunfälle ereignen sich beim Ballsport Joggen, Fitness 5% Wassersport 7% Bergsport 2% Reiten 2% Kampfsport 2% andere Sportarten 12% Fussball 25% 42‘000 Unfälle Wintersport 31% 145 Mio. CHF laufende Kosten anderer Ballsport 14% 23‘000 Unfälle 67 Mio. CHF laufende Kosten About one third of the leisure time accidents are sporting accidents, most prevalently winter and ball sports. - 35 - Aktion “Sicherheit an Grümpelturnieren“ Leistungen von Suva + Leistungen der Organisatoren Schiedsrichter Unterstützungsbeitrag Grümpelturnierset Unfälle: Sicherheits- und unfallverhütende Massnahmen gemäss Checkliste einhalten Während den Turnieren ereigneten sich: Ohne Massnahmen bei 26‘000 Mit Suva-Massnahmen bei 23‘000 Unfallrisiko: Auf 1000 Spieler ereigneten sich: Ohne Massnahmen = Mit Suva-Massnahmen = 440 Unfälle 100 Unfälle 16.7 Unfälle 4.3 Unfälle In Switzerland, the very popular football tournaments ("Grümpeltourniere") have a high accident risk. At these amateur tournaments, the players play as if they could get a high premium for each goal. By employing professional referees (Suva pays for the costs) the number of accidents could be reduced by the factor 4. There are many more prevention examples; I have picked out just some very important ones. - 36 - Wirtschaftliche Aspekte der gesetzlichen Unfallversicherung (dargestellt anhand des Schweizer Modells) Willi Morger Österreich - Schweiz was sich liebt, das neckt sich! 1. Einleitung Unser Präsident Helmut Pichler hat mich beauftragt, mich mit den wirtschaftlichen Aspekten der gesetzlichen Unfallversicherung an unserer heutigen Tagung auseinander zu setzen. Ich bin von meiner Ausbildung her Jurist und nicht Ökonom und ich bitte daher die anwesenden Ökonomen um Nachsicht oder, falls sie irgendetwas vermissen, um schonendes Anhalten. Eine gute Leistung oder die persönliche Überzeugung, dass man eine gute Leistung erbringt, genügt heute längst nicht mehr. Unsere schnelllebige Zeit hat in wirtschaftlichen Fragen kein Flair mehr für bald jahrhundert alte Lösungen. Nur das Beste ist gut genug. Mittels Benchmarking wird mit den Besten verglichen. Helmut Pichler hat natürlich gewusst, dass sich die Schweiz hervorragend für einen Vergleich zwischen verschiedenen, öffentlichen und privaten Anbietern eignet. Für Ökonomen dürfte klar sein, dass private Unternehmungen immer am besten arbeiten. Juristen glauben nicht einfach an Theorien, sie verlangen Beweise. Eine Studie der Universität St. Gallen, die im Auftrag der schweizerischen Landesregierung im Hinblick auf die Revision des Unfallversicherungsgesetzes in Auftrag gegeben worden ist, ging dieser Frage nach. Die Studie wurde durch Herrn Professor Franz Jaeger verfasst. Es handelt sich dabei um eine wissenschaftliche Arbeit und nicht um eine von der Suva oder den Privatversicherungen bestellte Auftragsarbeit. Bevor ich ihnen die Ergebnisse der Jaeger – Studie präsentiere, möchte ich ihnen das schweizerische System nochmals kurz in Erinnerung rufen. - 37 - 2. Das schweizerische Unfallversicherungssystem Bevor ich ihnen unser System nochmals kurz zu erklären versuche, gestatten sie mir einen Hinweis an die Organisatoren dieser Tagung. Vielleicht könnten sie während meinen allgemeinen Ausführungen über das schweizerische System noch Schutzbrillen für meine Zuhörerinnen und Zuhörer beschaffen. Die Zahlen die ich ihnen nämlich später vermitteln darf, sind nämlich so blendend, dass Schutzbrillen sehr dienlich sein könnten. Sozialversicherungssystem Alters- und Hinterlassenenversicherung Ergänzungsleistungen Unfallversicherung (UV) Invalidenversicherung Arbeitslosenversicherung Militärversicherung Erwerbsersatzordnung Familienzulagen Landwirtschaft Mutterschaftsversicherung Krankenversicherung Berufliche Vorsorge Die gesetzliche Unfallversicherung ist ein Teil des Sozialversicherungssystems der Schweiz. Zusammen mit den anderen Sozialversicherungen bildet sie das Netz der sozialen Sicherheit. Dieses Sozialversicherungssystem ist historisch gewachsen. Mit seinen elf Versicherungszweigen weist es einen beachtlichen Standard auf. Wegen der Entstehung über Jahrzehnte ist es jedoch sehr komplex und wenig kohärent. Um gemeinsame Begriffe wie zum Beispiel Unfall, Invalidität usw. einheitlich zu umschreiben und auszugestalten, um das Verfahren zu vereinheitlichen und um Leistungen besser zu koordinieren, wurde eine gemeinsame gesetzliche Basis geschaffen. Dieses Bundesgesetz über einen allgemeinen Teil der Sozialversicherung (ATSG) ist erst am 1. Januar 2003 in Kraft getreten. Seit dem 1. Juli dieses Jahres ist die Militärversicherung organisatorisch in die Suva integriert worden. Als Projektverantwortlicher wurde ich dadurch militärisch nicht befördert, so dass ich heute, vor allem zur Enttäuschung unserer italienischen Kollegen, nicht in der Generalsuniform auftreten muss. Nach einem Unfall können unter Umständen nicht nur Ansprüche gegenüber der Unfallversicherung entstehen, sondern zugleich gegenüber anderen Versicherungszweigen wie den Hinterlassenen und der Invalidenversicherung oder der beruflichen Vorsorge. - 38 - Versicherte Personen Obligatorisch ArbeitnehmerInnen Arbeitslose Freiwillig Selbständigerwerbende Die Unfallversicherung ist eine Arbeitnehmerversicherung. Obligatorisch versichert sind also in der Schweiz beschäftige Arbeitnehmerinnen und Arbeitnehmer. Auch Arbeitslose geniessen in der Schweiz den gleichen Unfallversicherungsschutz wie Arbeitnehmer, sofern und solange sie Entschädigung von der Arbeitslosenversicherung beziehen. Selbständigerwerbende haben die Möglichkeit, sich zu analogen Bedingungen freiwillig zu versichern. Nicht der obligatorischen Unfallversicherung unterstellt sind dem gegenüber Hausfrauen, Kinder und Pensionierte sowie Schüler und Studenten. Versicherte Risiken Unfälle Berufsunfälle Nichtberufsunfälle Wegunfälle = Nichtberufsunfälle Berufskrankheiten Listensystem Generalklausel Die obligatorische Unfallversicherung bietet Versicherungsschutz gegen Berufsunfälle und Berufskrankheiten. Daneben kennt die Schweiz eine Besonderheit: die Nichtberufsunfallversicherung. Arbeitnehmer, deren wöchentliche Arbeitszeit bei einem Arbeitgeber mindestens acht Stunden beträgt, sind auch gegen Freizeitunfälle, also rund um die Uhr, im In – und Ausland unfallversichert. Wegunfälle gelten als Nichtberufsunfälle (Ausnahme: Bei Teilzeitbeschäftigten, die nur Berufsunfall versichert sind, zählen sie zu den Berufsunfällen). Auf die Versicherungsleistungen möchte ich heute nicht eingehen, sondern mich mit der Durchführung der Unfallversicherung näher befassen. - 39 - Versicherungsträger Die Unfallversicherung wird durchgeführt durch: Schweizerische Unfallversicherungsanstalt (Suva) andere Versicherer Private Versicherungseinrichtungen Öffentliche Unfallversicherungskassen Anerkannte Krankenkassen Ersatzkasse Wir kennen in der Schweiz das System der Mehrfachträgerschaft. Das heisst, die Durchführung der obligatorischen Unfallversicherung ist auf mehrere Träger (Unfallversicherer) aufgeteilt, die das Gesetz aufzählt: - Die schweizerische Unfallversicherungsanstalt Suva - Andere Versicherer, das sind: - o Private Versicherungseinrichtungen o Öffentliche Unfallversicherungskassen o Anerkannte Krankenkassen Die Ersatzkasse Zur Zeit sind rund vierzig Versicherer registriert. Die Suva, private Unfallversicherer, Krankenkassen, zwei öffentliche Unfallversicherungskassen sowie die Ersatzkasse. Die Ersatzkasse soll den gesetzlichen Versicherungsschutz für diejenigen Arbeitnehmer sicherstellen, für welche die Suva nicht zuständig ist und deren Arbeitgeber den Abschluss einer UVG-Versicherung unterlassen haben. Die Ersatzkasse dient also als Auffangbecken. Tätigkeitsbereiche Suva-Bereich Sekundärer Sektor Industrie Handwerk Baugewerbe Nicht Suva-Bereich Primärer Sektor Land- und Forstwirtschaft Bergbau Fischerei Tertiärer Sektor Dienstleistung Gastgewerbe Banken Kleingewerbe Versicherungen - 40 - Die Tätigkeitsbereiche zwischen der Unfallversicherungsgesetz vorgezeichnet: Suva und den übrigen Versicherern sind durch das - Art. 66 des Gesetzes zählt die Betriebe und Verwaltungen auf, deren Arbeitnehmerinnen und Arbeitnehmer obligatorisch bei der Suva versichert sind. Der zwingende und abschliessende Katalog umfasst nach Wirtschaftszweigen Betriebe der Industrie, des industriellen Handels und bestimmte Kategorien von Gewerbebetrieben. Es handelt sich dabei weitgehend um Betriebe mit hohem Risiko, die bereits unter altem Recht der Suva unterstellt waren. Hinzu kommen die gesamte Bundesverwaltung, die Bundesbetriebe und Bundesanstalten. - Der Marktbereich der übrigen Versicherer wird negativ durch eine Generalklausel umschrieben. Personen, für deren Versicherung nicht die Suva zuständig ist, werden durch andere Versicherungsträger versichert. Dadurch wird ein Niemandsland vermieden. In diesen Bereich fallen vor allem reine Dienstleistungsbetriebe wie Banken, Versicherungen und Gastwirtschaftsbetriebe, zahlreiche Betriebe des Handwerks und die Betriebe der Landwirtschaft. Aus dieser gesetzlichen Zuteilung, bei der es selbstverständlich auch eine so genannte Grauzone gibt, ergibt sich folgende Marktaufteilung: Marktaufteilung Anzahl Vollbeschäftigte 49% 51% UVG Versicherer Suva Anzahl versicherte Betriebe 75% 25% UVG Versicherer Suva Gut die Hälfte aller Beschäftigten in der Schweiz, ca. 1.8 Millionen, sind bei der Suva versichert. Ein Viertel aller Betriebe sind bei der Suva versichert. Der Marktanteil der Suva nimmt kontinuierlich ab. Diese wirtschaftliche Entwicklung, die zurzeit zu Ungunsten der Suva verläuft, hatte der Gesetzgeber wohl übersehen. Deshalb ist es eine der Hauptaufgaben der eingeleiteten Revision des Unfallversicherungsgesetzes, die zukünftige Positionierung der SUVA zu hinterfragen und für die Zukunft festzulegen. - 41 - Zukunft Suva? Veränderung Wirtschaftsstrukturen Privatisierung Teilmonopol 100% 3,48 Mio. 3.42 Mio. 59,0 % 2,02 Mio. 51,8 % 1.80 Mio. 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Vollbeschäftigte übrige Versicherer UVG Vollbeschäftigte Suva Die wirtschaftliche Entwicklung bildet mittel- und langfristig eine existenzielle Gefahr für die Suva. Die Bedeutung und die Berechtigung der Institution Suva sinkt mit der Verkleinerung des Marktvolumens. Eine Unternehmung, die nicht mehr wachsen kann, hat mit Problemen für die Finanzierung neuer Investitionen zu rechnen. Klar ist, dass der Besitzstand der Suva, den der Gesetzgeber mit der Umschreibung des Tätigkeitsfeldes wahren wollte, heute nicht mehr gewährleistet ist. Eine Aufhebung des Teilmonopols der Suva würde das Problem des sinkenden Versicherungsbestandes lösen. Die Suva wäre nicht mehr an den schrumpfenden Sekundärsektor gebunden und bekäme die Chance, ihren Versichertenbestand zu halten oder sogar auszubauen. Die Kehrseite einer solchen Liberalisierung ist jedoch ein Verlust an Solidarität innerhalb der einzelnen Risikogruppen. Als Folge hätten die bei der Suva versicherten Betriebe höhere Prämien als heute zu entrichten. Es wäre zudem keineswegs sicher, dass sich die Suva in einem freien Markt halten könnte. Eine sehr teure Umstrukturierung wäre notwendig. Eine Suva mit privatrechtlicher Trägerschaft könnte flexibler agieren und besser auf Kundenwünsche eingehen. Sie wäre frei bei der Wahl ihrer Produkte und könnte auch privatwirtschaftliche Tätigkeiten ausüben. Damit wäre aber auch ein Wegfall der hoheitlichen Tätigkeiten der Suva in der Arbeitssicherheit verbunden. Sie würde die Legitimation als Durchführungsorgan in der Arbeitssicherheit und damit eine ihrer Stärken, nämlich die Verbindung von Prävention, Versicherung und Rehabilitation verlieren. Die Geschäftsleitung der Suva hat verschiedene Varianten eingehend geprüft. Sie vertritt die Auffassung, dass die heute geltende Lösung für Betriebe und Arbeitnehmer wesentliche Vorteile bietet. Die Suva soll ein finanziell unabhängiges non-profit Unternehmen des öffentlichen Rechts bleiben. Wir sehen die Zukunft der Suva in einem qualitativ hoch stehenden Angebot von Prävention, Versicherung und Rehabilitation. Gestützt auf diese Kernkompetenzen sollen die Geschäftsfelder erweitert werden und neue Leistungen im öffentlichen Interesse angeboten werden. Im Vordergrund stehen die Schadenerledigung für andere Versicherer, elektronische Beratungs- und Koordinationsdienstleistungen sowie Dienstleistungen für das Gesundheitswesen (z. B. Medizinaltarife, Statistik) und Dienstleistungen für Kapitalanlagen öffentlich-rechtlicher Institutionen. Dadurch kann ein Rückgang des Versichertenbestandes kompensiert und die Zukunft der Suva mit ihrer heutigen Rolle im Gesundheitswesen gesichert werden. Genau aus diesem Grund haben wir mit fast einheitlicher Zustimmung des Parlamentes die Militärversicherung in das Suva-System integriert. Um für die künftigen Diskussionen über die Organisation der Unfallversicherung gewappnet zu sein, holte die Landesregierung eine Kosten– Nutzenanalyse über die Unfallversicherung bei der Universität St. Gallen ein. - 42 - 3. Ergebnisse der Jaeger- Studie Ziel der Studie war es, die Kosten und den Nutzen einer Liberalisierung des schweizerischen Unfallversicherungsmarktes und einer Privatisierung der Suva im Vergleich zum Status quo abzuschätzen. Ein wichtiger Bestandteil der empirischen Analyse war der Vergleich der Output / Input Relation der verschiedenen Versicherer. Diese gibt an, welcher Prozentsatz der einem Versicherer in einem Rechnungsjahr zufliessenden Einnahmen in Form von Versicherungsleistungen wieder ausgegeben werden. Die verbleibenden Einnahmen, welche nicht als Versicherungsleistung (Outputs) wieder ausgegeben werden, werden vorwiegend für Verwaltungskosten des Versicherungsbetriebes sowie für die Finanzierung des Eigenkapitals der Versicherer verwendet. Je höher der Prozentsatz der als Versicherungsleistungen (Outputs) wieder ausbezahlten Inputs ausfällt, desto tiefer sind folglich die Verwaltungs- und Kapitalkosten welche einem Versicherer bei der Einbringung einer bestimmten Summe an Versicherungsleistungen entstehen. Aus Sicht des Versicherungsnehmers, ist deshalb eine möglichst hohe Output / Input Relation wünschenswert. Die Suva hat als non-profit Organisation keine Möglichkeit, längerfristig Gewinne zu erzielen und gibt daher die Kostenvorteile an die Versicherungsnehmer weiter. Die Output / Input Relation bildet in einem gewissen Sinne auch ein Effizienzmass. Suva - die effizienteste Unfallversicherung 94.9% 100% Prämien und Kapitalerträge Kosten- und Nutzenanalyse von Professor Franz Jaeger, Universität St. Gallen: als Leistung zurück an die Versicherten 83.2% 79.2% Private UVGVersicherer Krankenkassen SuvaVersicherte Jetzt kommt die Stunde der Wahrheit, oder eine meiner blendenden Zahlen. Professor Jaeger gelangte zu folgendem Fazit: Im Vergleich zu den Privatversicherern zahlt die Suva einen höheren Anteil ihrer Einnahmen in Form von verschiedenen Arten von Versicherungsleistungen wieder an ihre Versicherten aus. Die Vermutung liege nahe, dass die Suva unter anderem deshalb eine höhere Output / Input Relation aufweist, weil sie dank des Monopols nur wenig Eigenkapital benötigt, dieses zudem nicht verzinsen muss und überdies kaum Akquisitionskosten hat. Die vorliegende Untersuchung liefere keine Anzeichen dafür, dass allfällige Effizienznachteile der Suva diese Vorteile zunichte machen könnten. Bei der mündlichen Präsentation des Schlussberichts durfte Herr Professor Jaeger - vielleicht war es für ihn, den bekannten Liberalisierer, eher ein Müssen - dass die Suva sehr gut geführt worden sei und offensichtlich auch sehr gut gewirtschaftet habe. Ineffizienzen hätte er keine feststellen können. Die Suva sei für ihn ein Ausnahmefall. Eine Umstellung beziehungsweise eine Privatisierung brächte keinen eindeutigen Effekt. Obwohl für ihn rein theoretisch gelte, dass die Wettbewerbsökonomie eigentlich besser sei. - 43 - Für mich bleibt als Fazit der Studie der Universität St. Gallen: Einerseits der klare Beweis der Leistungsfähigkeit der SUVA als Unternehmung und andererseits die Tatsache, dass deren Ausgestaltung als öffentlich-rechtliche non-profit Organisation mit dem Produktemix Prävention, Versicherung und Rehabilitation ein durchdachtes, kluges Gesamtsystem darstellt. Ich möchte deshalb im Folgenden in der Form von Beispielen gelungene Teilbeiträge der Prävention der Versicherung und der Rehabilitation aufzeigen. 4. Wirkungsvolle Prävention 4.1 Beispiel Arbeitssicherheit Die Stürme “Viviane“ im Jahre 1990 und “Lothar“ im Jahre 2000 haben in unserem Land grosse Schäden angerichtet und zahlreiche Menschenleben gefordert. Sie können aus dem Bild ersehen, Wirkungsvolle Prävention im Forst Sturmholz (Mio. m3) Tödlich Verunfallte 16 14 12 10 8 6 4 2 0 16 14 12 10 8 6 4 2 0 "Viviane" 1990 Privatpersonen "Lothar" 2000 "Viviane" 1990 "Lothar" 2000 MA Forstbetriebe dass die von der Suva betreuten Forstbetriebe wesentlich besser geschützt sind als die Privatpersonen, die nicht von der Suva betreut werden. Die hohe Todesfallquote, welche auch die Suva beim Sturm “Viviane“ zu beklagen hatte, führte zu einer deutlichen Verschärfung der Präventionsmassnahmen. Dies hat beim Sturm “Lothar“, der im Vergleich zu “Viviane“ wesentlich stärker war, zu einer deutlichen Senkung des Todesfallsrisikos bei der SUVA geführt, während fast die gleiche Zahl der Privatpersonen bei den Aufräumungsarbeiten nach “Lothar“ tödlich verunfallt sind. - 44 - Forstunfälle je 1000 Vollbeschäftigte Arbeitssicherheit im Forst: Trendwende dank Kampagne SuvaPro-Kampagne „Wald – Sicherheit ist machbar“ 450 400 350 300 250 200 150 100 50 0 1985 1990 1995 2000 2005 Auch dieses Bild belegt, welch positive Trendwende der Sturm “Viviane“ bei den Suva versicherten Betrieben eingeleitet hat. 4.2 Freizeitsicherheit Erfolgreiche Velohelm- Kampagne Entwicklung der Velounfälle und Kopf-/Schädelverletzungen seit 1987 (Start Velohelm-Kampagne) 180% 160% 140% 120% 100% 80% 60% 40% 20% 19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 0% alle Velounfälle Anteil Kopf-/Schädelverletzungen Immer mehr Leute sind mit dem Fahrrad, wir reden in der Schweiz vom Velo, unterwegs. Die Suva hat als erste Versicherung in der Schweiz das Tragen des Velohelms propagiert und konnte trotz der steigenden Anzahl der Fahrradunfälle den Anteil der Kopf- und Schädelverletzungen deutlich und kontinuierlich senken. - 45 - Gegen 40% der Sportunfälle ereignen sich beim Ballsport Joggen, Fitness 5% Bergsport 2% Wassersport 7% Reiten 2% Kampfsport 2% andere Sportarten 12% Fussball 25% 42‘000 Unfälle Wintersport 31% 145 Mio. CHF laufende Kosten anderer Ballsport 14% 23‘000 Unfälle 67 Mio. CHF laufende Kosten Die Sportunfälle machen rund einen Drittel aller Freizeitunfälle aus. Die Winter- und Ballsportarten prägen den Sportunfallbereich. Aktion “Sicherheit an Grümpelturnieren“ Leistungen von Suva + Leistungen der Organisatoren Schiedsrichter Unterstützungsbeitrag Grümpelturnierset Unfälle: Sicherheits- und unfallverhütende Massnahmen gemäss Checkliste einhalten Während den Turnieren ereigneten sich: Ohne Massnahmen bei 26‘000 Mit Suva-Massnahmen bei 23‘000 Unfallrisiko: Auf 1000 Spieler ereigneten sich: Ohne Massnahmen = Mit Suva-Massnahmen = 440 Unfälle 100 Unfälle 16.7 Unfälle 4.3 Unfälle Die in der Schweiz beliebten Grümpelturniere haben ein gewaltiges Unfallpotenzial. Die Amateurfussballer pflegen bei solchen Turnieren so zu kämpfen, wie wenn sie für jedes Tor eine hohe Prämie erhalten könnten. Durch den Einsatz von professionellen Schiedsrichtern, deren Kosten die Suva übernimmt, konnten die Unfallzahlen um den Faktor Vier reduziert werden. Es gäbe weitere Beispiele aus dem Präventionsbereich. Ich habe hier nur einige wichtige besonders hervorgehoben. - 46 - Occupational diseases Peter Pils Dominique Dressler We are here addressing a community of countries that are members of the enlarged European Union. Almost all of the twenty-five are represented, and there are still other guests, and almost everyone speaks a different language. We all belong to the species Homo sapiens sapiens, and our genomes are largely the same. What unites us is the gift of language, but it is the way we use this gift that divides us. Just look at the astounding variety represented in this hall: from the agglutinating languages of Finland, Estonia and Hungary to the inflecting Indo-European languages of the Baltic, Slavic, Scandinavian-Germanic-Celtic area, to the Romance and Hellenic languages and the language of Malta with its Arabic roots. By our reflections we should like to set you thinking in a playful way. Our subject is “occupational diseases” – but what does than mean? What are we talking about, and in what words? Do we actually mean one and the same thing in our different languages? Our interpreters translate our presentations into four languages – English, French, German and Italian. A few centuries back we would have spoken Latin, the lingua franca of the time, and there is much to suggest that in future this lingua franca will be English, or some sort of English. If this is so, we will have to deal more earnestly with the concepts behind our words – translating words will not be good enough if we aim at understanding one another. Occupational diseases – the Austrian view Let us begin by briefly presenting occupational diseases from the Austrian perspective. There are, in fact, several perspectives to be borne in mind: 1. The legal perspective “Occupational diseases” is a concept defined in law – described, listed and regulated in the Austrian General Social Insurance Act. To put it simply: there are only such occupational diseases as are specifically listed in the Act. 2. The insurance perspective Occupational diseases have to be notified to a social accident insurance institution that operates along similar lines as a liability insurance. The notified cases have to be investigated and recognised as occupational diseases and compensated, if all the necessary prerequisites are met, compensated in the form of pensions, in kind – by every and any appropriate means, as the Austrian law expressly says. As long as the liability privilege of this accident insurance exists, employers are safe from lawsuits and employees need not go to the law in order to obtain justice. – All parties concerned are, however, aware that such a thing as full compensation does not exist. - 47 - 3. The medical perspective From the medical point of view, occupational diseases are no more and no less than diseases – with an aetiology most probably connected with the patient’s occupation. The physician will first of all have to diagnose the disease, and then to treat it, i.e. to combat the direct consequences of the disease, and ultimately to get the individual in question out of the danger zone and, by calling attention to the hazard, prevent other people from being exposed to similar hazards. In doing his job, the physician is assisted by epidemiology, which help establish the cause-and-effect relationship between the noxa and the disease and on that basis to initiate the necessary safety measures. The physician is in no way interested in the quibbling of other experts as to whether the disease is caused by the patient’s work, associated with his work, due to his occupation or whatever other shades of meaning might be thought up. The only thing that counts is the fact that somebody is ill and that there is some sort of causality (something that can only rarely established in the field of medicine, anyway). Since classic clinical medicine follows the same rules in civilised countries all over the world, we can at least forget to search for national differences in this respect. The concept of disease as such does not concern us, since the WHO has prepared an adequate definition. It suffices for us to define disease, like St. Thomas Aquinas in his Doctrine of Attributes, as the absence of health. The CONCEPT of occupational diseases in Europe This brings us all of a sudden to the heart of the matter: the reflection on how we should deal with the concept of occupational diseases in this new Europe of the Twenty-five – or maybe of the Forty or Fifty, if its borders extend one day the Caucasus and Urals or even beyond. It’s all very well to smile now, but just think for a moment whether way back in 1781 the Founding Fathers of the confederation of the eleven states that were to become the United States of America, could have believed that Hawaii, which had only just been discovered three years before (in 1778), would become the 50th State of the USA in 1959. It is a fact that – medicine apart – neither the Europe of the Fifteen nor that of the Twenty-five has ever handled or, in fact, handles, the concept of occupational diseases in one and the same way. Other speakers have presented, or are still going to present these differences, but I for one should like to invite you on a mystery tour into the realm of the intellectual bases on which these different systems have been built. We speak of the old and the new EU countries, the even newer and the newest ones, and disregard that all these are countries with a coherent history in the European context that extends over 1000 years or more, with traditions, legends, heroic epics, religions, affiliations with or imposed incorporations into other countries. Tradition – the handing-down of images and modes of behaviour from generation to generation – has woven patterns of rational and emotional thinking into national self-images of which other nations are not, or only partly, aware. What we propose to do today is examine, in a not too academic sort of way, how the differences in our understanding of occupational diseases may have come about. - To do this, we will first of all have to analyse three concepts such as “occupation”, “work/labour” or “vocation/profession” in the light of the different angles from which they are seen by those who want the work to be done in order to derive a - legitimate - profit and those who perform that work in order to earn a living. - 48 - Once we see more clearly, we will have to reflect on the interactions between these groups, on the ability of the persons concerned to decide to which of the two groups they want to belong, on the contract on which their relationship is based, and on the mutual responsibilities resulting therefrom. The significance that is attached in a given tradition to the freedom of decision and the responsibility of the individual may help us to better understand the way those who belong to this or that tradition use the concept of “occupational disease”. Let us first of all consider the language aspect, that is to say, the meaning of the terms “occupation”, “work/labour” and “vocation/profession” The term “occupation” - occupatio in Latin, - describes a target-oriented activity. It is the broadest term, since it implies neither any material objective or purpose nor any valuation; it refers to the human endeavour to engage in the coherent act of creating something. These activities may be fraught with risks, i.e. there may be a cause-and-effect relationship between the circumstances of the activity and the adverse effect it may generate – in certain cases a disease. This insight demands – apart from the need for medical treatment of the damage caused – that further damage should be immediately prevented by a clear and understandable description of the risk and by strategies designed to avoid it in future. Disregarding or belittling our knowledge of the significance of a noxa would be an inexcusable omission (faute inexcusable). Before moving on to the next point, let us broaden the meaning of the term by adding another aspect – a reference to the result achieved, or in other words, the work done – the result of labour. This brings us to a discussion of the next concept: Labour – from Latin labor, - describes an occupation for the purpose of making a living. In the IndoEuropean languages, the roots lab/rab/arb, which are etymologically related, appear to have something to do with suffering, lack of freedom, serfdom, painful and laborious efforts, as in a woman’s labour pains, in working the soil, etc. The term labour thus has negative connotation, be it that it refers to the farmer’s struggling against the forces of nature or to the labourer’s work for the benefit of others. Similarly, the French word travail and its equivalents in other Romance languages are derived from late Latin trepalium, an instrument of torture, and basically point in the same direction. The decisive element is suffering, lack of freedom – implying a polarity between those who do the work and those that make them do it. Accordingly, the world of values gives way to a world of diverging interests, and no matter whether those who represent these interests strive for consensus or conflict, the very fact that the one who does the work is necessarily unfree imposes on those who require their work the duty to take care of and assume responsibility for those working, or in other words, liability for damages. Preventing damage by taking the edge off any potential risks before it is too late is reduced to a mere recommendation. The argument that there are indirect benefits is advanced as a defence, sanctions remain fairly harmless, and only gross negligence in defiance of better knowledge will be sanctioned by the law. As a result, while there are strict rules and rituals governing compensation for permanent damage, the failure to prevent damage in the first place is not seen as an inexcusable omission in the sense referred to above. Vocation/profession, in Latin vocatio or professio, raises the concept of work to a higher level of awareness. The concept comprises such elements as aptitude, skills, training and knowledge, possibly also adherence to a certain group or guild that offers a measure of protection to its members. Even though there is no fundamental difference between dependent work as a labourer and practicing a vocation in dependent employment, there may be a tendency towards privileging certain groups, affording them special protection, providing for special preventive measures or training etc. Conceivably, more thorough special information and training regarding the working conditions in a given vocation might help raise risk - 49 - awareness and the individuals’ sense of responsibility, which would, in turn, help to warn of hardly excusable omissions before real damage occurs. In the second part of these reflections on the nature of occupational diseases we ought to deal with the relationship between those who work for a remuneration and those who benefit from the work of others. In this context, we will have to look at three concepts – free will, work contract, and the responsibilities to be derived therefrom. Any discussion of free will is inseparably linked with the fascinating personality of St. Augustine. He was the first to see and analyse the dilemma of a supreme, omnipotent, omniscient, all-bountiful, incomprehensible power and the free decision of the human being exercising his free will. For Augustine that power is the God of Christianity, but the concept can easily be replaced by Fate, the State, Providence or simply Society. In 4th-century Christianity, Augustine realised that it was Divine Grace in the Pauline sense that endowed the human being with freedom of action in an ethical, social or religious context. In other words: it is God’s will that human beings should decide freely. A most elegant solution, and one that has formed the basis for all further considerations of the subject of free will. One may be for it in the spirit of neoliberalism , or against it and therefore leave decisions to society, one can opt for a minimum of governmental interference or for a state that regulates life in all its aspects. One can be a free cat among free pigeons, or, in the spirit of solidarity, be willing to share the burden of remedying guiltless misery through government action. Most of the current ideologies have their place somewhere in between these extremes. The idea of freedom of action is also of decisive importance for the quality of the work contract. Those willing to do good work - to perform a job - meet partners willing to accept that work. This means at the same time, that someone will look for an individual willing to do the work the other person requires in order to meet his entrepreneurial objective. As always in a setting of free enterprise, what counts is the interplay of supply and demand and the resulting price to be paid for the work needed. Irrespective of the formal conditions, some agreement, relationship or contract must be brought about between the person who has a demand for a given work and the person willing to do what is needed. Such an agreement or contract means that both parties take on responsibilities. Such agreements cover a wide range of workers and activities – from the day labourer in a supermarket who puts purchased goods in paper bags to the skilled worker protected by a collective agreement or minimum wage guarantee and statutory social insurance. Whatever the case may be, there are at least two partners who come to an understanding on the basis of their freedom of action – and this takes us back to the two ideologies described above: is the contract concluded between two individuals who enjoy freedom of action, or is it in reality the result of coercion or duress? This question brings us logically to the extent of responsibility. Responsibility means no more and no less than that I have to justify my actions and their consequences before a higher instance – God, the government, society, the courts of law - even my own conscience, the Socratic daimonon, just as though there were a material being that scrutinises the quality of my action, or an anticipated Last Judgment pronounced by a court sitting in permanency. Responsibility, however, presupposes the existence of free will, of the freedom of action: the greater my freedom of action the greater my responsibility and, vice versa, the less free I am to decide the less I am responsible for what I do. It follows that ideologies that claim to enhance personal freedom and the ability to take free decisions tend to have responsibilities shared more or less equally by the parties to a work contract, while those who wish to protect the “unfree” tend to shift most of the responsibility to those who seek, and pay for, the work of others. Any damage and the responsibility for it call for compensation, and the way in which such compensation is awarded is largely a matter of different traditions. - 50 - Ladies and gentlemen, we have confronted you with six terms which most probably also exist in your native languages. We would now like to ask you to give to these words the meaning traditionally associated with them in your language and to use them as “building blocks” to define the essential characteristics of occupational diseases. “Occupation”, “labour”, “vocation”, “free will”, “work contract” and “responsibility” are the components by means of which you can position, in a system of coordinates as it were, diseases that may be caused by target-oriented bread-winning activities in the field of tension between employer and employee. In conclusion, I should like to describe two extreme positions: - According to the first position, two free citizens conclude a contract under which good work is to be done by for a good wage, the performer of the work in question intending to do so with the greatest circumspection and the other party ensuring working conditions that meet all safety concerns in keeping with state-of–the-art knowledge. This knowledge about prevention includes the awareness of the risks inherent in any occupation, not only in the working conditions in the narrow sense. If, at a later date, some health impairment should emerge, neither party will be considered guilty, and the consequences will be borne by the general health care system. - At the other extreme, unfree subjects experience their occupation or vocation as slave labour they have to perform for their superiors, without having a choice or a chance to influence the conditions under which they perform their work. Prevention is almost inexistent and considered irrelevant. A sophisticated system of money compensation for damage already caused provides merely insufficient cover in those cases where the necessary safety measures have failed to be taken. The principal objective in such a system is the minimisation of damages, and any attempt to add to the catalogue of occupational diseases leads to narrow-minded bickering. It may be assumed that the statutory principles on the basis of which your respective countries handle what we call occupational diseases are positioned somewhere in between these two extremes. Please consider your definitions and those of your partners in Europe in order to make sure that in that Tower of Babel which we call the New Europe we assign more or less comparable meanings to the different words we use in the context of “occupational diseases”. - 51 - - 52 - Berufskrankheiten Peter Pils Dominique Dressler Wir sprechen hier in einer Gemeinschaft von Ländern, die jetzt der erweiterten Europäischen Union angehören, fast alle fünfundzwanzig sind vertreten, dazu noch Gäste, fast jedes Land spricht eine eigene Sprache. Nun, wir sind alle Menschen der Species homo sapiens sapiens, vom Genom her eng verwandt, uns vereint die Gabe der Sprache, uns trennt die Ausübung der Sprache. Bewundern Sie bitte die heutige Vielfalt: von den agglutinierenden Sprachen Finnlands, Estlands und Ungarns, zu den flektierenden indo-europäischen Sprachen des baltischen, slawischen, skandinavisch-germanisch-keltischen, romanischhellenischen Raumes, bis zum Arabischen Maltas. Der Inhalt unserer Überlegungen soll Sie spielerisch zum Nachdenken anregen, das Thema ist "Berufskrankheiten", nur: worüber sprechen wir eigentlich? Mit welchen Worten? Meinen wir alle in unseren jeweiligen Sprachen das Gleiche? Vier Sprachen der Übersetzer werden hier angeboten, Englisch, Französisch, Deutsch und Italienisch. Vor einigen Jahrhunderten wäre die Lingua franca dieses Forums Latein gewesen, vieles spricht dafür, dass dies weltweit Englisch, oder das, was man dafür hält oder daraus macht, sein wird. Wir müssen uns daher mehr mit den Begriffen, die sich in den Wörtern verstecken, befassen. Übersetzen allein wird da nicht genügen - Ziel soll ja das jeweilige Verständnis sein. Berufskrankheiten aus österreichischer Sicht Beginnen wir mit einer kurzen Darstellung der Berufskrankheiten aus österreichischer Sicht. Da gibt es unterschiedliche Blickwinkel: 1. Juridisch Berufskrankheiten sind zunächst ein juridischer Begriff, im österreichischen Allgemeinen Sozialversicherungsgesetz abgebildet, aufgelistet und entsprechend reglementiert. Vereinfacht gesagt, es gibt nur Berufskrankheiten, die gesetzlich als solche angeführt sind. 2. Versicherungstechnisch Berufskrankheiten sind einer haftpflicht-ähnlichen sozialen Unfallversicherung anzuzeigen, sind zu begutachten, anzuerkennen und, falls die Haftungsbegründung und die Haftungsausfüllung gegeben ist, zu kompensieren - mit Renten, mit Sachleistungen, kurz mit allen geeigneten Mitteln, wie es, in Österreich ausdrücklich heißt. Solange es ein Haftungsprivileg dieser Unfallversicherung gibt, werden Arbeitgeber vor Prozessen und Arbeitnehmer vor dem Prozessieren geschützt, allen ist aber klar, dass ein vollständige Kompensation nicht erreicht wird. - 53 - 3. Medizinisch Berufskrankheiten sind medizinisch schlicht und einfach Krankheiten, deren wahrscheinlichste Ätiologie auf dem Zusammenhang mit der Arbeit des Betroffenen beruht. Hier hat der Arzt zunächst die Erkrankung festzustellen, dann zu behandeln, also die direkten Krankheitsfolgen zu bekämpfen, letztlich den Patienten aus der Gefahrenzone, beziehungsweise Exposition zu entfernen und durch Aufzeigen des Risikos die Exposition allfällig weiterer Menschen zu verhindern. Unterstützt wird der Arzt durch die Epidemiologie, die ihm hilft, die Kausalität zwischen Noxe und Erkrankung herzustellen, um in logischer Folge dann die sicherheitstechnischen Initiativen auszulösen. Den Arzt interessieren nicht Wortklaubereien, ob nun die Krankheit arbeitsbedingt, arbeitsassoziiert, tätigkeitsbegründet und so fort ist, für ihn zählt nur die Tatsache der Erkrankung und die in der Medizin ohnehin so seltene Kausalität. Da die klassische, klinische Medizin de facto in ihren Grundzügen in allen zivilisierten Ländern der Welt gleichen Regeln gehorcht, kann zumindest dieser Aspekt bei der Suche nach nationalen Verschiedenheiten zur Seite gelegt werden. Mit dem Begriff der Krankheit selbst brauchen wir uns nicht auseinanderzusetzen, hier hilft uns die Definition der Gesundheit der WHO. Gleich dem Hl. Thomas von Aquin und dessen Attributenlehre brauchen wir daher nur die Krankheit als Nicht-Gesundheit definieren. Der BEGRIFF der Berufskrankheiten in Europa So sind wir unvermutet zum eigentlichen Thema gekommen, zur Überlegung, wie nun in diesem neuen Europa der Fünfundzwanzig, das ebenso einmal jenes der Vierzig, Fünfzig sein könnte, wenn sich die Grenzen bis zum Kaukasus, zum Ural und vielleich weiter erstrecken sollten, mit dem Begriff der Berufskrankheiten umgegangen werden soll. Sie lächeln jetzt, doch bedenken Sie, ob 1781 die Schöpfer der Konföderation der elf Staaten, die die USA begründen sollten, an die 1959 erfolgte Einbeziehung des drei Jahre vorher (1778) entdeckten Hawaiis als 50. Bundesstaat geglaubt hätten. Nun, Tatsache ist, dass, wenn man von der Medizin absieht, weder im Europa der Fünfzehn, noch der Fünfundzwanzig ein einhelliger Umgang mit dem Begriff der Berufskrankheiten besteht. Andere Redner haben diese Unterschiede dargestellt oder werden diese darstellen, ich aber möchte Sie gedanklich entführen und Sie bitten, mit mir über den geistigen Unterbau nachzudenken. Wir sprechen von alten und neuen, noch neueren, ganz neuen EU-Ländern und verdrängen dabei, dass wir mit Ländern zu tun haben, die über eine zumindest tausendjährige, kohärente Geschichte im europäischen Kontext verfügen, mit Traditionen, Legenden, Heldenepen und Religionen, Zugehörigkeiten und politischen Vereinnahmungen. Die Tradition, also die Übermittlung von Bildern und Verhaltensformen über Generationen hinweg, verbindet rationale und emotionale Denkmuster des jeweiligen nationalen Selbstverständnis, von dem die anderen Nationen zumeist wenig oder keine Ahnung haben. Es soll heute unsere Aufgabe sein, spielerisch darüber nachzudenken, wie es zu Unterschieden im Verständnis von Berufskrankheiten kommen kann. Dazu müssen wir die sprachlichen Begriffe analysieren, also "Beschäftigung", "Arbeit" und "Beruf" im Spannungsfeld von jenen, die das Ergebnis der Arbeit einfordern, um daraus legitimen Gewinn zu ziehen, und jenen, die Arbeitsleistung erbringen, um daraus ihren Lebensunterhalt zu sichern. - 54 - Nach Klärung der Begriffe muss über die Interaktionen der beiden Personengruppen nachgedacht werden, den freien Willen der Beteiligten, der einen oder der anderen Gruppe anzugehören, den Vertrag, der zwischen den beiden Partnern besteht, sowie die sich daraus ergebende wechselseitige Verantwortung. Gemäß dem Stellenwert, den freier Willen des Einzelnen und die individuelle Verantwortung in der jeweiligen Tradition einnehmen, müßte es möglich sein, den jeweiligen Umgang mit dem Begriff "Berufskrankheit" besser zu verstehen. Kommen wir also zum ersten, zum sprachlichen Teil und widmen wir uns zunächst der Wortbedeutung von Beschäftigung, dann Arbeit und zuletzt Beruf. Beschäftigung, lateinisch occupatio, beschreibt eine zielgerichtete Tätigkeit. Es ist dies der umfassendste Begriff, hier ist noch keine Rede vom materiellen Zweck oder einer Wertung, hier wird das menschliche Bemühen angesprochen, eine kohärente Handlung des Schaffens zu setzen. Diese Tätigkeiten können Risiken ausgesetzt sein, somit ein ursächliches Verhältnis zwischen den Umständen der Tätigkeit und der Auslösung einer adversen Wirkung, gegebenfalls einer Erkrankung, bedingen. Diese Erkenntnis verlangt, unabhängig von der medizinischen Behandlung des entstandenen Schadens, nach sofortiger Vermeidung weiterer Schäden durch die nachvollziehbare Darstellung des Risikos und durch Strategien, die das nun als solches erkannte Risiko im weiteren vermeiden helfen. Mißachtung oder Verniedlichung bekannten Wissens um die Bedeutung einer Noxe ist ein unverzeihlicher Fehler (faute inexcusable). Bevor wir zum nächsten Punkt kommen, erweitern wir den Begriff der Beschäftigung durch den Hinweis auf das Ergebnis, die erbrachte Leistung, auf Deutsch "wirken, Werk" und finden dies wieder im englischen Wort work. Somit leiten wir über zu Arbeit, lateinisch labor. Diese beschreibt eine Beschäftigung, die dem Lebensunterhalt dient. Ethymologisch sollen im indo-europäischen Sprachraum die Silben lab/rab/arb verwandt sein, sind mit den Begriffen Leid, Unfreiheit, Knechtschaft und Mühsal verbunden und finden sich wieder in den Geburtswehen, Äcker bewirtschaften, usf. Sinngemäß ist somit Arbeit negativ besetzt, ob sie nun den Kampf gegen die Natur als Bauer oder die Leistungserbringung für andere betrifft. Travail und ähnliche Wörter sind spätlateinische Begriffe, die von trepalium, einem Folterinstrument, herrühren, aber somit grundsätzlich in die gleiche Richtung weisen. Das entscheidende Sinnelement ist im Falle der Arbeit also das Leid, bzw. die Unfreiheit und impliziert somit eine Polarität zwischen denen, die Arbeit leisten und jenen, die das Ergebnis dieser Arbeit einfordern. Die Wertewelt wird hier von der Interessenswelt abgelöst, die jeweilige Vertretung dieser Interessen kann Konsens oder Konflikt suchen, aber durch die postulierte Unfreiheit des Arbeitenden im ursprünglichen Sinne wird zwingend dem Arbeit Einfordernden Obsorgepflicht und Verantwortlichkeit, somit Haftung für Schäden auferlegt. Vermeidung von Schäden durch rechtzeitige Entschärfung allfälliger Risiken wird hingegen zur Empfehlung, es werden Umwegsrentabilitäten als Argumente eingebracht, die Sanktionen sind eher sanft, nur schwere, fahrlässige Verfehlungen gegen bekanntes Wissen werden durch das Gesetz verfolgt. Es bestehen daher strenge Regeln und Rituale für die Kompensation bereits auf Dauer entstandener Schäden, bei der Vermeidung der Schäden wird der bereits weiter oben angesprochene Fehler als verzeihlich gesehen. Beruf, lateinisch vocatio oder professio, stellt den Begriff der Arbeit gleichsam auf eine höhere Bewußtseinsstufe. Hier sind Eignungen, Kenntnisse, Ausbildung und Wissen angesprochen, eventuell die Zugehörigkeit zu einem Stand, einer Gilde, die wiederum ständischen Schutz anbieten. Obwohl grundsätzlich kein - 55 - sinngemäßer Unterschied zwischen unselbständiger Arbeit und unselbständigem Beruf besteht, können gewisse Privilegierungen bestehen, gewisse Berufsgruppen besonders geschützt werden, besondere Präventionsmaßnahmen oder Ersatzausbildungen angeboten werden. Denkbar wäre, dass eine dem Berufe zugehörige, eingehendere Ausbildung das Risikobewußtsein schärfen, die Eigenverantwortlichkeit steigern könnte, die wiederum zum rechtzeitigen Aufzeigen fraglich verzeihlicher Fehler hilfreich wären. Im zweiten Teil der Überlegungen zu Berufskrankheiten sollten wir uns mit dem Verhältnis befassen, das zwischen jenen besteht, die die Arbeit gegen Entgelt leisten und jenen, die das Ergebnis dieser Arbeit entgegennehmen. Wir sollten uns drei Begriffen widmen, dem freien Willen, dem Arbeitsvertrag und der daraus abzuleitenden, jeweiligen Verantwortung. Gedanken zum freien Willen sind untrennbar mit der faszinierenden Persönlichkeit des Hl.Augustinus verbunden. Er war der Erste, der das Dilemma einer übergeordneten, allmächtigen, allwissenden, allgütigen, nicht verstehbaren Macht und der freien Entscheidung des menschlichen, individuellen Wollens erkannt und analysiert hat. Bei Augustinus ist diese Macht der christliche Gott, aber dieser Begriff ist problemlos durch Schicksal, Staat, Vorsehung oder einfach abstrakt Gesellschaft zu ersetzen. Im Christentum des 4. Jahrhunderts erkannte Augustinus, dass es die paulinische, göttliche Gnade ist, die dem Menschen die freie Wahl der Handlung im ethischen, sozialen oder religiösen Kontext verleiht. Es ist also Gottes Willen, dass der Mensch freie Entscheidungen trifft. Diese elegante Lösung ist bis heute die Grundlage jeder Überlegung zum Thema des freien Willens. Man kann neoliberal dafür sein, man kann dagegen sein, und der Gesellschaft das Lenken übertragen, man kann den Staat minimieren oder jede Aktivität durch den Staat reglementieren, freier Hecht unter freien Karpfen sein, oder solidar das schuldbefreite Unglück sozusagen von Staatswegen mittragen. Irgendwo dazwischen sind die meisten Ideologien angesiedelt. Der Begriff des freien Handelns stellt auch die Grundlage der Qualität des Arbeitsvertrages dar. Der, der bereit ist, gute Arbeit anzubieten, stößt auf einen Partner, der diese Leistung entgegennehmen will. Ebenso gilt, dass jemand einen Menschen sucht, der bereit ist, die für ein unternehmerisches Ziel notwendige Leistung zu erbringen. Hier gilt, wie immer in einer freien Unternehmenslandschaft, Angebot und Nachfrage und die sich daraus ergebende Preisgestaltung der zu erbringenden Leistung. Wie immer auch die formalen Bedingungen sein mögen, zwischen dem, der die Leistung entgegennehmen und dem, der die Leistung erbringen will, muss sich eine Verbindung, eine Relation, ein Vertrag ergeben, in dem beide Vertragspartner Verpflichtungen eingehen. Der Bogen spannt sich da zwischen dem Waren in Papiersäcke stapelnden Taglöhner eines Supermarktes und dem durch Kollektiv- oder Mindestlohnvertrag gesicherten und verpflichtend sozialversicherten Facharbeiter. Wie auch immer, für die Schließung eines Vertrages braucht es zumindest zwei Partner, beide müssen einverstanden sein, soweit die persönliche Freiheit des Handelns gegeben ist – und da sind wir wieder bei unseren beiden oben beschriebenen Ideologien : schließe ich den Vertrag zwischen zwei freien Willensfähigen ab oder stellt der Abschluss des Vertrags in Wirklichkeit eine Nötigung dar. Aus dieser Diskrepanz leitet sich in logischer Folge das Ausmaß der Verantwortung ab. Dieser Begriff bedeutet nichts anderes, als dass ich mein Handeln und dessen Folgen vor einer höheren Instanz, Gott, Staat, Gesellschaft, Justiz, sogar dem eigenem Gewissen, dem sokratischen Daimonon, zu rechtfertigen habe – so als gäbe es ein materielles Wesen, das die Qualität meines Handelns prüft, oder ein vorgezogenes, dauernd tagendes, Jüngstes Gericht. Verantwortung - 56 - wiederum setzt aber freies Handeln, freies Entscheiden voraus, je höher mein Freibereich, desto höher meine Verantwortung, und umgekehrt, je geringer meine persönliche Entscheidungsmöglichkeit, desto geringer meine Verantwortung. Daraus kann abgeleitet werden, dass Weltbilder, die behaupten, dass sie zu persönlicher Freiheit und Entscheidung verhelfen, die Verantwortung zwischen den Arbeitsvertragspartnern etwa gleich aufteilen, während jene, die "Unfreie" schützen wollen, die Verantwortung auf den, der die Leistung einfordert und einkauft, hauptsächlich übertragen. Entstandener Schaden und Verantwortung bedingen Kompensation, die vermutlich je nach Tradition unterschiedlich gehandhabt wird. Meine sehr geehrten Damen und Herren, wir haben Ihnen sechs Wörter präsentiert, die Sie mit größter Wahrscheinlichkeit in Ihrer jeweiligen Sprache wiederfinden. Geben Sie diesen Wörtern die Bedeutung, die der Tradition Ihres Landes entspricht und versuchen Sie, mit diesen Bausteinen das Wesen von Berufskrankheiten zu definieren. Mit Beschäftigung, Arbeit und Beruf, mit freiem Willen, Arbeitsvertrag und Verantwortung, können Sie Krankheiten positionieren, die durch gerichtete, dem Lebensunterhalt dienende Tätigkeit, im Kraftfeld von Arbeitgeber und Arbeitnehmer, kausal entstehen können. Zum Abschluss möchte ich Ihnen zwei extreme Positionen beschreiben, - zum einen schließen zwei Citoyens , also zwei freie Bürger, einen Vertrag mit der Absicht gute Arbeit zu gutem Lohne zu erbringen, wobei der, der die Arbeit leistet, dies mit größtmöglicher Umsicht zu tun beabsichtigt, während jener, der die Leistung entgegennimmt, Arbeitsbedingungen geschaffen hat, die dem größtmöglichen Wissen um Sicherheit entsprechen. Diese Präventionskenntnis weiß um die impliziten Risiken jeder Beschäftigung, nicht nur der Arbeitsbedingungen im engen Sinne. Sollte dennoch zu einem späteren Zeitpunkt ein Gesundheitsschaden entstehen, liegt keine Schuld vor und das allgemeine Versorgungssystem übernimmt die Folgen. - zum anderen erleben Untertanen Arbeit oder Beruf als Fron, der der Herrschaft zu leisten ist, ohne Wahlmöglichkeit und ohne Chance, die Bedingungen der Arbeitserbringung zu beeinflussen. Prävention ist kaum erkennbar, irrelevant, lediglich ein ausgeklügeltes System der finanziellen Abgeltung bereits entstandener Schäden deckt die verabsäumten Sicherheitsmaßnahmen unvollständig ab - Schadensminimierung ist das Betriebsziel und um jede neue Eintragung in einen Krankheitenkatalog wird kleinlich gerungen. Irgendwo zwischen diesen beiden, frei erfundenen Extremen liegen vermutlich Ihr gesetzlich ratifizierter Umgang mit dem, was wir in Österreich Berufskrankheiten nennen. Überdenken Sie bitte Ihre Definitionen und jene Ihrer europäischen Gesprächspartner, damit im babylonischen Sprachen- und Begriffsgewirr des Neuen Europa alle die so unterschiedlichen Wörter zum Thema "Berufskrankheiten" mit vergleichbarer Bedeutung erfüllt werden. - 57 - - 58 - New prevention plans for older employees Alfons Grösbrink 1. Demands and expectations in politics and the business world The demands of policymakers and the business world for sweeping changes in German statutory accident insurance have sparked a fundamental discussion in Germany. With regard to prevention, these groups call for the deregulation of occupational safety legislation and the elimination of the dual system consisting of Berufsgenossenschaften (BG, or German social insurance institutions for occupational risks) and government occupational safety authorities. This will impose limitations on the rule-making authority of parity-based self-governing bodies as well as calling into question the monitoring mandate of prevention services within the Berufsgenossenschaften. In this regard, the federal and state governments have developed differing models on the basis of the Occupational Safety Act. The employer associations and unions have also taken up clear positions on this issue, but their objectives show fundamental differences. The objective pursued by policymakers and the business world is to further promote the individual responsibility of businesses with regard to occupational safety, and this goal has been accounted for in legislation and government regulations in this area. Requirements, Rules, Information - 59 - The national implementation of European occupational safety law in government regulations is leaving less and less space for the rule-making authority of the Berufsgenossenschaften. Along with the Workplaces Regulations and the Hazardous Substance Regulations, Germany's Workplace Safety Regulations have recently prompted the Berufsgenossenschaften to retract a number of accident prevention rules. Aside from government occupational safety requirements, therefore, only a few basic rules issued by Berufsgenossenschaften now remain with regard to prevention activities at the workplace. Due to these changes in the general environment, the prevention services at the Berufsgenossenschaften are now increasingly cooperating with national and European decision-making bodies in order to ensure that industry-specific aspects of occupational safety are included in rules and regulations. 2. A modern prevention strategy The Berufsgenossenschaften see businesses and insured employees as both partners and customers, identifying and accounting for the specific needs and wishes of each target group. In the past, prevention was viewed as a process of intervention which primarily consisted of rules, measures and sanctions. Today, prevention work is regarded more as a service focusing on providing information, advice and incentives for innovation. Paradigm Shift in Prevention - 60 - The basis of a modern prevention strategy is to provide businesses with support in relation to specific risks and events. In this context, it is necessary to support businesses by providing information and fostering motivation as well as creating incentives for businesses to take individual responsibility for implementing health and safety measures. A Modern Prevention Strategy This approach to prevention focuses on advising businesses on the efficient organization of occupational health and safety, workplace planning and construction, the procurement of equipment and vehicles, as well as the operation and inspection of plants, machines and equipment. The prevention service units are still subject to their monitoring mandate, but they now perform these duties with increased attention to specific risks and events and less as a routine task. The support plan developed by BG BAHNEN defines the policy objectives for practical prevention work in its member companies. Here, BG BAHNEN primarily focuses on the companies' need for advising services and on the actual occurrence of accidents and occupational diseases. The overview below shows the priority of various on-site support situations: - 61 - Classification of On-Site Support Situations 3. Changing responsibilities Berufsgenossenschaften are required to ensure the prevention of accidents at the workplace, occupational diseases and (since 1996) work-related health hazards by all suitable means available. This was consciously articulated in this way by Germany's legislators and provides a great deal of latitude for parity-based selfgoverning bodies in designing the protection of insured employees at the workplace. How this latitude is used in specific areas of prevention depends on the consensus reached by the social partners. These selfgoverning institutions enjoy a maximum of autonomy in the design process. This legal mandate has brought about a shift in focus areas from technical occupational safety to healthoriented prevention. As a result, prevention work also focuses on hazards and strains of a psychological nature. - 62 - Changing Responsibilities BG BAHNEN is the provider of statutory accident insurance in Germany for businesses which operate trams, railroads, mountain railways and cable ropeways, as well as related service providers. For this reason, I would like to mention several examples from the transportation industry. In public passenger transportation, drivers and crew are exposed to various types of strain arising directly from their work activities. Moreover, adverse effects also result from their working conditions, which are characterized by problems such as irregular work shifts and difficult dietary conditions. This overall burden leads to individual burdens specific to each activity and may pose a threat to employee health in the long term. In order to ensure that drivers and crew can sustain their ability to handle these challenges at the workplace, it is important to reduce strain and enhance resources by taking preventive measures related to working conditions and worker behavior. These could include ergonomically designed driver cabins, employee-friendly work scheduling and skills development. Next, I would like to present several target group-specific prevention plans which also account for agingrelated aspects and thus benefit older drivers and crew members: - 63 - Tailored Work Scheduling One focus of advising in transportation businesses is work scheduling based on the needs of the business and of the employees. The strain on drivers and crew arising from shift work can be reduced by taking individual working time requests into account in work scheduling. A special software program developed by BG BAHNEN in an interdisciplinary prevention project makes it possible to produce individually tailored duty rosters for drivers at reasonable expense. In the medium term, this has been shown to improve employee satisfaction and motivation, and to bring about health effects which reduce absences. Stress Prevention Training - 64 - One specific measure in the avoidance of work-related health hazards is stress prevention training for drivers and crew. This training program is offered to businesses by BG BAHNEN as a means of reducing the stress related to driving activities. This computer-based training (CBT) program, which conveys theoretical knowledge about stress and at the same time offers practical exercises, enables drivers to improve their personal resources, skills and competence in stressful situations. Interested parties can request the media package developed for this product from BG BAHNEN. Assaults by Third Parties Accidents or injuries at the workplace related to third-party assaults are a key focus area in transportation businesses. By nature, public passenger transportation involves contact between crew members, passengers and other parties. As the liaison between customers and the business, the crew is held responsible for many incidents, and this often gives rise to conflicts which employees have to resolve on the spot. Reasons for conflict situations include the sale and checking of passenger tickets, delays and the like. Potential aggressions and reactions on the part of passengers and other parties depend heavily on the specific situation and are thus difficult to predict. BG BAHNEN cooperates with transportation companies to develop specific prevention plans which include measures such as employee selection, job-specific training (including conflict resolution and deescalation training), the creation of work instructions to ensure legal security, and workplace design. At present, we are preparing a seminar plan for the training of in-house moderators with the support of the BG Institute for Health and Safety (BGAG) in Dresden. - 65 - Psychological Strain due to Traumatic Experiences Vehicle drivers in public passenger transportation are exposed to considerable psychological strain when they are involved in violent attacks or accidents involving personal injury. In coordination with experts and businesses, BG BAHNEN has developed a set of recommendations for supporting insured employees who experience psychological injuries due to accidents (shock). Almost all of the larger transportation companies in Germany have developed and introduced support plans based on these recommendations. These plans include operational, medical and psychological support measures. Experience has shown that this approach considerably reduces absences as well as the number of incapacitated drivers. - 66 - 4. Prevention for older employees Prevention for Older Employees Statistics indicate that the population of Germany will shrink from its current level of 82 million to 65 million by the year 2050. At the same time, male and female life expectancy figures are on the rise. Moreover, the dwindling resources of social institutions will require increases in the length of employee careers; for example, one current topic of discussion is increasing the statutory pension age to 67. This development requires viable, forward-looking concepts to deal with demographic changes in businesses in the field of prevention at the workplace. The ability to work can be defined as the sum of factors which enable a man or woman to perform specific duties successfully. These factors include physical and mental abilities as well as social competence. The table below compares the performance potential of younger and older employees from the companies' perspective: - 67 - Performance Potential of Younger and Older Employees Any existing deficits should be offset by targeted measures. Prevention plans for dealing with demographic developments thus comprise measures related to working conditions as well as behavior. The table below shows a sample compilation of operational and behavior-related measures for crews in public passenger transport: Measures for Public Passenger Transportation Drivers/Crew In its target group-specific prevention plans for public passenger transportation personnel, BG BAHNEN has always paid due attention to older employees. For example, the individual work scheduling software also makes it possible to set up special rotations for older drivers and crew members. The CBT program for stress prevention offers older drivers and crew a personalized learning experience without requiring computer literacy, allowing the user to learn at his/her own pace and thus avoiding much-feared embarrassments in front of colleagues. - 68 - Prevention for Older Employees Moreover, BG BAHNEN also accompanies and supports in-house projects as much as possible. For example, one of our member companies, VAG Nürnberg, already began investigating ways of relieving stress among older employees and crew members with health problems several years ago. As the maximum performance potential of employees decreases as they get older and it is necessary to expect longer recovery times in cases of illness, VAG Nürnberg decided that all drivers and crew members should be assigned a less strenuous workload once they turn 57, regardless of their state of health. For this group, shift rotations were changed in such a way that each rotation includes an additional day off of driving/crew work without a reduction in wages. In addition, the concept of a "limited capacity to drive" was also introduced, that is, older employees with health problems can be assigned half driving shifts for up to three months. VAG Nürnberg's health promotion measures for older employees, which have enjoyed success to this day, have brought about a decrease in illness-related absences, a reduction of early incapacitation among drivers and crew, and positive economic effects. Ladies and gentlemen, the current state of economic development in Germany often causes decisionmakers to focus too heavily on finding ways to cut costs. In this context, we must not overlook the fact that employees are a company's most important resource. Therefore, health and safety at work must become an integral component of corporate culture. Ultimately, a company which shows little interest in the well-being of its employees can hardly expect them to care about its products or the well-being of its customers. Especially in a competitive environment, healthy and capable employees are an indispensable asset. - 69 - - 70 - „Neue Präventionskonzepte (ältere Arbeitnehmer)“ Alfons Grösbrink 1. Forderungen und Erwartungen von Politik und Wirtschaft Forderungen von Politik und Wirtschaft hinsichtlich umfassender Veränderungen der Gesetzlichen Unfallversicherung haben in Deutschland zu einer Grundsatzdiskussion geführt. Für die Prävention wird die Deregulierung des Arbeitsschutzrechtes und die Beseitigung des Dualismus bezogen auf Berufsgenossenschaften und staatliche Arbeitsschutzbehörden gefordert. Dies führt einerseits zur Einschränkung der Rechtsetzungsbefugnis der paritätischen Selbstverwaltung und andererseits wird der Überwachungsauftrag der Präventionsdienste der Berufsgenossenschaften infrage gestellt. Bund und Länder haben hierzu auf der Basis des Arbeitsschutzgesetzes unterschiedliche Modelle entwickelt. Von den Arbeitgeberverbänden und den Gewerkschaften gibt es klare Standpunkte hierzu, die sich jedoch in der Zielsetzung grundlegend unterscheiden. Das Ziel von Politik und Wirtschaft ist es, die Eigenverantwortung des Unternehmers im Arbeitsschutz weiter zu stärken. Dies wurde bei staatlichen Arbeitsschutzgesetzen und -verordnungen aktuell berücksichtigt. Aufgrund der nationalen Umsetzung des Europäischen Arbeitsschutzrechts durch staatliche Verordnungen bleibt für das Satzungsrecht der Berufsgenossenschaften immer weniger Raum. Insbesondere die Betriebssicherheitsverordnung hat neben der Arbeitsstättenverordnung und der Gefahrstoffverordnung in jüngster Zeit dazu geführt, dass die Berufsgenossenschaften eine Vielzahl von Unfallverhütungsvorschriften zurückgezogen haben. Neben den staatlichen Arbeitsschutzvorschriften stehen den Unternehmen somit nur noch wenige berufsgenossenschaftliche Basisvorschriften für die betriebliche Präventionsarbeit zur Verfügung. Aufgrund dieser veränderten Rahmenbedingungen arbeiten die Präventionsdienste der Berufsgenossenschaften verstärkt in nationalen und europäischen Gremien mit, um branchenspezifische Arbeitsschutzaspekte in Normen, Regeln und Vorschriften zu verankern. - 71 - 2. Moderne Präventionsstrategie Betriebe und Versicherte sind für die Berufsgenossenschaften Partner und Kunde. Sie ermitteln und berücksichtigen deren Bedarf und Wünsche und arbeiten zielgruppenspezifisch. In der Vergangenheit wurde die Prävention als Intervention mit den Schritten Vorschrift, Maßnahme, Sanktion betrachtet. Heute wird die Präventionsarbeit als Dienstleistung gelebt: Information, Beratung, Anreiz für Innovation stehen im Vordergrund. Grundlage einer modernen Präventionsstrategie ist die risiko- und ereignisbezogene Betreuung der Unternehmen. Diese sind durch Information und Motivation sowie durch Schaffung von Anreizen in der eigenverantwortlichen Umsetzung des Arbeitsschutzes im Betrieb zu unterstützen. - 72 - Die Beratung zur effizienten Arbeitsschutzorganisation, zur Planung und zum Bau von Betriebsanlagen, zur Beschaffung von Arbeitsmitteln und Fahrzeugen sowie zum Betrieb und zur Prüfung von Anlagen, Maschinen und Geräten steht dabei im Vordergrund. Der Überwachungsauftrag ist nach wie vor wahrzunehmen, jedoch mehr risiko- und ereignisbezogen und weniger routinemäßig. Das Betreuungskonzept der BG BAHNEN setzt die politische Zielsetzung für die praktische Präventionsarbeit in den Mitgliedsunternehmen um. Dabei orientiert sich die BG BAHNEN primär am Beratungsbedarf der Unternehmen sowie am Unfall- und Berufskrankheitengeschehen. Die Prioritäten für Betreuungsanlässe vor Ort sind in der nachfolgenden Übersicht dargestellt: 3. Verändertes Aufgabenspektrum Die Berufsgenossenschaften haben mit allen geeigneten Mitteln für die Verhütung von Arbeitsunfällen, Berufskrankheiten und seit 1996 für die Verhütung arbeitsbedingter Gesundheitsgefahren zu sorgen. Dies ist vom Gesetzgeber bewusst so formuliert worden und bietet der paritätischen Selbstverwaltung einen weiten Gestaltungsspielraum zum Schutz der Versicherten in den Betrieben. Wie dieser Freiraum für konkrete Präventionsthemen genutzt wird, hängt vom Konsens der Sozialpartner ab. Die Selbstverwaltung ist hinsichtlich der Ausgestaltung weitestgehend autonom. Dieser gesetzliche Auftrag hat dazu geführt, dass sich die Aufgabenschwerpunkte verschoben haben und zwar von der technischen Arbeitssicherheit zur gesundheitlichen Prävention. Damit stehen auch psychische Gefährdungen und Belastungen im Vordergrund der Präventionsarbeit. - 73 - Die BG BAHNEN ist Träger der Gesetzlichen Unfallversicherung für Unternehmen mit Straßenbahnen, Eisenbahnen, Bergbahnen, Seilbahnen sowie für Serviceunternehmen von Bahnen in Deutschland. Deshalb erlaube ich mir einige Beispiele hierzu aus dem Verkehrsbereich zu nennen. Im öffentlichen Personennahverkehr (ÖPNV) ist das Fahrpersonal vielfältigen Belastungen aus der unmittelbaren Fahrtätigkeit ausgesetzt. Zusätzlich ergeben sich aus der Arbeitssituation, die u. a. durch unregelmäßige Schichtarbeit und schwierige Ernährungsbedingungen gekennzeichnet ist, Beeinträchtigungen. Die Gesamtbelastung führt zu tätigkeitsspezifischen individuellen Beanspruchungen und kann langfristig eine Gesundheitsgefährdung darstellen. Damit Beschäftigte im Fahrdienst den betrieblichen Anforderungen auf Dauer gewachsen bleiben, ist es wichtig, durch Maßnahmen der Verhältnis- und Verhaltensprävention, wie ergonomisch gestalteter Fahrerarbeitsplatz, mitarbeiterbezogene Dienstplangestaltung, Vermittlung von Handlungskompetenz, Belastungen abzubauen und Ressourcen zu fördern. Im Folgenden möchte ich Ihnen einige zielgruppenbezogene Präventionskonzepte vorstellen, die insbesondere auch alternsgerechte Aspekte berücksichtigen und damit älteren Fahrdienstmitarbeitern zugute kommen: - 74 - Ein Beratungsschwerpunkt in Verkehrsunternehmen ist die betriebs- und mitarbeiterbezogene Dienstplangestaltung. Belastungen des Fahrpersonals durch Schichtarbeit können verringert werden, indem bei der Dienstplanung individuelle Wünsche der Fahrer hinsichtlich ihrer Arbeitszeit Berücksichtigung finden. Das in einem interdisziplinären Präventionsprojekt durch die BG BAHNEN entwickelte EDV-Programm ermöglicht mit vertretbarem Aufwand einen individualisierten Dienstplan für Fahrerinnen und Fahrer. Mittelfristig ergibt sich nachweislich eine Verbesserung der Arbeitszufriedenheit und der Motivation sowie ein Gesundheitseffekt, durch den Fehlzeiten reduziert werden. Eine spezifische Maßnahme zur Vermeidung arbeitsbedingter Gesundheitsgefahren ist das Stresspräventionstraining für Fahrzeugführer. Dieses Training ist ein Angebot der BG BAHNEN an die Unternehmen, mit dem die Stressbelastung bei der Fahrtätigkeit reduziert werden kann. Mit dem Konzept, das eine Vermittlung von theoretischem Wissen über Stress mit praktischen Übungen auf der Basis eines Computer Based Trainings (CBT) verbindet, lassen sich persönliche Ressourcen und Handlungskompetenz des Fahrpersonals in Stresssituationen verbessern. Das hierzu entwickelte Medienpaket kann von Interessenten bei der BG BAHNEN angefordert werden. - 75 - Arbeitsunfälle durch Übergriffe Dritter sind ein Unfallschwerpunkt in Verkehrsunternehmen. Der ÖPNV ist durch den Kontakt zwischen Fahrdienstpersonal, Fahrgästen und Dritten geprägt. Das Fahrdienstpersonal als Schnittstelle zwischen Kunden und Betrieb wird für viele Vorkommnisse verantwortlich gemacht. Dies führt immer wieder zu Konflikten, die von den Mitarbeitern vor Ort gelöst werden müssen. Anlässe für Konfliktsituationen sind z. B. Kontrolle und Verkauf von Fahrausweisen, Verspätungen. Aggressionen und Reaktionen von Fahrgästen oder Dritten sind situationsabhängig und schwer vorhersehbar. Mit Verkehrsunternehmen entwickelt die BG BAHNEN ein spezifisches Präventionskonzept mit Maßnahmen wie Mitarbeiterauswahl, tätigkeitsbezogene Ausbildung einschließlich Konfliktbewältigungsund Deeskalationstraining, Erstellung von Dienstanweisungen zur Schaffung von Rechtsicherheit, Gestaltung der Betriebsanlagen. Ein Seminarkonzept zur Schulung betrieblicher Moderatoren wird derzeit mit Unterstützung des Berufsgenossenschaftlichen Instituts Arbeit und Gesundheit (BGAG) in Dresden vorbereitet. Fahrzeugführer im ÖPNV sind erheblichen psychischen Belastungen ausgesetzt, wenn sie in tätliche Übergriffe oder Verkehrsunfälle mit Personenschaden verwickelt werden. Die BG BAHNEN hat in Abstimmung mit Fachleuten und Unternehmen „Empfehlungen zur Betreuung von Versicherten mit psychischen Beeinträchtigungen aufgrund von Unfallereignissen (Schockverletzung)“ erarbeitet. Fast alle größeren Verkehrsunternehmen in Deutschland haben auf dieser Basis ein Betreuungskonzept entwickelt und eingeführt. Der Inhalt dieser betriebsbezogenen Konzepte sind Maßnahmen der betrieblichen, ärztlichen und psychologischen Betreuung. Die Erfahrungen zeigen, dass hierdurch die Fehlzeiten sowie die Anzahl fahrdienstuntauglicher Fahrer erheblich verringert werden konnten. - 76 - 4. Prävention für ältere Arbeitnehmer Statistiker haben errechnet, dass die Bevölkerung in Deutschland von heute ca. 82 Millionen auf 65 Millionen im Jahr 2050 zurückgehen wird. Gleichzeitig steigt die Lebenserwartung bei Männer und Frauen. Darüber hinaus erfordern leere Sozialkassen zunehmend längere Lebensarbeitszeiten, z. B. ist eine Anhebung des gesetzlichen Rentenalters auf 67 Jahre in der Diskussion. Diese Entwicklung macht es erforderlich, für die betriebliche Präventionsarbeit zukunftsfähige Konzepte zur Bewältigung des demographischen Wandels in den Unternehmen zu entwickeln. Arbeitsfähigkeit ist die Summe von Faktoren, die einen Mann oder eine Frau in die Lage versetzen, eine bestimmte Arbeitsaufgabe erfolgreich zu lösen. Diese Faktoren sind zum einen die physische und geistige Leistungsfähigkeit und zum anderen die sozialen Kompetenzen. In der nachfolgenden Tabelle sind die Unterschiede der Leistungspotenziale jüngerer und älterer Beschäftigter aus der Sicht von Betrieben gegenübergestellt: - 77 - Auftretende Defizite sind durch zielgerichtete Maßnahmen auszugleichen. Bestandteil eines Präventionskonzeptes zur Bewältigung des demographischen Wandels sind daher sowohl Maßnahmen der Verhältnisprävention als auch der Verhaltensprävention. In der nachfolgenden Übersicht sind betriebsund mitarbeiterbezogene Maßnahmen für den Fahrdienst des ÖPNV beispielhaft zusammengestellt: Die BG BAHNEN hat im Rahmen ihrer zielgruppenbezogenen Präventionskonzepte für das Fahrpersonal im ÖPNV immer auch die älteren Arbeitnehmer im Blick gehabt. Beispielsweise ermöglicht das Programm zur individuellen Dienstplangestaltung auch für ältere Fahrer einen Sonderturnus einzurichten. Das CBT-Lernprogramm „Stressprävention“ bietet älteren Fahrern ein individualisiertes Lernen ohne PC-Kenntnisse, mit eignem Lerntempo und vermeidet somit das gefürchtete „Blamieren“ vor den Kollegen. - 78 - Darüber hinaus werden betriebliche Projekte von der BG BAHNEN begleitet und soweit wie möglich unterstützt. Das Mitgliedsunternehmen VAG Nürnberg hat sich beispielsweise bereits vor Jahren mit Möglichkeiten zum Abbau von Belastungen bei älteren und gesundheitlich beeinträchtigten Fahrdienstmitarbeitern beschäftigt. Weil mit zunehmendem Alter die maximale Leistungsfähigkeit sinkt und im Erkrankungsfall mit einer langsameren Genesung zu rechnen ist, wurde festgelegt, dass alle Fahrdienstmitarbeiter mit Vollendung ihres 57. Lebensjahres unabhängig von ihrem Gesundheitszustand der sogenannten „Schonrotte“ zugeteilt werden. Für diese Gruppe wurde der Dienstturnus so geändert, dass in jedem Turnus ein Tag mehr bei vollem Lohnausgleich fahrdienstfrei ist. Darüber hinaus wurde die eingeschränkte Fahrtauglichkeit eingeführt, das heißt, gesundheitlich beeinträchtigte ältere Mitarbeiter können zeitlich befristet bis zu drei Monaten zu halben Diensten im Fahrdienst eingesetzt werden. Die bis heute bei der VAG Nürnberg erfolgreich durchgeführte Gesundheitsförderungsmaßnahme für ältere Arbeitnehmer hat zu einer Reduzierung der krankheitsbedingten Fehltage, einer Verringerung der vorzeitigen Fahrdienstuntauglichkeit und damit auch zu positiven wirtschaftlichen Auswirkungen geführt. Meine Damen und Herren, aufgrund der aktuellen wirtschaftlichen Entwicklung in Deutschland wird der Blick von den Verantwortlichen oft zu einseitig auf Möglichkeiten zur Kosteneinsparung gerichtet. Dabei darf nicht übersehen werden, dass Mitarbeiter die wesentliche Ressource eines Betriebes sind. Der Arbeitsschutz muss deshalb integraler Bestandteil der Unternehmenskultur sein. Letzten Endes können Unternehmen, die wenig Interesse am Wohlbefinden ihrer Arbeitnehmer zeigen, kaum erwarten, dass sich diese um ihre Produkte oder um das Wohlbefinden ihrer Kunden sorgen. Gerade im Wettbewerb sind gesunde und leistungsfähige Mitarbeiter unverzichtbar. - 79 - - 80 - Trends and patterns of violence-related injuries at schools in Germany Efthimia Dima, MA-Päd. Kurt Scherer Hartmut Weber-Falkensammer Sheet 2: „Statutory Pupils´ Accident Insurance (1971)“ The often dramatising media reports of spectacular isolated cases of severe violence at German schools convey the notion that aggression and crime happen all the time. On the basis of the legal accident insurance for students (SUV) which has been in existence since 1971 the extent and the development of violence related injuries can be studied. The results of these studies can provide empirical corrective to the problematic criminal statistics of the police (high number of unreported cases, high dependency of reporting on third factors like public attention, Oswald 1998). Nationwide all children in day care centres, students in schools of general and vocational education as well as university students are covered by SUV, i.e. in 2004 17.4 million people which equals 21.2 percent of the overall population. SUV covers the attendance of these facilities as well as the travel to and fro. Data concerning morbidity and mortality of accidents and injuries are continually, systematically and thoroughly collected, analyzed and published on the basis of the so-called School Injury Surveillance System (SISS-Ger). In 2004 there were 1.5 million accidents involving medical treatment. This corresponds to an overall accident rate (UR) of 84.6 accidents per 1,000 students (or 8.5 %). 129,000 of these accidents were caused by violence. Sheet 3: „Trends in Violence Related Injury (VI) Morbidity“ After an increase in the mid 1990s the VI-Incidence has been decreasing since 1997. The same development can be observed with the incidence rate (short VI-rate or scuffle accident rate). Sheet 4: “Geographic Distribution of VI Rates“ The VI rate shows obvious differences between the federal states. There is a south – east/west divide. The highest rates are to be found in Sachsen, Sachsen-Anhalt and Thüringen (New Federal States) and SchleswigHolstein (old federal state). Sheet 5: “VI by Type of School“ Greater differences can also be found in the different types of school. The majority of scuffle accidents happens in the 'Hauptschulen' (secondary schools). These schools are also troubled with the highest rates (32.8 scuffle accidents per 1.000 students). - 81 - Sheet 6: “VI Rate by Sex and Age“ The VI rate involving boys is more than twice as high as the rate involving girls. The maximum age is 12 years with boys and 11 years with girls. Sheet 7: “VI Rate by Place of Occurrence“ By far the most frequent place of scuffle accidents is the schoolyard. About 40 % of violence related injuries happen there, namely during the break. Sheet 8: “VI Trends by Type of School“ The trends in the development of VI rates according to the type of school are relatively stable. Behind the 'Hauptschulen' on second place there are the 'Realschulen' (another type of secondary school) and the 'Sonderschulen' (special school). Grammar schools and primary schools have the lowest rates. Sheet 9: “VI Trends by Type of School and Nationality“ The assumption that the involvement of foreign students in aggressive, injury-inducing behaviours has generally increased cannot be proven empirically. The trend is rather regressive. The comparison of trends by type of school and nationality unearths an especially interesting connection: Whereas in primary schools and grammar schools there are no differences in the scuffle accident rates between students of German nationality and students of foreign nationality, in 'Sonderschulen' and 'Realschulen' and especially in 'Hauptschulen' the rate of violence induced injuries is clearly higher in students of German nationality. A study at the chair of Criminology, Juvenile Law and Criminal Justice at the Gießen University is currently exploring why the rate of violence related injuries in Hauptschulen, Realschulen and Sonderschulen is higher in students with German nationality. An explanatory approach which will have to be scrutinised is the immigration from the successor states of the former Soviet Union. Sheet 10: “VI Fracture Trends by Type of School“ Whether the quality of violence under students has changed towards an increasing brutalisation of violent conflicts can be verified indirectly drawing on fractures as criterion for the severity of violence induced injuries. Even when using this kind of indicator there is no increase to be seen in any type of school. The trend is rather regressive. - 82 - Statutory Pupils´Accident Insurance (1971) Meeting and Conference, 5./6. September 2005, Vienna - Population at Risk All children and adolescents from nursery school through university (17.4 million insured young persons, resp 21.1% of the Trends and Patterns of Violence-Related Injuries at Schools in Germany - Time and Place german population 2004) School and day-care; way to and from school - Monitoring Data School Injury Surveillance System (SISS-Ger) - Overall Incidence 2004 Univ.-Prof. Dr. Weber-Falkensammer, 1.5 Mio. Injuries (Indicator: Injuries with medical attendance) Central Federation of Public Sector Accident Insurers ->Injury Incidence Rate (IR) 83.6 (per 1000 students) Munich, Germany - Violence Related Incidence 2004 (www.unfallkassen.de) 129.000 Injuries (IR: 7,4 per 1000 students) Trends in Violence Related Injury (VI) Morbidity Geographic Distribution of VI Rates (Injuries with medical attendance) Incidence Rat e Incidence ( per 1000 st udent s) 10 180.000 160.000 9 140.000 8 120.000 7 6 100.000 5 80.000 4 60.000 3 40.000 2 20.000 1 0 0 1994 1995 1996 1997 1998 1999 VI Incidence 2000 2001 2002 2003 VRI Rate Mapping 8,37 bis 11,42 (4) 7,9 bis 8,37 (3) 7,41 bis 7,9 (5) 2,73 bis 7,41 (4) 2004 VI Incidence Rate (per 1.000 students) VI by Type of School VI by Sex and Age VI VI Rate 40.000 40 36.907 A ge Girls Boys >= 18 17 35.000 35 32,8 30.000 30 25.000 25 19.931 18,4 20.000 15.542 20 15,5 13.009 15.000 15 16 15 14 13 12 11 10 7.905 10.000 5.000 10 9 5 8 0 <= 6 5,7 4,9 7 0 Grundschule Hauptschule So nderschule Realschule Gymnasium 15 VI VI Rate 10 5 0 5 VI Rate (per 1000 students) 10 15 20 25 VI by Place of Occurrence VI Trends by Type of School School yard VI Rate 50 34.801 Gymnasium 15.821 45 40 Classroom 13.630 Hall 35 30 7.798 25 2.352 Playing field Stairw ay 20 15 1.386 10 1.160 Lunch room 5 0 451 Other 1993 0 5.000 10.000 15.000 20.000 25.000 30.000 35.000 40.000 1994 1995 Grundschulen 1996 1997 Hauptschulen 1998 1999 2000 Sonderschulen 2001 2002 Realschulen 2003 Gymnasien VI VI Fracture Trends by Type of School VI Trends by Type of School and Nationality VI Rat e Grundschule VI Rat e 60 Gymnasium 60 50 50 40 40 30 30 20 20 Fr act ure Rat e (per 1000 st udent s) 6 5 10 10 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Sonderschule VI Rat e 60 1993 2003 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Realschule VI Rate 3 60 50 50 40 40 30 30 20 20 4 2 1 10 10 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Hauptschule VI Rat e 60 Nationality – german – others 50 40 30 20 10 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Gr undschulen Haupt schulen Sonderschulen Realschulen Gymnasien Insgesamt Trends und Strukturen gewaltassoziierter Verletzungen an Schulen in Deutschland Efthimia Dima, MA-Päd. Kurt Scherer Hartmut Weber-Falkensammer Folie 2: „Statutory Pupils´Accident Insurance (1971)“ Die oftmals dramatisierenden Medienberichte über spektakuläre Einzelfälle von schwerer Gewalt an deutschen Schulen vermitteln den Eindruck, als seien dort Aggression und Kriminalität an der Tagesordnung. Auf Basis der seit 1971 bestehenden gesetzlichen Schüler-Unfallversicherung (SUV) können Ausmaß und Entwicklung gewaltverursachter Verletzungen untersucht werden und somit als empirisches Korrektiv zur problembehafteten Polizeilichen Kriminalstatistik (hohes Dunkelfeld; starke Abhängigkeit des Anzeigeverhaltens durch Drittfaktoren wie öffentliche Aufmerksamkeit; Oswald 1998) gelten. Bundesweit sind in der SUV alle Kinder in Tageseinrichtungen, Schülerinnen und Schüler in allgemeinbildenden und beruflichen Schulen sowie Studierende versichert. Im Jahr 2004 waren das 17,4 Millionen Personen oder 21,2 Prozent der Gesamtbevölkerung. Die SUV umfasst sowohl den Besuch der Einrichtungen als auch die Hin- und Rückwege. Daten zu Morbidität und Mortalität von Unfällen und Verletzungen werden kontinuierlich, systematisch, und vollständig anhand des sog. School Injury Surveillance Systems (kurz: SISS-Ger) erfasst, analysiert und veröffentlicht. Im Jahr 2004 ereigneten sich insgesamt 1,5 Millionen Unfälle mit ärztlicher Behandlung. Dies entspricht einer Gesamt-Unfallrate (UR) von 84,6 Unfällen pro 1000 Schülern (bzw. 8,5%). Davon waren 129.000 Unfälle (UR: 7,4 / 1000) durch Gewalt verursacht. Folie 3: „Trends in Violence Related Injury (VI) Morbidity“ Nach einem Anstieg Mitte der 90er Jahre ist die VI-Inzidenz seit 1997 rückläufig. Denselben Verlauf zeigt die Inzidenzrate (kurz: VI-Rate bzw. Raufunfallrate). Folie 4: “Geographic Distribution of VI Rates“ Die Raufunfallkarte zeigt deutliche Unterschiede zwischen den einzelnen Bundesländern. Es gibt ein NordSüd- und Ost-West-Gefälle. Die höchsten Raten befinden sich in Sachsen, Sachsen-Anhalt und Thüringen (Neue Bundesländer) sowie Schleswig-Holstein (Altes Bundesland). Folie 5: “VI by Type of School“ Größere Unterschiede gibt es auch bei den Schulformen. Der hauptsächliche Anteil des Raufunfallgeschehens ist in den Hauptschulen vorzufinden. Auch bezogen auf die Raten sind die Hauptschulen am stärksten belastet (32,8 Raufunfälle pro 1000 Schüler). Folie 6: “VI Rate by Sex and Age“ - 85 - Die Raufunfallraten sind bei Jungen mehr als doppelt so hoch wie bei den Mädchen. Das Altersmaximum liegt bei Jungen im Alter von 12 Jahren und bei Mädchen im Alter von 11 Jahren. Folie 7: “VI Rate by Place of Occurrence“ Mit Abstand der häufigste Unfallort beim Raufen ist der Schulhof. Etwa 40% der gewaltverursachten Verletzungen ereignen sich dort, und zwar in der Pause. Folie 8: “VI Trends by Type of School“ Die Entwicklung der schulformbezogenen Raufunfallraten ist relativ stabil. Nach den Hauptschulen kommen an zweiter Stelle die Real- und Sonderschulen. Die niedrigsten Raten weisen die Gymnasien und Grundschulen auf. Folie 9: “VI Trends by Type of School and Nationality“ Die These, dass die Involvierung ausländischer Schüler in verletzungsbewirkende aggressive Verhaltensweisen generell zugenommen hätte, lässt sich empirisch nicht belegen. Die Entwicklungen sind auch hierbei eher rückläufig. Der Vergleich nach Schulform und Staatsangehörigkeit fördert einen besonders interessanten Zusammenhang zutage. Während bei den Grundschulen und Gymnasien keine Unterschiede bei den Raufunfallraten hinsichtlich deutscher und nichtdeutscher Staatsangehörigkeit bestehen, sind an Sonder- und Realschulen sowie insbesondere an Hauptschulen die Raufverletzungsraten bei Schülern mit deutscher Staatsbürgerschaft deutlich höher. Am Lehrstuhl für Kriminologie, Jugendstrafrecht und Strafvollzug der Uni Gießen wird gegenwärtig untersucht, weshalb es in Haupt- Real- und Sonderschulen höhere Raufverletzungsraten bei Schülern mit deutscher Staatsangehörigkeit gibt. Ein zu prüfender Erklärungsansatz bietet die Zuwanderung aus den Nachfolgestaaten der ehemaligen Sowjetunion. Folie 10“ VI Fracture Trends by Type of School“ Die Frage, ob sich die Qualität der Gewalt unter Schülern im Sinne einer zunehmenden Brutalisierung der tätlichen Auseinandersetzungen verändert hat, kann indirekt überprüft werden, indem Frakturen ersatzweise als Maßstab für die Schwere von aggressivitätsbedingten Verletzungen herangezogen werden. Es zeigt sich auch bei diesem Indikator in allen Schularten keine Zunahme. Der Trend ist eher rückläufig. - 86 - Insurance against accidents at work and occupational diseases in agriculture: Specificities and special needs Harald Deisler Hans-Jürgen Sauer I. Introduction The "European Forum of Insurances against Accidents at Work and Occupational Diseases" was founded about 15 years ago. Its object is to establish the position of this branch of social security in relation to other branches, in particular health insurance, and to defend its cause. Membership is not dependent on whether accident insurance is a separate branch of statutory social insurance, as in Germany and Austria, or integrated into it. Similarly, its legal status is irrelevant – whether it is an autonomous corporation under public law, a governmental institution or a semi-private body. The important question for the Forum has always been whether the potential member is ready to promote the specific objectives of accident insurance. This also holds, in principle, for agricultural accident insurance, which shows highly diverse forms of organisation throughout Europe. It is worth noting that actual conditions prevailing in agriculture are greatly different from those on industry and trade. Important elements that make for this difference from other economic activities can be listed as follows: the entrepreneur (the farmer) and his family are actively engaged in the work, often far beyond normal retirement age, the work required at home and on the farm is subject to constant change, much of the work is done out of doors, it involves handling animals, the farm as such still constitutes some sort of security, there are a varying number of temporary – in particular seasonal – workers, agriculture is undergoing drastic structural changes, and agricultural earnings are in jeopardy. This situation may justify different approaches, in different countries, to the organisation of accident insurance – in all areas, and in particular with regard to the persons insured, the rules governing benefits, financing and governmental financial support. This accounts for the fact that Europe has developed special agrosocial systems which, over and above covering the usual risks of old age and sickness, show characteristic departures from the rest of accident insurance systems. Recently, i.e. on 20 April 2005, the agrosocial systems of Germany, Finland, France, Greece, Luxembourg, Austria and Poland formed a European network. The objective of this network, with its seat in Brussels, is amongst other things, to undertake a comparative study of the legislation in the various countries, and to examine whether there is a continued need for a branch-specific approach within the scope of social insurance. No results can be presented yet, but the similarities with the traditions and insights of the German system of agricultural accident insurance suggest that the specific features of agricultural accident insurance that distinguish it from other forms of accident insurance by and large continue to exist. It is therefore our intention to use the example of Germany – vicariously and as a point of departure for future discussions – to highlight the specificities and special needs of agricultural accident insurance. - 87 - II. Accident insurance as a guarantee for reducing accidents at work and occupational diseases European statistics on accidents at work and occupational diseases continue to be alarming, though it should be noted that the number of first-time compensations for accidents at work (newly granted accident pensions) has been halved in the last thirty years. At the same time, fatal accidents at work have been reduced by two thirds. In the field of agriculture the balance has been even more favourable despite the traditionally high risk and recent structural changes. Here, statistics show a 2/3 reduction of firsttime compensations and a decline of fatalities by as much as 4/5. This emphasises the need for a special approach to the risks of accidents at work and occupational diseases Statutory – i.e. industrial - accident insurance in Germany, the accident insurance of public authorities and agricultural accident insurance are characterised by three fundamental principles: Prevention, rehabilitation and compensation, the latter in the form of money, in particular pensions. These three pillars in one hand are closely interrelated. Preventive measures reduce accidents and thus the level of benefits, while on the other hand a better understanding of the accident mechanisms helps make preventive measures more effective. Now for the specific features of agricultural accident insurance (AAI). III. Specific features of AAI compared with industrial AI 1. Scope of insurance and persons insured a) Scope of insurance AAI covers all enterprises, irrespective of their size, in the field of agriculture, forestry, horticulture and viticulture as well as inland fisheries, bee-keeping, hunting and wildlife protection, gardening (parks and gardens), wage-paying enterprises in agricultural and forestry and enterprises engaged in the protection and promotion of agriculture. This means that both full-time and part-time farmers are classed as agricultural enterprises, and so are mini-farms with just a few 100 square metres under cultivation. b) Persons insured While industrial accident insurance is predominantly characterised by elements specifically attuned to the needs of workers, compulsory insurance of entrepreneurs is the exception rather than the rule. In the field of agricultural accident insurance, the insurance of enterprises is the rule and constitutes the bulk of the insured volume. AAI covers all individuals working in agriculture and forestry. Due to its origins in the 19th century persons covered are, on the one hand, agricultural labourers on account of their need for social protection and with a view to excluding all liability claims against their employer; the cover extends, however, also to the agricultural entrepreneurs, their spouses and family members, to the extent that the latter share in the farmwork. The underlying idea is that these persons, just as much as those in dependent employment, are themselves agricultural workers and thus exposed to the same risks. In terms of the volume of insurance cover, one important aspect is that it also includes all those who work on a farm occasionally or temporarily. This means that seasonal workers employed for the asparagus - 88 - or cucumber campaigns or the grape harvest and even harvest helpers or vacationers who help out occasionally are covered. On account of increasing rationalisation and the resulting reduction of the number of workers other than family members, insurance cover for the farmers and their families is clearly predominant. Summary: In the Federal Republic of Germany approximately 1.7 million agricultural entrepreneurs are covered by AAI, more than half of them cultivating farmland up to five hectares. The total number of insured persons, i.e. including workers other than family as well as temporary and occasional workers, has been estimated at roughly 4 million. It has to be pointed out that the very composition of the circle of insured persons gives rise to specific features and needs regarding the benefits granted. And there are considerable problems as well: For instance, farmers and their family members often continue working long past pensionable age and account for a large share of accidents and benefit payments, which causes considerable problems on the financial side. At the same time, preventive measures in this particular area are difficult to regulate. Add to this the major structural changes in agriculture including the drastic reduction of the number of contributing entrepreneurs. Of the total amount of roughly 430 million Euros payable in accident pensions, more than one half is due for accidents that occurred in or before 1980. We shall come back to this aspect. 2. Specifics of benefits granted a) Curative treatment Curative treatment and rehabilitation by qualified therapeutic procedures are the same for all branches of statutory accident insurance, so that no specific features of AAI need be reported. b) Money benefits Special features are found in the field of loss of wages or other earnings. The rules governing money benefits in AAI differ from those of general accident insurance in that annual earnings, the assessment basis for entrepreneurs and their spouses as well as other family members sharing in the work, are not based on the actual amounts earned but on lump sums. This method is attuned to the specific conditions of farming. In many cases it is difficult or impossible to exactly determine earnings from agricultural activity in the year preceding the accident, because accounting records are missing or incorrect. The lump sums also serve as the basis for minimum accident insurance cover independent of the amount actually earned, while at the same time indirectly ensuring that the burden of contributions paid is equitable. c) Farm and household aids One of the most important benefits of AAI is the provision of farm and household aid for farmers for the time they are undergoing curative treatment or rehabilitation in a hospital or similar institution, if they cannot continue their work on the farm on account of such treatment and if there are no family members or hired workers in permanent employment. This form of assistance is provided by trained helpers or a - 89 - money compensation for replacement staff hired by the entrepreneur. Such replacement may take the form of persons helping with the farm-work or in the household. The object is to prevent, or to compensate for, a threatening loss of earnings. Since this aid constitutes an insurance benefit to which the insured is legally entitled, no extra cost devolves on the enterprise. The compensatory payments are made from members’ contributions. 3. Co-insurance of the farm household In view of the wide range of activities on a farm, it is also important that the jurisdiction of agricultural accident insurance also extends to the insurance of the farm household – strictly speaking a separate economic area within the province of the entrepreneur. Accordingly, the households of the entrepreneur and of those employed by the enterprise are included in the scope of insurance cover if they render an essential service to the enterprise. This has frequently led to difficulties of interpretation, since the criteria, which stem from times when livestock-raising required large numbers of staff, are hardly relevant to a modern enterprise. Still, there are also modern criteria, such as the dual function of the farmer’s wife who works both on the farm and in the household. All in all, this form of insurance cover, which takes into account the specific conditions of farming, has stood the test of time, since it is in many cases impossible to distinguish clearly between activities that benefit the business operations and those that fall within the province of housework. 4. Provision of Funds and Financing As in the case of general accident insurance, the financing system is based on the principle of adjustable contributions whereby requirements are met subsequently. In other words, contributions must meet the requirements of the preceding business year in respect of the costs of prevention, compensation for accidents at work, administrative costs, costs of proceedings as well as the accumulation of reserves and the procurement of operating resources. As in the case of other forms of accident insurance AAI contributions are exclusively paid by the entrepreneurs. While the contributions paid to industrial accident insurance institutions are based on the remuneration, i.e. the total payroll and the degree of risk incurred, agricultural accident insurance have been allowed to use contribution scales related to the area under cultivation. The criteria used in determining contributions are thus the value of the land under cultivation, the value of labour and the amount of work required, or a combination thereof. Problems have arisen on an increasing scale on account of the fact that these contribution criteria do not adequately reflect the characteristic risks. Thus, the number of insured persons and accordingly the increasing degree of rationalisation of farm-work is not taken into account. Some reforms are being considered, as will be reported below. 5. State participation in financing The continuous structural changes that agriculture has undergone in recent decades, with a drastic reduction of the number of agricultural enterprises responsible for making the necessary contributions, have given rise to considerable problems with regard to financing. A steadily diminishing number of enterprises have to defray expenditures arising from previous claims. Let us recall in this context that one half of the total amount of pensions in the amount of 430 million Euros results from accidents that occurred - 90 - in or before 1980. This illustrates clearly that the active contributors have to a large extent to finance inherited burdens, which means that state participation in defraying the costs is indispensable. These requirements continue unabated, both in regard of the deficits incurred on account of structural changes – i.e. the considerable inherited burden of pension payments – and in recognition of the farmers’ contribution to the conservation of nature and the protection of landscape, which is not adequately compensated in any other form. All European countries support special agrosocial systems, partly with considerable subsidies. This does not constitute any distortion of competition and is entirely in conformity with EU legislation. 6. Assessment of specific features When assessing the specific features of AAI as compared with general accident insurance, the following may seem of particular importance: - compulsory insurance for self-employed agricultural entrepreneurs and their spouses constitutes a form of cooperative self-help institution arising from society’s need to afford protection. The individuals concerned are not subject to the principle characteristic of other aspects of the protection of workers, viz. the assumption of the employer’s liability by the insurance institution, which limits the state authorities’ discretionary power, for instance, regarding a reduction of benefits. As a consequence, farmers and their spouses are more vulnerable to legislative decisions curtailing their benefits; - the government-promoted structural changes result in a constant reduction of the size of the solidarity community, which will therefore have to be at least partly relieved of the “inherited burden” (the deficit caused by structural change) by state intervention. IV. Possible reforms Like all social security institutions, AAI will have to face up to the need for reforms. Reforms of the welfare state are currently under discussion in virtually all countries. Agricultural accident insurance is not exempt from such considerations. We should therefore like to briefly mention a few aspects that might have some relevance to the current debate. 1. Savings potential and more precisely targeted work injury pensions. - Work injury pensions serve a dual purpose: on the one hand, they are intended, in line with the compensatory principle underlying statutory accident insurance, to compensate for the loss or reduction of earned income suffered on account of a permanent physical injury – ranging from the loss or stiffening of a limb to paraplegia; on the other hand, they serve as compensation for the physical health damage sustained by the injury. This is where some reforms are being considered. It has been proposed that no work accident pensions should be granted in cases of accidents at work sustained by persons of pension age. The reasoning is as follows: if an insured person has no income from gainful employment, there is no need to compensate him. As we have indicated above, the group of insured persons under discussion is largely composed of family members who make their work available free of charge, including in many cases persons who had formerly themselves been agricultural entrepreneurs. If they are of pensionable age and are working free of charge, they do not suffer any loss of earnings that ought to be compensated and are therefore merely eligible – apart from curative treatment - for a compensation for the - 91 - health impairment they have suffered. It should, however, be noted that the part of a work accident pension designed to compensate for a health impairment is much smaller than the one granted to compensate for a loss of earnings. - Another proposal aims at limiting the granting of accident pensions to the time up to attaining pensionable age. Thereafter, the individual concerned would fall within the province of statutory pension insurance. - A further point under discussion is that low accident pensions – i.e. up to a defined level of diminished earning capacity – should be replaced by statutory lump-sum payments. In terms of the intended savings potential this would only make sense if the lump sum were not calculated on the basis of the individual’s life expectancy, as is now the case, but limited to a specified number of years – such as five or ten years. - It has also been proposed that the loss-of-earning-capacity percentage required for the granting of a pension should be raised (for instance, from 20 to 30 %). This would, of course, put the insured persons at a considerable disadvantage. - Lastly, it has been proposed to adjust contribution scales to the accident risk. As a consequence of the structural changes and rationalisation, the number of people working on farms is steadily falling. Work is increasingly being farmed out to hired companies or farm machinery cooperatives. Large-scale farming enterprises therefore criticise the fact that, since the area under cultivation is taken as a yardstick, the reduction of accident risks does not translate into a reduction of contributions payable. On the other hand, degressive rates for large-scale enterprises and the introduction of minimum contributions have also put an additional burden on smaller farms. What is more, greater emphasis on the degree of risk would result in redistribution rather than open up new sources of funds. Both public acceptability and fairness would nevertheless require that contributions should be more closely tied to the accident risk while at the same time not neglecting the aspect of solidarity. This would lead to the definition of self-supporting risk groups to which the costs of benefits are assigned. - 92 - Bedürfnisse und Besonderheiten der Versicherung gegen Arbeitsunfälle und Berufskrankheiten in der Landwirtschaft Harald Deisler Hans-Jürgen Sauer I. Einleitung Das Europäische Forum Unfallversicherung ist vor nunmehr knapp 15 Jahren gegründet worden. Mit ihm sollen die Belange dieses Teils der sozialen Sicherheit im Verhältnis zu anderen Zweigen, insbesondere der Krankenversicherung zur Geltung gebracht und verteidigt werden. Dabei spielt es für die Mitgliedschaft keine entscheidende Rolle, ob die Unfallversicherung - wie in Österreich und Deutschland ein abgegrenzter Zweig der gesetzlichen Sozialversicherung oder in diese integriert ist. Auch ist die Organisationsform durch selbstverwaltete Körperschaften des öffentlichen Rechts, durch staatliche Institutionen oder in teilprivatisierten Einrichtungen unerheblich. Entscheidend für das Forum war stets das Eintreten für die durch qualifizierte Besonderheiten geprägten Ziele und Inhalte dieses Risikobereichs. Dies gilt im Grundsatz auch für die landwirtschaftliche Unfallversicherung. Auch diese ist in Europa ganz unterschiedlich organisiert. Immerhin ist zu konstatieren, dass die Landwirtschaft gegenüber der Industrie und dem Gewerbe einen in den tatsächlichen Verhältnissen stark abweichend geprägten Bereich darstellt. Die "eigenhändige" Mitarbeit des Betriebsunternehmers und der gesamten bäuerlichen Familie, häufig weit über die Grenze des normalen Pensionsalters hinaus, die ständig wechselnde Tätigkeit im betrieblichen und häuslichen Bereich, die weitgehende Arbeit im Freien, der Umgang mit Tieren, die immer noch vorhandene Teilabsicherung durch den Hof, die Vielzahl vorübergehend mithelfender Personen, insbesondere von Saisonarbeitern, der starke Strukturwandel und die schwierige Einkommenslage der Landwirtschaft prägen in ganz erheblichem Maße den Unterschied zu den Verhältnissen des sonstigen Erwerbslebens. Dadurch können je nach einzelstaatlicher Entscheidung auch Besonderheiten in der Ausgestaltung der Unfallversicherung gerechtfertigt sein. Dies gilt im Grunde für alle Bereiche, insbesondere den versicherten Personenkreis, das Leistungsrecht, die Finanzierung und die finanzielle Unterstützung durch den Staat. So sind in Europa agrarsoziale Sondersysteme entstanden, die neben den Risiken des Alters und der Krankheit auch für die Unfallversicherung charakteristische Abweichungen von der übrigen Unfallversicherung aufweisen. Kürzlich, d. h. am 20.04. d. J. haben sich daher die europäischen agrarsozialen Sondersysteme in Deutschland, Finnland, Frankreich, Griechenland, Luxemburg, Österreich und Polen in Brüssel zu einem europäischen Netzwerk zusammengeschlossen. Die Zielsetzung besteht u. a. darin, in einer Art Rechtsvergleichung die jeweils bestehenden Regelungen zu analysieren. Auch soll die Prüfung vorgenommen werden, ob für einen zweigspezifischen Ansatz im Rahmen der Sozialversicherung weiterhin ein Bedürfnis besteht. - 93 - Die Ergebnisse können wir Ihnen noch nicht präsentieren. Gleichwohl lässt sich aufgrund der Ähnlichkeiten zu den Traditionen und Erkenntnissen des deutschen LUV-Systems bereits feststellen, dass diese Besonderheiten im Wesentlichen auch heute noch Bestand haben. Wir möchten daher - gewissermaßen stellvertretend und als Diskussionseinstieg - die Besonderheiten und Bedürfnisse der landw. Unfallversicherung am Beispiel Deutschland exemplarisch darstellen. II. Unfallversicherung als Garant für die Reduzierung von Arbeitsunfällen und Berufskrankheiten Die europäischen Zahlen über Arbeitsunfälle und Berufskrankheiten sind nach wie vor alarmierend. Allerdings ist darauf hinzuweisen, dass sich die Zahl der erstmals entschädigten Arbeitsunfälle (neue Unfallrenten) in den letzten 30 Jahren halbiert hat. Die Zahl der tödlichen Arbeitsunfälle ist in diesem Zeitraum sogar um 2/3 zurückgegangen. Für die Landwirtschaft fällt diese prozentuale Erfolgsbilanz trotz traditionell hohem Risikobereich und auch unter Berücksichtigung des eingetretenen Strukturwandels noch günstiger aus. Hier weist die Statistik im Vergleichszeitraum einen Rückgang der erstmals entschädigten um 2/3 und der tödlichen Arbeitsunfälle gar um 4/5 aus. Dies unterstreicht eindrucksvoll die Notwendigkeit eines besonderen Ansatzes für die Risiken des Arbeitsunfalls und der Berufskrankheit. Die gesetzliche Unfallversicherung in Deutschland, d. h. die gewerbliche, die Unfallversicherung der öffentlichen Hand und auch die landw. Unfallversicherung sind durch drei tragende Grundprinzipien geprägt: dies sind die Prävention, die Rehabilitation und die Entschädigung, letztere in Gestalt von Geldleistungen, insbesondere Renten. Diese drei Säulen in einer Hand stehen in einer engen Wechselbeziehung zueinander. So führen die Anstrengungen in der Prävention zu einer Reduzierung der Unfallzahlen und damit der Leistungsaufwendungen. Andererseits kann durch die Erkenntnisse aus dem Unfallgeschehen eine wirksame Prävention durchgeführt werden. Nun aber zu den Besonderheiten der landw. Unfallversicherung. III. Besonderheiten der LUV gegenüber der gewerblichen UV 1. Versicherungsumfang und Versicherter Personenkreis a) Versicherungsumfang Die landw. Unfallversicherung umfasst außer den Unternehmen der Land- und Forstwirtschaft einschl. des Garten- und Weinbaus auch Unternehmen der Binnenfischerei, der Imkerei, der Jagden, Park- und Gartenpflege, land- und forstwirtschaftliche Lohnunternehmen und Unternehmen zum Schutz und zur Förderung der Landwirtschaft. Die Größe des Unternehmens ist dabei nicht entscheidend. Das bedeutet, dass nicht nur Vollerwerbsbetriebe, sondern auch Nebenerwerbs-Landwirtschaften und Zwergbetriebe von einigen 100 qm als landw. Unternehmen gelten. b) Versicherter Personenkreis Während die gewerbliche Unfallversicherung vornehmlich von der auf Arbeitnehmer zugeschnittenen Konzeption der Unfallversicherung geprägt ist, ist die obligatorische Versicherung von Unternehmern die Ausnahme. Dagegen ist sie in der landw. Unfallversicherung die Regel und hinsichtlich des Volumens dominierend. - 94 - Die landw. Unfallversicherung gewährt allen in der Land- und Forstwirtschaft Tätigen Versicherungsschutz. Ausgehend von ihrem Ursprung im vorletzten Jahrhundert sind das zum Einen die landw. Arbeitnehmer aus Gründen der sozialen Schutzbedürftigkeit und wegen der mit ihrem Unfallschutz einhergehenden Ablösung aller sonst gegenüber dem Arbeitgeber bestehenden Haftungsansprüche. Wie gesagt, sind aber auch die landw. Betriebsunternehmer, deren Ehegatten und die mitarbeitenden Familienangehörigen in den obligatorischen Versicherungsschutz einbezogen. Dem liegt der Gedanke zugrunde, dass diese Personengruppe, - ebenso wie die abhängig Tätigen -, selbst die landw. Tätigkeiten verrichtet und damit den Gefahren ausgesetzt ist. Nicht unwesentlich für das vom Versicherungsschutz abgedeckte Volumen ist auch, dass alle gelegentlich oder vorübergehend Tätigen Versicherungsschutz genießen. Dies bedeutet, dass die bei der Spargelund Gurkenernte oder der Weinlese, um nur einige Beispiele zu nennen, eingesetzten Saisonarbeitskräfte ebenso wie Erntehelfer oder zufällig gelegentliche Arbeiten verrichtende Feriengäste versichert sind. Durch den starken Druck zur Rationalisierung und den damit einhergehenden Verlust von Fremdarbeitskräften steht die Versicherung der Unternehmer und Familienangehörigen eindeutig im Vordergrund. Fazit: In der Bundesrepublik sind rund 1,7 Mio. landw. Unternehmer versichert, wobei mehr als die Hälfte nur Flächen bis zu fünf ha bewirtschaftet. Die geschätzte Zahl von Versicherten insgesamt, d. h. unter Einbeziehung von Fremdarbeitskräften und vorübergehend Tätigen ist dagegen mit ca. 4 Mio. anzusetzen. An dieser Stelle ist bereits darauf hinzuweisen, dass diese Zusammensetzung des versicherten Personenkreises Besonderheiten und Bedürfnisse im Leistungsrecht auslöst. Auch treten nicht unerhebliche Probleme auf: So arbeiten ehemalige landw. Unternehmer und mitarbeitende Familienangehörige noch weit über das eigentliche Pensionsalter im Unternehmen mit. Sie stellen im Unfallgeschehen und in der Belastung mit Leistungsaufwendungen einen großen Anteil dar, der zu erheblichen Finanzierungsproblemen führt. Auch ist dieser Bereich in der Prävention nur schwer steuerbar. Hinzu kommt der starke Strukturwandel in der Landwirtschaft mit der einhergehenden drastischen Abnahme von Unternehmern, die für die Beitragslast verantwortlich sind. So entfällt von dem rd. 430 Mio. Euro betragenden Gesamtrentenbestand die Hälfte auf Unfälle aus 1980 und früher. Wir werden hierauf noch gesondert eingehen. 2. Besonderheiten im Leistungsrecht a) Heilbehandlung Die Heilbehandlung bzw. Rehabilitation wird in der gesamten gesetzlichen Unfallversicherung im Rahmen qualifizierter Heilverfahren durchgeführt. Insoweit gibt es keine Besonderheiten in der landw. Unfallversicherung. b) Geldleistungen Besonderheiten gelten im Bereich der Leistungen für den Ausfall an Verdienst oder Erwerbseinkommen. Das Geldleistungsrecht der landw. Unfallversicherung unterscheidet sich von dem der allgemeinen Unfallversicherung vor allem dadurch, dass die für Unternehmer und ihre Ehegatten sowie die mitarbeitenden Familienangehörigen maßgebliche Bemessungsgrundlage, der Jahresarbeitsverdienst nicht - 95 - nach dem tatsächlichen Verdienst, sondern nach Pauschalsätzen festgelegt ist. Dieser pauschalierte Jahresarbeitsverdienst wird den Besonderheiten in der Landwirtschaft gerecht. Oft sind die Einkünfte aus der Landwirtschaft mangels eigener Buchführung im Jahr vor dem Unfall nur unter großen Schwierigkeiten und darüber hinaus nur mit Ungenauigkeiten zu ermitteln. Dadurch ist eine Berechnung des Jahresarbeitsverdienstes in vielen Fällen kaum möglich. Den Pauschalsätzen kommt aber auch die Funktion eines von der Höhe des tatsächlichen Einkommens unabhängigen Unfallversicherungsmindestschutzes zu. Andererseits gewährleistet er mittelbar eine interessengerechte angemessene Steuerung der Beitragsbelastung. c) Betriebs- und Haushaltshilfe Eine der wichtigsten Leistungsarten der landw. Unfallversicherung ist die Betriebs- und Haushaltshilfe. Diese erhalten landw. Unternehmer während einer stationären Heilbehandlung, wenn ihnen wegen dieser Behandlung die Weiterführung des Unternehmens nicht möglich ist und in dem Unternehmen Arbeitnehmer und mitarbeitende Familienangehörige nicht ständig beschäftigt werden. Sie geschieht durch den Einsatz von geschulten Ersatzkräften oder Erstattung angemessener Kosten für selbst beschaffte Ersatzkräfte. Ersatzkräfte sind Betriebshelfer, Betriebshelferinnen und Haushaltshelferinnen. Mit dieser Leistung soll der drohende Einkommensverlust des Unternehmens verhindert oder ausgeglichen werden. Da die Betriebs- und Haushaltshilfe eine Versicherungsleistung ist, auf die ein Rechtsanspruch besteht, entstehen für die Betriebe selbst keine besonderen Kosten. Sie wird vielmehr durch die Zahlung der Beiträge abgegolten. 3. Mitversicherung des landwirtschaftlichen Haushalts Für den Zuständigkeitsumfang der landw. Unfallversicherung ist im Hinblick auf das weit gefächerte bäuerliche Tätigkeitsspektrum auch die Mitversicherung des landwirtschaftlichen Haushalts, - eines streng genommen eigenwirtschaftlichen Bereichs - von Bedeutung. So werden die Haushalte der Unternehmer und der im Unternehmen Beschäftigten dem Versicherungsumfang zugeordnet, wenn die Haushalte dem Unternehmen wesentlich dienen. Dieses Erfordernis hat in der Praxis oft zu Auslegungsschwierigkeiten geführt, weil die hierfür maßgeblichen Indizien aus einer Zeit personalintensiver, weitgehend Viehhaltung betreibender Landwirtschaft heute nicht mehr im gleichen Umfang maßgeblich sind. Immerhin lassen sich moderne Kriterien anführen, wie z. B. die in Landwirtschaft und Haushalt wechselweise tätige Bäuerin als Bindeglied. Insgesamt hat sich dieser Versicherungsschutz für die besonderen Verhältnisse in der Landwirtschaft bewährt, weil oft eine Trennung echt betriebsdienlicher und hauswirtschaftlicher Tätigkeiten kaum möglich ist. 4. Aufbringung der Mittel und Finanzierung Wie in der allgemeinen Unfallversicherung ist das Finanzierungssystem geprägt durch das Umlageprinzip der nachträglichen Bedarfsdeckung. Dies besagt, dass die Beiträge den Bedarf für die Aufwendungen für Prävention, die Entschädigung von Arbeitsunfällen und Berufskrankheiten, Verwaltungs- und Verfahrenskosten sowie die Ansammlung von Rücklagen und die Beschaffung von Betriebsmitteln des abgelaufenen Geschäftsjahres decken müssen. Ebenso wie in der übrigen Unfallversicherung sind auch in der landw. Unfallversicherung die Unternehmer allein beitragspflichtig. Während der Beitragsmaßstab der gewerbl. Berufsgenossenschaften sich nach dem Entgelt, d. h. der Lohnsumme und nach dem Grad der Unfallgefahr richtet, wurde den landw. Berufsgenossenschaften seither die Möglichkeit eingeräumt, flächenbezogene Beitragsmaßstäbe - 96 - anzuwenden. So gehören zu den Beitragsmaßstäben der Flächenwert, der Arbeitswert, der Arbeitsbedarf oder eine Kombination dieser genannten Beitragsmaßstäbe. Probleme entstehen hierbei zunehmend dadurch, dass sich der für die Unfallversicherung charakteristische Risikobezug nicht hinreichend genug in diesen Beitragsgrundlagen widerspiegelt. So bleibt die Zahl der Versicherten und damit die zunehmend wachsende Rationalisierung der Arbeit unberücksichtigt. Insoweit gibt es aber Reformüberlegungen, über die noch berichtet wird. 5. Beteiligung des Staates an der Finanzierung Durch den in den letzten Jahrzehnten vollzogenen und fortdauernden Strukturwandel mit dem drastischen Rückgang landw. Betriebe, die für die Aufbringung der Beiträge verantwortlich sind, wirft die Finanzierung der landw. Unfallversicherung besondere Probleme auf. So muss eine immer kleiner werdende Solidargemeinschaft die Aufwendungen aus früheren Versicherungsfällen erbringen. Hierzu beziehen wir uns nochmals auf die Aussage, dass die Hälfte des Gesamtrentenbestands von 430 Mio. Euro aus Unfällen aus 1980 und früher resultiert. Dies macht deutlich, dass die aktiven Beitragszahler erhebliche Altlasten zu finanzieren haben und sich daran der Staat beteiligen muss. Diese Zweckbestimmung gilt unverändert fort. Es betrifft sowohl das strukturwandelbedingte Defizit in Form der genannten erheblichen Rentenaltlast als auch die Honorierung des Beitrags der Landwirtschaft zu Landschaftspflege und Naturschutz, der keine adäquate Gegenleistung erfährt. So werden sämtliche europäischen agrarsozialen Sondersysteme durch teilweise erhebliche Zuschüsse des Staates unterstützt. Diese Mittel stellen keine Wettbewerbsverzerrung dar und sind EUkonform. 6) Bewertung der Besonderheiten Bewertet man die wesentlichen Besonderheiten der landw. Unfallversicherung gegenüber der allgemeinen Unfallversicherung, so lassen sich folgende Feststellungen treffen: - die obligatorische Versicherung der Selbständigen landw. Unternehmer und deren Ehegatten stellt aus Gründen des sozialen Schutzbedürfnisses eine genossenschaftliche Eigenhilfe dar. Für diesen Personenkreis gilt nicht das ansonsten für den Arbeitnehmerschutz charakteristische Prinzip der Ablösung der Unternehmerhaftung, das dem Staat in seinem gestalterischen Ermessen, z. B. für Leistungskürzungen Grenzen auferlegt. Daher ist der Personenkreis der Unternehmer und Ehegatten eher gesetzlichen Einschnitten zugänglich. - der staatliche gewollte Strukturwandel bedingt, dass die immer kleiner werdende Solidargemeinschaft von zumindest Teilen der sogenannten "Alten Last" (strukturwandelbedingtes Defizit) durch Beteiligung des Staates entlastet werden muss. IV. Reformüberlegungen Auch die landw. Unfallversicherung muss sich gegenwärtig den alle Sozialleistungsbereiche tangierenden Reformüberlegungen stellen. Die Diskussion um den Umbau des Sozialstaates findet derzeit in fast allen Ländern statt. Diese Diskussion betrifft auch die landw. Unfallversicherung. Wir möchten daher insoweit nur einige Aspekte möglicher Reformüberlegungen in die Diskussion einbringen. - 97 - 1. Reformüberlegungen im Hinblick auf Einsparpotentiale als auch auf eine zielgenauere Funktion der Verletztenrente - Die Unfallrente hat eine doppelte Funktion: sie soll nach dem der gesetzlichen Unfallversicherung zugrunde liegenden Schadensersatzgedanken einerseits den gänzlichen oder teilweisen Verlust des Erwerbseinkommens, der durch den körperlichen Dauerschaden - z. B. den Verlust oder die Versteifung von Gliedmaßen bis hin zu Querschnittslähmungen - eintritt, ausgleichen. Darüber hinaus soll die Unfallrente den durch die Verletzung eingetretenen körperlichen Gesundheitsschaden entschädigen. Reformüberlegungen setzen hier an. So wird zum einen vorgeschlagen, keine Unfallrenten bei einem Arbeitsunfall im Rentenalter zu gewähren. Soweit Versicherte kein Arbeitseinkommen mehr erzielen, bedarf es auch keiner Entschädigung des Teils der Rente, der gerade auf diesen Ausgleich abzielt. Wie ausgeführt setzt sich der versicherte Personenkreis zu einem erheblichen Volumen aus unentgeltlich tätigen mitarbeitenden Familienangehörigen, insbesondere auch ehemaligen landw. Unternehmern zusammen. Diesen entsteht im Rentenalter bei unentgeltlicher Tätigkeit kein auszugleichender Einkommensverlust. Für sie kommt neben den Maßnahmen der Heilbehandlung lediglich ein Ausgleich für den erlittenen Gesundheitsschaden in Betracht. Im Verhältnis zum Erwerbsschadensanteil der Unfallrente ist dieser GesundheitsschadenAnteil allerdings der weitaus geringere Teil. - Ein weiterer Vorschlag will die Gewährung von UV-Renten bis zum Eintritt in das Rentenalter begrenzen. Für die anschließende Zeit soll die gesetzliche Rentenversicherung vorrangig eintrittspflichtig sein. - Ferner wird diskutiert, niedrige Unfallrenten, d. h. bis zu einem bestimmten Schweregrad der Minderung der Erwerbsfähigkeit gesetzlich abzufinden. Ein solcher Vorschlag macht hinsichtlich Einsparpotentialen allerdings nur Sinn, wenn die Abfindungssumme nicht - wie bisher nach der prognostizierten Lebensdauer des Verletzten, sondern nach einem begrenzten Zeitraum - z. B. 5 oder 10 Jahren - bemessen wird. - Auch gibt es Vorschläge, den Einstiegswert für den Bezug einer Rente der maßgeblichen Minderung der Erwerbsfähigkeit anzuheben (z. B. von 20 auf 30 %). Mit diesem Vorschlag sind aber auch erhebliche Nachteile für die Versicherten verbunden. - Schließlich gibt es Überlegungen, die Beitragsmaßstäbe am Unfallrisiko auszurichten und damit risikogerechter zu gestalten. Infolge des Strukturwandels und der vorgenommenen Rationalisierung werden immer weniger Arbeitskräfte in der Landwirtschaft beschäftigt. Vermehrt wird die Arbeit an Lohnunternehmen oder Maschinenringe vergeben. Flächenstarke Großbetriebe kritisieren daher, dass aufgrund der Flächenmaßstäbe die verminderte Unfallbelastung sich nicht in einer Beitragsreduzierung auswirkt. Andererseits haben die Berufsgenossenschaften durch Degressionen für größere Betriebe und die Einführung von Grundbeiträgen auch die kleineren Betriebe belastet. Ferner ist zu berücksichtigen, dass ein stärkerer Risikobezug nur zu einer Umverteilung führt und keine zusätzlichen Finanzquellen erschließt. Es erscheint aus Gründen der Akzeptanz und der Gerechtigkeit dennoch notwendig, die Beitragsgestaltung am Unfallrisiko stärker auszurichten, ohne die Solidarität entscheidend zu vernachlässigen. Diese Überlegungen gehen dahin, die Leistungsaufwendungen Risikogruppen zuzuordnen, die sich anschließend im Beitrag selbst tragen. - 98 - Insurance against accidents at work and occupational diseases in the new member countries and candidate countries of the EU Die Unfallversicherung in den neuen EU-Mitgliedsstaaten und in Beitrittskandidatenstaaten L'assurance contre les accidents du travail et les maladies profesionnelles dans les nouveaux pays membres de l'UE et les pays candidats Assicurazione contro gli infortuni sul lavoro e le malattie professionali nei nuovi paesi membri dell'UE e nei paesi candidati - 99 - Accident insurance systems in the new EU member countries – An overview Bernhard Pabst 1. Introduction A review of the accident insurance systems of the ten new members of the European Union in a matter of 30 minutes can obviously be little more than a broad-brush painting. Not only will the review be incomplete, it must also be an exercise in modesty, since no individual can truthfully maintain that he is absolutely familiar with the systems of so many different countries, all the more so since – and this may appear banal but ought nevertheless to be borne in mind – these countries and their accident insurance traditions are not as homogeneous as we would hope. While there is a common tradition based on the Soviet model that developed in “Eastern bloc“ times up the 1989, but in this tradition a special accident insurance system did not exist. In the last fifteen years, the countries in question embarked in reforms that led them, at least partly, in different directions. In some countries – Poland and Slovakia, for instance – pre-Communist national traditions of the inter-war period were revived, while the course pursued in other countries, such as the Czech Republic, broke with legal traditions and led to a new system that was a long way from the public solidarity model of the pre-war years. The need to be brief also suggests that I should confine myself to the Central and East-European (CEE) countries. The Maltese system will then be described by Mr. Micallef. 2. Recognition of “accident at work“ and “occupational disease“ claims Unless I am wrong, all of the eight CEE countries and the candidate countries Romania, Bulgaria and Croatia recognise accidents at work and occupational diseases as “insured events“. None of them have introduced what is called a “final“ system such as the one in the Netherlands, where no distinction is made between work-related accidents or diseases on the one hand and leisure-time accidents and diseases of a general nature on the other. The consequences of accidents or diseases are handled within the scope of the general invalidity, descendants and health insurance system, and a cause-and-effect relationship with occupational activities is not a prerequisite. 3. Independent insurance systems for accidents at work and occupational diseases Nevertheless, separate specialised administrative systems for work accidents and occupational diseases, like the Austrian statutory accident insurance institution AUVA or its counterparts, the Berufsgenossenschaften, in Germany, do not exist in all of the CEE countries: The countries without such a system are Estonia, Slovenia and Hungary. In Estonia a bill envisaging work accident insurance failed in Parliament. The risks of work accidents and occupational diseases are covered by the health insurance (short-term money allowances and benefits in kind) - 101 - and pension insurance (long-tem benefits) providers. On the basis of the employers’ civil-law liability additional benefits are granted as a form of compensation. New draft legislation governing accident insurance is expected to be introduced in Parliament early next year. In Hungary work accident insurance forms part of statutory health insurance. The administration of this compulsory insurance is in the hands of the National Health Insurance Fund (OEP) and other institutions. A proposal for a separate accident insurance institution is to be introduced in Parliament before 2008. In Slovenia the risks of accidents at work and occupational diseases are covered by the compulsory pension and invalidity insurance institution, which pays pensions and provides additional benefits both in terms of money and in kind, also in the case of accidents at work and occupational diseases. With regard to some benefits, workers affected by work accidents or occupational diseases are better off than other accident victims or persons suffering from non-work-related diseases. Possible reforms have long been under discussion but have not resulted in legislation Four of the eight new members in Central and Eastern Europe administer accidents at work and occupational diseases in specialised departments of a social insurance institution. Such a system is found, in particular, in Poland, where the social insurance institution ZUS has uniform competence with regard to pension and invalidity insurance as well as workers’ health and accident insurance, while the social insurance fund for agricultural workers KRUS is in charge of these matters for the benefit of self-employed farmers. This means that one insurance carrier handles different risks for a given group of persons, while in Austria, Germany or France there are different insurance institutions for, let us say, pension insurance on the one hand and health and/or accident insurance on the other. In the interest of the transparency of the allocation of funds it is particularly important, in systems with a unitary insurance institution, to ensure that the work accident fund is separate from the financial resources covering the other risks, such as is the case in ZUS and, to give another example, in the combined French model for the administration of health and accident insurance. Further examples of this organisational model are found in the social insurance institutions of Lithuania, Latvia and Slovakia. Typically, the social insurance institutions, both in the countries with accident insurance departments and in the other three countries, have managing bodies with a “three-way parity“ system involving the government and the social partners, much in the same way as we see it in SUVA in Switzerland. Slovakia is a typical example: The social insurance institution SVA has jurisdiction over the entire territory of Slovakia and maintains its headquarters in the capital as well as three dozen regional offices. Its budget is separate from the national budget. There is a statutory deficiency guarantee by which the state ensures that the liquidity of the institution. Its 15-person supervisory board consists of five representatives each of the government, the trade unions and employer associations. The chief administrative body is a Board of Directors with five members. In the Czech Republic there are two civil-law insurance institutions (corporations) that handle accidents at work and occupational diseases. They compete with other commercial insurance carriers in such fields as life insurance, third-party liability motor insurance etc., but administer separately the employers’ liability insurance for accidents at work and occupational diseases, in which field they are subject to far-reaching conditions imposed by the government. These include the obligation to conclude insurance contracts, the non-profit principle and/or the duty to transfer any profits achieved to the state budget. The state holds considerable participations in the companies. This means that there are no public insurance carriers but the existing civillaw institutions have been entrusted with the tasks in question; such a solution is also found in Belarus and some other countries. In recent times this system has been widely criticised, and reforms are also called for under European law. The objective is to replace the compulsory employers’ insurance against liability both - 102 - under civil and labour law by a genuine accident insurance that would form part of the public social insurance system. At the earliest the reform will enter into force in July 2006. None of the eight CEE countries that have recently joined the EU has a system that provides for one or more public insurance bodies predominantly or exclusively responsible for the risks of accidents at work and occupational diseases such as exist in such countries as Italy, Germany and Austria. 4. Financing As regards financing, the five “accident insurance countries“ Latvia, Lithuatnia, Poland Slovakia and the Czech Republic have systems that are financed from obligatory employer contributions. This is in line with the practice in most of the old EU members except for the United Kingdom and the Republic of Ireland, where the insurance is financed from tax revenue. While Poland staggers contributions in proportion to the risk involved, Latvia, for instance, has no table of risk groups yet and levies a flat contribution. The new accident insurance law does, however, envisage the introduction of hazard classes. The situation is different in the countries that have no accident insurance system or do not have one yet Estonia, Slovenia and Hungary. In Slovenia accident insurance is in principle financed in the same way as the other branches of social insurance, but within the scope of health insurance there is a separate (uniform) rate of contribution earmarked for accidents at work and occupational diseases and payable exclusively by the employers. In Hungary both employers and employees finance health and old-age insurance, the employers’ share being much higher, at 11%, than the percentage payable by employees (4%). In Estonia the employer pays what is called a “social tax“ for each employee to finance old-age pension and health insurance. As a result, employers bear the lion’s share of work accident costs, and the contributions made by some groups of persons other than employees are of minor importance. 5. The insured persons As regards insured persons, the core group – persons in dependent gainful employment – is fairly straightforward. Much more interest attaches to a number of special groups, such as self-employed persons, civil servants, pupils, students, rescue and salvage workers and persons serving in an honorary capacity etc. On the initiative of the Federal Association of Accident Funds the Forum drew up a most helpful synoptic table some five years ago. It would be most appreciated if the Forum could, amongst a large number of other important projects, bring that table up to date in the form of a survey covering the 25 EU members. In order not to encroach on the time of those who will speak after me, and in view of the national reports that may well cover these aspects, I will not go into any more detail at this point. 6. Claims and events insured Similar considerations obtain in respect of events insured and the claims resulting therefrom. It would go much too far to engage in a comparison of the definitions of “accidents at work“ at this point. Subsequent presentations will deal with the insurance systems for occupational diseases. On a Belgian initiative, the Forum has prepared a survey of occupational diseases (OD) for which compensation is granted even though the disease in question is not contained in the relevant list; this survey ought to be updated by - 103 - the inclusion of the new member states. Is it true, for instance, - as it would appear – that Latvia has a closed list of ODs which precludes any sort of compensation outside that list? Some Forum studies of various ODs have been coordinated and published by Eurogip and other institutions. This is a most timely and important subject, as is proved by the fact that several countries, for instance Hungary and Slovenia, feel there is a need for action to modify national regulations governing occupational diseases. Politically the hottest iron in the West European countries is probably the issue of travel accidents, especially on the way to and from work. Estonia, Lithuania, Slovenia and Hungary recognise such accidents, while Latvia recognises such accidents only if they involve transport made available by the employer – which means that they are hardly ever recognised. Nor do Poland and Slovakia recognise travel accidents as accidents at work. The overall picture, then, is that the new member countries’ approach is different from that in Western Europe, where travel accidents are overwhelmingly covered by the accident insurance. 7. Benefits In preparing for their accession to the European Union in the 1990s many countries undertook great efforts to meet the conditions for signing Convention No. 121 of the International Labour Organisation (ILO) on (Minimum) “Benefits in the Case of Employment Injury“ and/or the Council of Europe’s Social Charter. As far as that is concerned, the catalogues of benefits, for all their details and complexity, contain hardly any surprises. All the various systems appear to grant injured parties and their dependants the classic money benefits and benefits in kind in line with national cost of living standards. In accordance with German usage, these benefits are in particular injury allowances, permanent accident benefits, pensions for widows and dependants, death benefits and reimbursement of funeral costs. The national reports will certainly present more details. In spite of suggestions made and a tentative start by the Luxembourg Presidency the Forum has so far done very little in this field and has, for example, failed to attempt a systematic comparison of benefits in the individual countries. Among the host of possible issues I would in particular call for comparative studies on the question of compensation for immaterial damage, i.e. for what Switzerland calls an integrity compensation, and on the interplay between social benefits and civil-law damage claims – issues usually dealt with under the heading “liability privilege“ or “employer privilege“. While the old member states generally limit civil-law and labour-law claims for damages on the part of an injured employee against his employer to very narrowly defined cases (for instance accidents caused intentionally or due to gross negligence), a number of new members appear to recognise no such exclusions of liability. As far as we know, this is the case in Poland, the Czech Republic, Estonia and probably some other countries. This issue becomes relevant in practice on account of the fact that under European coordination legislation the admissibility of a civil lawsuit on the part of a seasonal worker is governed by the law of that seasonal worker’s home country, rather than the country of residence of the employer, so that later might be faced with unexpected liability claims. 8. Prevention and Rehabilitation In the past the Forum has on several occasions dealt with issues of prevention and rehabilitation within the scope of accident insurance. This was amongst other things the case under the German and Austrian Presidencies. On account of the specifics of the risks involved in accidents at work and occupational diseases, successful prevention and rehabilitation can result in particularly effective cost reductions in this insurance branch. Accident insurance is therefore the classic field in which the European Commission’s calls for active welfare ought to be heeded – a form of social policy which is not confined to compensation but is committed - 104 - to prevention and rehabilitation to enhance the employability and working capacity of the individual and in this way raise the employment rate. It appears that unlike some western European countries none of the accident insurance providers in the eight CEE countries operate separate services in the field of the protection of workers and rehabilitation. Rehabilitation is in the province of health insurance and/or a national health service, which are reimbursed for their expenditures, and the protection of workers is left to governmental labour inspectors. This holds even for Poland, the largest new member by far, and for ZUS, the largest accident insurance company in the new member countries, although some tentative efforts have been made to assume some tasks of prevention: Since early 2003 1 % of the contributions have been earmarked for accident research, safety education and similar projects. 9. Summary Fifteen years after the collapse of the Soviet bloc and one year after the accession of the CEE countries to the EU, we note a considerable degree of diversity in these countries’ accident insurance systems, which are still in a state of flux. All eight countries recognise accidents at work and occupational diseases as claims in their own right, five of them have separate accident insurance carriers, four of these in the form of departments of social insurance institutions with self-governing bodies featuring three-way-parity representation. In three countries accidents at work and occupational diseases are currently handled by other branches of social insurance. Competences and duties in the field of prevention and rehabilitation are still lagging behind those in many western European systems. Legislation has so far focused especially on compensation and the financing of the newly created systems. At least in Estonia, the Czech Republic and Hungary concrete reform projects by parliaments or governments are under way, while in other countries such as Slovenia and Latvia, reforms are being discussed. Eleven years ago, at its 1994 meeting in Copenhagen, the European Forum discussed the accident insurance systems of the CEE countries for the first time. At that time, hardly any of the current accident insurance laws was yet in force. The European Forum ought to continue to play its role as a platform for the accident insurance institutions in Europe, both East and West, and to contribute to the continued development of their systems. - 105 - - 106 - Unfallversicherungssysteme in den neuen EU-Mitgliedstaaten im Überblick Bernhard Pabst 1. Einleitung In 30 Minuten auch nur einen Überblick über die Unfallversicherungssysteme der zehn neuen EGMitgliedstaaten zu geben, bedeutet offensichtlich, mit einem höchst groben Pinsel zeichnen zu müssen. Notgedrungen muss man sich in der Kunst des Weglassens, aber noch mehr der Bescheidenheit üben, denn wer überblickt schon souverän die Systeme einer solchen Vielzahl von Staaten? Zumal – und das scheint mir eine zwar banale, aber gleichwohl wichtige erste Feststellung – diese Staaten und ihre Unfallversicherungstraditionen nicht so homogen sind, wie Interessierte es sich vereinfachend gerne vorstellen. Zwar gibt es aus der Zeit des sog. „Ostblocks“ bis zur Wende 1989 eine gemeinsame Tradition einer Sozialversicherung nach sowjetischem Modell, das aber eine spezielle Unfallversicherung gerade nicht kannte; in den letzten 15 Jahren sind die Staaten aber teilweise recht unterschiedliche Reformwege gegangen. In einigen Fällen, z.B. in Polen oder der Slowakei, wurde an vorkommunistische nationale Traditionen aus der Zwischenkriegszeit angeknüpft. In anderen Fällen, insbesondere in Tschechien, wurde aus der Sicht der Rechtstradition ein Systemwechsel gegenüber dem öffentlichen Solidarmodell der Vorkriegszeit vollzogen. Beschränkung bedeutet vorliegend auch Konzentration auf die mittel- und osteuropäischen Länder (MOEL). Zu Malta hören wir anschließend den Länderbericht von Herrn Micallef. 2. Anerkennung der Versicherungsfälle „Arbeitsunfall“ und „Berufskrankheit“ Wenn ich recht sehe, kennen alle acht MOE-Neumitglieder ebenso wie die Kandidatenländer Rumänien, Bulgarien und Kroatien die speziellen Versicherungsfälle von „Arbeitsunfall“ und „Berufskrankheit“. Ein sogenanntes finales System wie in den Niederlanden wurde nirgendwo eingeführt. Wir verstehen darunter ein Sozialversicherungssystem, das keine Unterscheidung zwischen berufsbezogenem Unfall bzw. Erkrankung einerseits, Freizeitunfall bzw. Allgemeinerkrankung andererseits macht. Die Folgen von Unfall oder Erkrankung werden im allgemeinen Invaliditäts-, Hinterbliebenen- bzw. Krankenversicherung behandelt, ohne dass es auf die Verursachung durch die berufliche Tätigkeit ankommt. 3. Eigenständige Versicherung für Arbeitsunfälle und Berufskrankheiten Gleichwohl gibt es nicht in allen MOEL einen eigenen spezialisierten Verwaltungsaufbau für Arbeitsunfälle und Berufskrankheiten, wie z.B. die AUVA in Österreich oder die Berufsgenossenschaften in Deutschland. Dies ist die Situation in Estland, Slowenien und Ungarn. In Estland ist ein UV-Gesetzesentwurf im Parlament gescheitert. Die Risiken von Arbeitsunfall und Berufskrankheit sind durch die Krankenversicherung (kurzfristige Geld- und Sachleistungen) und die Rentenversicherung (langfristige Leistungen) gedeckt. Aufgrund der zivilrechtlichen Haftung des Arbeitgebers werden zusätzliche Leistungen als Schadensausgleich gewährt. Der Entwurf einer gesetzlichen Neuregelung der Unfallversicherung wird für Anfang nächsten Jahres erwartet. - 107 - In Ungarn ist die Arbeitsunfallversicherung Teil der gesetzlichen Krankenversicherung. Die Verwaltung der Pflichtversicherung obliegt der Nationalen Krankenversicherungskasse OEP und anderen Einrichtungen. Ein Vorschlag für eine separate Unfallversicherung soll bis 2008 dem Parlament vorgelegt werden. In Slowenien deckt die obligatorische Renten- und Invaliditätsversicherung auch die Risiken Arbeitsunfall und Berufskrankheit durch Renten und ergänzende Leistungen. Die obligatorische Krankenversicherung bietet Sach- und Geldleistungen auch bei Arbeitsunfällen und Berufskrankheiten. Von diesem Risiko betroffene Arbeitnehmer sind gegenüber allgemein Verletzten bzw. Erkrankten hinsichtlich verschiedener Leistungen besser gestellt. Reformüberlegungen werden schon recht lange diskutiert, ohne dass sie bisher Niederschlag im Gesetz gefunden haben. Vier der acht Neumitglieder in Mittel- und Osteuropa Staaten verwalten die Risiken Arbeitsunfall und Berufskrankheit separat durch spezialisierte Abteilungen einer Sozialversicherungsanstalt. Diese Lösung finden wir insbesondere in Polen, wo die Sozialversicherungsanstalt ZUS einheitlich für die Renten- und Invalidenversicherung, die Kranken- und Unfallversicherung der Arbeitnehmer zuständig ist, während die Sozialversicherungskasse für Landwirte KRUS diese Aufgaben für die selbstständigen Landwirte wahrnimmt. Ein Träger verwaltet also verschiedene Risiken für eine bestimmte Gruppen, während es etwa in Österreich, Deutschland oder Frankreich verschiedene Träger z.B. für Rentenversicherungs einerseits, Kranken- und/oder Unfallversicherung andererseits gibt. Im Sinne einer Transparenz der Mittelallokation ist in Systemen mit einheitlichem Träger von besonderer Bedeutung, dass der Arbeitsunfallfonds von den finanziellen Resourcen für die übrigen Risiken getrennt ist, wie dies bei ZUS der Fall ist oder auch bei der kombinierten französischen Kranken- und Unfallversicherungsverwaltung. Weitere Beispiele dieser verwaltungsorganisatorischen Lösung sind die Sozialversicherungsanstalten von Litauen und Lettland sowie der Slowakei. Typischerweise sind an der Leitung der Sozialversicherungsanstalten sowohl dort wo es UnfallversicherungsAbteilungen gibt als auch in den drei anderen Ländern der Staat und die Sozialpartner drittelparitätisch an den Leitungsgremien beteiligt, ähnlich wie wir dies etwa von der schweizerischen Suva kennen. Typisch erscheint mir das slowakische Beispiel: Die Sozialversicherungsanstalt (SVA) ist landesweit zuständig und verfügt über eine Zentrale in der Hauptstadt und drei Dutzend Regionalbüros. Der Haushalt ist vom Staatshaushalt getrennt. Es gibt eine gesetzliche Ausfallgarantie, der Staat garantiert die Liquidität der Anstalt. Der 15-köpfige Aufsichtsrat ist mit je fünf Vertretern des Staates, der Gewerkschaften und der Arbeitgeberverbände besetzt. Oberstes Lenkungsgremium ist ein fünfköpfiges Direktorium. In Tschechien erbringen bei Arbeitsunfällen und Berufskrankheiten zwei Versicherungen des Zivilrechts (Aktiengesellschaften) Leistungen. Während diese u.a. im Bereich von Lebensversicherungen, KfzHaftpflichtversicherungen usw. als kommerzielle Versicherer im Wettbewerb stehen, sind sie im getrennt zu verwaltenden Bereich der Unternehmerhaftpflichtversicherung bei Arbeitsunfällen und Berufskrankheiten weitgehenden staatlichen Vorgaben unterworfen, insbesondere Abschlusszwang und Ausschluss von Gewinnerzielung bzw. Verpflichtung, einen Gewinn an den Staatshaushalt abzuführen. Der Staat ist an den Gesellschaften in erheblichem Maße beteiligt. Man hat also keinen eigenen öffentlichen Träger geschaffen, sondern die Aufgabe ohnehin bestehenden, nach Zivilrecht gegründeten Einrichtungen übertragen; eine Lösung wie wir sie z.B. auch in Weißrussland finden. Das System steht seit einiger Zeit in der Kritik und gilt – u.a. aus europarechtlichen Gründen - als reformbedürftig. Die Pflichtversicherung gegen die zivil- und arbeitsrechtliche Haftung des Unternehmers soll durch eine echte Unfallversicherung als Teil der öffentlichen Sozialversicherung ersetzt werden, die Reform frühestens Juli 2006 in Kraft treten. - 108 - Eine Lösung in Form eines oder mehrerer öffentlicher Träger, der bzw. die überwiegend oder ausschließlich für das Risiko von Arbeitsunfällen und Berufskrankheiten zuständig ist, wie dies z.B. in Italien, Deutschland oder Österreich der Fall ist, finden wir in keinem der acht mittel- und osteuropäischen Neumitglieder. 4. Finanzierung Im Bereich der Finanzierung besteht in den fünf „UV-Ländern“ Lettland, Litauen, Polen, Slowakei sowie Tschechien Alleinfinanzierungspflicht durch den Arbeitgeber. Dies entspricht der Regelung in den meisten Alt-EU-Mitgliedstaaten mit Ausnahme insbesondere der steuerfinanzierten Systeme des Vereinigten Königreichs und der Republik Irland. Während Polen einen risikogestaffelten Beitrag kennt, gibt es z.B. in Lettland derzeit noch keine Tabelle der Risikogruppen und daher einen Einheitsbeitrag. Das Unfallgesetz sieht jedoch bereits den Übergang zu Gefahrklassen vor. In den „Nicht- “ oder „Noch-Nicht-UV-Ländern“ Estland, Slowenien und Ungarn stellt sich die Situation unterschiedlich dar. In Slowenien wird die Unfallversicherung grundsätzlich auf die gleiche Art wie die übrigen Zweige der Sozialversicherung finanziert. Jedoch besteht innerhalb der Krankenversicherung ein getrennter (einheitlicher) Beitragssatz für Arbeitsunfälle und Berufskrankheiten, der nur von den Arbeitgebern aufzubringen ist. In Ungarn finanzieren Arbeitgeber und Arbeitnehmer Kranken- und Altersversicherung je anteilig, wobei der Arbeitgeberanteil deutlich über dem des Versicherten liegt, z.B. in der ungarischen Krankenversicherung im Verhältnis von 4% zu 11%. In Estland zahlt der Arbeitgeber eine sog. „Sozialsteuer“ für alle Beschäftigten, die auf Renten- und Krankenversicherung verteilt wird. Im Ergebnis tragen dadurch die Arbeitgeber die Hauptlast der Arbeitsunfallkosten, das Beitragsaufkommen einiger Gruppen von Nichtbeschäftigten hat nicht das gleiche Gewicht. 5. Kreis der Versicherten Hinsichtlich des Kreises der Versicherten gibt es bei der Kerngruppe, bei den lohnabhängig Beschäftigten, wenig Überraschungen. Die Frage ist spannender hinsichtlich verschiedener Sondergruppen wie Selbstständigen, Beamten, Schülern, Studenten, Lebensrettern, Nothelfern, ehrenamtlich Tätigen usw. Auf Initiative des Bundesverbands der Unfallkassen hat das Forum vor fünf Jahren zu diesem Thema einmal eine sehr verdienstvolle Synopse erarbeitet. Es wäre eine der vielen lohnenden Aufgaben des Forums hier in einer Aktualisierung zu einem Überblick mit dem Stand EU25 zu kommen. Vorliegend möchte ich aus Zeitgründen und angesichts der nachfolgenden Länderberichte diesen Aspekt nicht vertiefen. 6. Versicherungsfall Ähnliches gilt für die Versicherungsfälle. Ein Vergleich der Definition des Begriffs „Arbeitsunfall“ führte vorliegend zu weit. Zu den Berufskrankheitensystemen werden wir anschließend noch mehr hören. Auf belgische Initiative hat das Forum hier eine Übersicht erarbeitet zu Berufskrankheiten (BK), die außerhalb der Liste entschädigt werden und die um die neuen Mitgliedstaaten zu ergänzen wäre. Hat beispielsweise – wie es den Anschein hat - Lettland eine geschlossene BK-Liste, ohne die Möglichkeit zur Entschädigung außerhalb der Liste? ForumUntersuchungen zu verschiedenen einzelnen Berufskrankheiten hat insbesondere Eurogip koordiniert und veröffentlicht. Die Brisanz und Aktualität des Themas zeigt sich auch darin, dass gerade im Bereich der - 109 - Berufskrankheiten mehrere Staaten Handlungsbedarf hinsichtlich der jeweiligen nationalen Regelung sehen, etwa Ungarn und Slowenien. Am politisch brisantesten in den westeuropäischen Staaten ist möglicherweise derzeit der Wegeunfall. Estland, Litauen, Slowenien und Ungarn erkennen ihn an, Lettland nur, wenn sich der Unfall in einem Transportmittel des Arbeitgebers ereignet, d.h. grundsätzlich nicht. Auch in Polen und der Slowakei gilt ein Wegeunfall nicht als Arbeitsunfall. Insgesamt also ein Befund, der vom allgemeinen Bild in Westeuropa, wo der Wegeunfall überwiegend als Versicherungsfall der Unfallversicherung abgedeckt ist, abweicht. 7. Leistungen Im Rahmen der Vorbereitungen auf den Beitritt zur Europäischen Union haben viele Staaten in den 1990iger Jahren erhebliche Anstrengungen unternommen, die Voraussetzungen für die Unterzeichnung von Übereinkommen Nr. 121 der Internationalen Arbeitsorganisation (IAO) zu (Mindest-) „Leistungen bei Arbeitsunfällen und Berufskrankheiten“ und/oder der Sozialcharta des Europarats zu schaffen. Insofern bieten – wenn ich recht sehe – die Leistungskataloge trotz aller Komplexität und Details wenig Überraschungen. Überall scheint es die klassischen Geld- und Sachleistungen für den Verletzten und seine Hinterbliebenen, in der Höhe ausgerichtet an den nationalen Lebenshaltungsstandards, zu geben. In der Terminologie der Bundesrepublik Deutschland sind dies insbesondere Verletztengeld, dauerhafte Unfallrenten, Witwen- und Waisenrenten, Sterbegeld, Ersatz der Beerdigungskosten. Einzelheiten werden wir sicher in den Länderberichten hören. Trotz einer Anregung und Ansätzen der luxemburgischen Präsidentschaft hat das Forum auf diesem Gebiet bisher relativ wenig gearbeitet und beispielsweise bisher nicht den Versuch einer vergleichenden Systematisierung des Leistungsbereichs unternommen. Unter der Vielzahl möglicher Untersuchungskriterien erscheinen mir derzeit insbesondere vergleichende Studien wünschenswert zur Frage des immateriellen Schadensersatzes, also zur in der Schweiz sog. Integritätsentschädigung, und zum Zusammenspiel von Sozialleistung und zivilrechtlichem Schadensersatz, meist unter dem Stichwort „Haftungsprivileg“ oder „Unternehmerprivileg“ behandelt. Während die Altmitglieder einen zivil- oder arbeitsrechtlichen Schadensersatzanspruch des verletzten Arbeitnehmers gegen den Arbeitgeber im Allgemeinen nur unter engen Voraussetzungen (z.B. bei vorsätzlichem oder grob fahrlässigem Herbeiführen des Unfalls) zulassen, scheint eine ganze Reihe von Neumitgliedern keinen entsprechenden Haftungsausschluss zu kennen. Dies ist soweit wir wissen die Rechtslage z.B. in Polen, Tschechien, Estland und vermutlich einigen anderen Staaten. Praktische Bedeutung erhält die Frage dadurch, dass nach europäischem Koordinierungsrecht das Heimatrecht z.B. des Saisoniers, nicht das Recht des Arbeitgebers über die Zulässigkeit einer Zivilrechtsklage entscheidet und auf den Arbeitgeber hier unerwartete Haftungsfolgen zukommen können. - 110 - 8. Prävention und Rehabilitation Fragen von Prävention und Rehabilitation der Unfallversicherung waren in der Vergangenheit bereits mehrfach Gegenstand im Forum, u.a. während der deutschen und österreichischen Präsidentschaft. Auf Grund der Spezifika der Risiken Arbeitsunfall und Berufskrankheit können erfolgreiche Prävention und Rehabilitation in diesem Versicherungszweig besonders kostensenkend wirken. Die Unfallversicherung ist daher das klassische Anwendungsgebiet des von der Europäischen Kommission propagierten active welfare, d.h. einer Sozialpolitik, die nicht nur entschädigt, sondern durch Prävention und Rehabilitation aktiv zur Hebung der Beschäftigungsfähigkeit des Einzelnen und damit der Beschäftigungsquote insgesamt beiträgt. Anders als einige westeuropäische Staaten hat anscheinend keiner der Unfallversicherungsträger in den acht mittel- und osteuropäischen Ländern eigene Dienste im Bereich von Arbeitsschutz und Rehabilitation. Bei letztgenannter bedient man sich des Systems der Krankenversicherung bzw. eines Nationalen Gesundheitsdienstes und erstattet die Kosten, bei erstgenanntem liegt die Zuständigkeit bei der staatlichen Arbeitsinspektion. Dies gilt selbst im Falle Polens als dem mit Abstand größten Neumitglied und ZUS als größtem neuen Träger. Hier gibt es allerdings Ansätze zu eigenen Aufgaben im Bereich der Prävention: Seit Anfang 2003 stehen 1% der Beiträge für Unfallerforschung, Aufklärung über Arbeitssicherheit u.ä. Aufgaben zur Verfügung. 9. Resümee 15 Jahre nach dem Zerfall des sowjetischen Blocks und ein Jahr nach dem Beitritt zur EU finden wir in den mittel- und osteuropäischen Staaten eine bunte Landschaft im Bereich der Unfallversicherung vor, die noch relativ in Bewegung ist. Alle acht Staaten erkennen die Versicherungsfälle Arbeitsunfall und Berufskrankheit an; fünf haben eigene UV-Träger, vier davon als Abteilungen von Sozialversicherungsanstalten mit drittelparitätischer Selbstverwaltung. In drei Ländern werden Arbeitsunfälle und Berufskrankheiten derzeit durch andere Zweige der Sozialversicherung verwaltet. Kompetenzen und Aufgaben im Bereich der Prävention und Rehabilitation sind im Vergleich mit zahlreichen westeuropäischen Systemen bisher relativ schwach ausgeprägt. Der Schwerpunkt der bisherigen gesetzgeberischen Maßnahmen lag eindeutig auf der Kompensation und Finanzierung der neu geschaffenen Systeme. Zumindest in Estland, Tschechien und Ungarn gibt es konkrete Reformvorhaben mit Vorgaben von Parlament oder Regierung in weiteren Ländern, z.B. in Slowenien und Lettland, Reformdiskussionen. Vor elf Jahren, auf seiner Tagung 1994 in Kopenhagen, hat sich das Europäische Forum erstmalig mit den Unfallversicherungssystemen der MOE-Länder befasst. Kaum eines der aktuell geltenden Unfallversicherungsgesetze war damals bereits in Kraft. Auch heute kann und sollte das Europäische Forum Unfallversicherung eine Rolle als Plattform der Unfallversicherungen in Europa in West und Ost spielen und einen Beitrag zur Weiterentwicklung der Systeme leisten. - 111 - - 112 - Insurance against accidents at work and occupational diseases in the Slovak Republic Marek Lendacký The Slovak Republic has been a member of the European Union since 1 May 2004 and has since undertaken a number of fundamental reforms. The Slovak social welfare system, which also encompasses social insurance, has undergone major changes. The new social insurance system has been introduced as from 1 January 2004. It consists of five parts: Health insurance pension insurance • old-age insurance • invalidity insurance accident insurance insolvency insurance unemployment insurance. While these branches or sub-systems are independent, they are nevertheless interconnected. Since this conference is dedicated to the subject of the accident insurance, I would now like to discuss the latter in somewhat greater detail. In Slovakia, accident insurance falls within the remit of the Social Insurance Agency, which is a public legal corporation. Ministry of Labour, Social Affairs and Family of the Slovak Republic, which does not, however, interfere with the activities of the Social Insurance Agency as an insurance carrier, implement the law governing the reform of the entire system of social insurance. The Social Insurance Agency is the central body responsible for implementation. In this capacity it ensures communication between its member institutions and insured persons and contacts with its sister institutions in the other EU member countries. While accident insurance in its present form was first introduced the 1st January 2004, this does not mean that accidents at work and occupational diseases indemnities had not previously existed in the Slovak Republic. Under labour law, the general liability for accidents at work and occupational diseases is a responsibility of employers. Until the 31st December 2003, a commercial insurance agency administered compensations for accidents at work and occupational diseases. Accident insurance provides insurance for the employer. It is compulsory for all employers who have at least one employee on their payroll. Since the Slovak social insurance system is a universal one, there are no separate accident insurance institutions, with one exception: Military personnel is not covered by the general social insurance system but by a special system which also provides for compensation in the case of accidents sustained or occupational diseases contracted in the exercise of their duties. - 113 - The general accident insurance system does not extend to self-employed persons. If, however, such persons are at the same time employers – i.e. employ at least one person - they are under the obligation to take out accident insurance. The system of accident insurance in Slovakia also provides insurance cover for persons who undertake work for an employer without being formally employed by him, i.e. under a free service contract. Under Slovak labour legislation; there are two types of work contracts: free service contracts under which an individual undertakes to perform some specified work over a limited period, and contracts covering work undertaken by students. Accordingly, natural and juridical persons who give employment to at least one person have to take out accident insurance from the Social Insurance Agency, even if the relationship with the employee is only a contractual and temporary one. Within the scope of accident insurance, there are specific groups of persons who are entitled, in case of a work t or an occupational disease, to social granted by the state. These groups are: secondary school and university students, soldiers in active service, volunteer members of fire brigades, mountain rescue services and Red Cross volunteers, and persons who render assistance in case of road accidents and natural disasters or in salvage operations. The Slovak accident insurance system offers protection against the risks of accidents at work and occupational diseases; the relevant definitions are probably not much different from those prevailing in other countries. In our definition an accident at work is an event impairing the health or causing the death of a natural person by temporary, sudden and violent external action to which the employee is, independently of his/her will, exposed in the course of fulfilling his/her duty, in direct connection with or on account of said duty, or in the course of averting damage that might otherwise have threatened his/her employer; and impairing the health or causing the death of persons pertaining to specific groups covered by accident insurance, i.e. the above-mentioned groups of students, volunteer fire fighters and rescue workers etc. Occupational diseases are diseases recognised as such by a health institution in charge of occupational medicine and which are listed in the register of occupational diseases as a part of the relevant law. Diseases diagnosed at the time when the disease in question was not yet contained in said register are also recognised as occupational diseases if diagnosis was made less than three years prior to its inclusion in the list. - 114 - To decide whether a health impairment or death has been caused by an accident at work or an occupational disease, the criteria to be met are whether the impairment or death occurred in the course of discharging a duty that forms part of the usual or traditional activities of the employee; in the course of work performed by the employee in compliance with his/her employer’s instructions; in the course of an activity being subject to the employee’s business trip; in the course of an activity in direct connection with the employee’s performing his/her duty; in the course of a routine health check ordered by the employer; in the course of the employee’s participation in a training or further training seminar organised by a trade union organisation, on condition that the employer had been duly informed of such participation beforehand. The accident insurance system of the Slovak Republic does not consider as an accident at work or occupational disease if the health impairment was sustained or death occurred on the way to or from work. As it is the employer who is the holder of the accident insurance, the employee who has sustained an injury or suffered death is seen as the injured party. For other subsystems of the social insurance he/she is still considered to be a policyholder. The Slovak system of accident insurance also relies on the performance of the other branches of social insurance in respect of sick leave pay, i.e. benefits paid by the health insurance branch, and with regard to old-age pensions, early-retirement pensions, and invalidity pensions, i.e. benefits made available by the pension insurance institution. At this point we should mention the methods of accident insurance financing. As it has been mentioned, accident insurance is an integral part of the social insurance system, which is in the hands of the Social Insurance Agency, a corporation under public law. It is financed along the lines of the “pay as you go” (PAYG) principle. Accident insurance premiums are exclusively paid by employers and are determined as a percentage of the assessment basis. The period from the entry into force of the new Social Insurance law the 1st January 2004 to 31st December 2006 has been called a transition phase regarding accident insurance contributions. This phase is characterised by the requirement for all employers to take out an accident insurance at a flat 0.8% premium. As from 1st January 2007 onwards, there will be a “bonus-malus” system according to which employers will pay different percentages. This system of 10 danger categories will enter into force so that the 1st grade danger category will be liable to pay 0.3% up to 2.1% for the 10th grade danger category. The danger degree will be determined according to the safety risk of each activity according to the branch classification. The starting date 1st January 2007 was determined so that the accident policyholder would have sufficient time to create the necessary database, which will allow making a correct classification. Assignment of employee into a danger category shall be determined by the Social Security Agency according to the prevailing group of economic activities performed by the employer. As I have already mentioned, the Slovak accident insurance system is a superstructure based on the performance of a number of other insurance institutions, to which the same principle will apply with regard to insurance premium payments and in particular the assessment basis. - 115 - Generally speaking, the assessment basis serves to determine both the amounts of premium payments and of the benefits to be paid by the insurance institutions. The purpose of accident insurance in the Slovak Republic is to compensate the injured party for the part of his/her net income that he/she has lost on account of the accident or occupational disease. This is what distinguishes accident insurance from the other four branches of social insurance, where both the insurance premiums and the scale of benefits are based on the employee’s gross earnings. In the case of health, pension, unemployment and insolvency insurance there is a maximum assessment basis, which does, however, not apply to the case of accident insurance. Accident Insurance Benefits Accident benefit –payments made to an injured party who is unable to work on account of an accident at work or occupational disease, to ensure that the beneficiary receives, through the combination of accident and sickness benefits, the same net income as he/she had prior to the accident or disease onset. Accident pensions are granted on condition that the reduction of the beneficiary’s working capacity by an accident at work or occupational disease amounts to at least 40% as compared with the work undertaken by the beneficiary immediately prior to the accident or disease onset. The amount payable under this heading is as a rule determined on the basis of the net earnings of the injured party (roughly 80% of gross earnings) and the percentage by which his/her working capacity has been reduced. If the beneficiary also receives an old age or invalidity pension, the accident pension is reduced accordingly. If the beneficiary’s impaired state of health changes but his/her working capacity continues to be reduced by more than 40%, the disability benefit is adjusted according to the new circumstances. Disability benefits are adjusted annually by the same percentage as pension payments. In cases where an accident at work or an occupational disease has resulted in a health impairment not eligible for disability benefits, i.e. a reduction of the injured party’s working capacity by less than 40% but more than 10%, the beneficiary is entitled to damages – a one-off payment the amount of which is calculated from the beneficiary’s gross earnings on the basis of the percentage reduction of his/her working capacity. The accident insurance system also provides for benefits payable to the survivors of employees who have died on account of an accident at work or occupational disease. Such benefits may take the form of a survivors’ allowance or a lump-sum payment. The survivors’ allowance is granted in cases in which a court has established the decedent’s maintenance obligation vis-àvis a third party, while the lump-sum payment is made to the decedent’s spouse and dependent children. Other financial benefits payable by the accident insurance system include: - damages for pain and suffering as well as compensatory payments in case of re-integration difficulties; - reimbursement of health care expenses in excess of the amounts payable by the compulsory health insurance - reimbursement of funeral expenses. - 116 - The accident insurance system may also offer vocational rehabilitation or retraining programmes covering a maximum of six months. The decision on what benefits should be granted rests with the insurance institution; rehabilitation or retraining opportunities cannot be granted to beneficiaries receiving old-age pensions. In cases in which the insurance institution decides in favour of vocational rehabilitation or retraining after assessing the result to be expected from either benefit, the beneficiary is entitled to financial compensation corresponding to his/her net earnings. Since accident insurance is based on the principle that the general responsibility is borne by the employer, it must be stressed that accident insurance benefits cannot be claimed if the employer can provide a proof that he is in no way responsible for the accident at work or occupational disease in question. The employer is under the obligation to notify the insurance carrier of an accident at work within three days, if his employee was in need of medical assistance or is unable to work on account of said accident, and to submit to the insurance carrier a record of the accident in question and the medical findings within eight days at the latest. Health institutions (hospitals etc.) are likewise required to report accidents at work or occupational diseases to the insurance carrier. The Social Insurance Agency is not responsible for the prevention of accidents at work or occupational diseases. Prevention of accidents at work is the legal responsibility of the employer, who is obliged at all times to warrant, and take all necessary precautionary measures to guarantee, the safety and health protection of his employees in the course of work and to ensure the availability of prevention measures and instruments and a practicable system of workplace safety organisation. The employer is also required to steadily improve the level of workers’ safety in all respects and to modify safety precautions as changing circumstances may require. - 117 - Changes planned in compensation for accidents at work and occupational diseases in the Czech Republic Vit Samek Current situation Legislation Under the legislation contained in Section 205d of Act No 65/1965 Coll., the Labour Code, as amended, since 1 January 1993, the protection of employees from the consequences of accidents at work and occupational diseases in the Czech Republic is, by nature, a statutory insurance of employer’s liability for damage as set forth in Section 789 of the Civil Code. It is covered in more detail in the Regulation of the Ministry of Finance No 125/1993 Coll. laying down conditions and rates of statutory insurance of employer’s liability for damage. Given the complementary nature of statutory insurance, other legal regulations are also important in relation to compensation for accidents at work and occupational diseases, including, without limitation: - Government Decree No 108/1994 Coll. implementing the Labour Code and certain other laws, as amended by Government Decree No 461/2000, - Government Decree No 290/1995 Coll. establishing a list of occupational diseases, - Government Decree No 494/2001 Coll. appointing the method used to keep records, make reports, and send accident reports, a specimen of an accident report and the set of authorities and institutions to whom an occupational accident is notified and to whom an accident report is sent, - Government Decree No 482/2003 Coll. on the regulation of compensation for loss of earnings during a period of inability to work resulting from an occupational accident or occupational disease and on the regulation of compensation for loss of earnings during a period of inability to work or in the event of disability (regulation of compensation for loss of earnings); and a further 11 government decrees issued annually since 1993 further to authorization granted in Section 202(2) of the Labour Code, - Regulation No 440/2001 Coll. on compensation for pain and aggravation of social self-assertion (usefulness), as amended. Current legislation on compensation for accidents at work and occupational diseases contained in the Labour Code respects the principles of the equal treatment of men and women and the prohibition of discrimination in keeping with the relevant provisions of the Labour Code. By law, employers employing at least one employee (with the exception of the State’s organizational components) are insured against liability for damage caused by an occupational accident or occupational disease at Česká pojišťovna, a.s., provided that they had taken out statutory insurance of employer’s liability for damage with this insurance company as at 31 December 1992. Other employers are required by law to be insured at Kooperativa pojišťovna, a.s. - 119 - The scope of an employer’s liability and compensation for damage in the event of an accident at work or occupational disease is defined in Sections 190 to 203 of the Labour Code. An employer’s liability is objective and subject to the outcome. An employer may be fully or partly absolved of liability under the conditions specifically listed in the Labour Code. The payment of compensation for damage is an obligation incumbent on the employer. An employer is entitled to have the relevant insurance company pay compensation for damage incurred by employees as a result of an accident at work or occupational disease insofar as the employer is held liable for such damage under the Labour Code. However, insurance companies only cover claims seeking compensation for damage filed against an employer as a result of insured events, which occur over the duration of statutory insurance. Compensation for damage, which occurred prior to the introduction of statutory insurance in Section 205d of the Labour Code, is still covered by employers. The claimant, or the party incurring expenses, has a claim to compensation for loss of earnings, compensation for pain and aggravation of social self-assertion (usefulness), compensation for purposefully incurred costs connected with treatment, and compensation for material damage. Compensation for loss of earnings over an employee’s period of inability to work is provided at the amount of the difference between the employee’s average earnings prior to the damage and the full amount of sickness benefit. Compensation for loss of earnings during a period of inability to work or in cases when full or partial disability is acknowledged is provided to an employee at such an amount that, together with his earnings after the occupational accident or after the discovery of the occupational disease, inclusive of any full or partial invalidity benefit granted for the same reason, it is equal to the employee’s average earnings before the damage was sustained. Further compensation is provided in the event of an employee’s death, which has a causal nexus with an accident at work or occupational disease. This is compensation for purposefully expended costs connected with the employee’s treatment, compensation for reasonable funeral expenses, compensation for the maintenance of survivors, lump-sum compensation for survivors, and compensation for damage to property. Statutory insurance of employer’s liability for damage is implemented on a non-profit basis. Any tangible loss incurred by insurance companies through the operation of this insurance is covered out of the national budget; any surplus from this insurance is transferred to the national budget by insurance companies. Insurance companies are set a fixed amount of expenses as administrative overheads. When statutory insurance was established, these expenses amounted to 29.5 % of the total volume of premiums received (paid by employers) in the given calendar year, and was gradually reduced as the volume of premiums received rose; it now stands at 13.5 % of premiums received. However, the premium rates have also been increased. For example, with the economic activity of hard-coal mining and similar operations, the premium has gone up from 12 per mille to 50.4 per mille of the assessment base; in agriculture it has risen from five per mille to seven per mille. With statutory insurance, the employer has the status of both policyholder and the insured. The beneficiary of insured payments is the injured employee. Statutory insurance does not apply to the State’s organizational components; in the event of an accident at work or occupational disease, their employees receive compensation from their employer in the scope laid down by the Labour Code – these funds come from the national budget. The case is similar with professional soldiers and members of security - 120 - corps, whose compensation for accidents in the course of duty or occupational diseases is governed by separate legal regulations. Because the legislation on statutory employer’s liability insurance is based on the different economic and legal situation in existence at the beginning of the 1990s, when it was expected to be a temporary measure until the adoption of a new accident insurance act and the establishment of Úrazová pojišťovna [Accident Insurance Company], it has been plagued by legal problems that have led the current government to prepare new legislation. For example, the employer’s obligation to pay premiums in respect of this statutory insurance contravenes the constitutional order of the Czech Republic as laid down in an implementing regulation (the abovementioned Regulation No 125/1993 Coll., as amended). The fact that the Labour Code designates two commercial insurance companies as the bearers of insurance means that other commercial insurers operating in the Czech Republic are unable to take part in statutory insurance of employer’s liability for damage. Implementation and results of statutory insurance An analysis of the development of statutory insurance to date and an estimate of insurance benefit paid as a result of damage sustained in the scope of this insurance up to 2003 (the situation in December 2004) reveals the following: 1. In terms of the pay-as-you-go financing scheme used as the basis for the current insurance system, the estimated outcome for 2004 will be a ‘surplus’ of CZK 1.376 billion. Therefore, in the wake of the hike in premiums in 2002 there is no danger to the national budget of a loss from this insurance. 2. However, in terms of developments in payments of compensation for loss of earnings this result is alarming. It is forecast that insurance payments stemming from events which occurred up to the end of 2004 will total more than CZK 54 billion in the period up to 2033. If these funds were accumulated, with a discount rate of 3.5 % the total payments would be reduced to an amount of over CZK 33 billion. As this insurance is financed as a pay-as-you-go scheme, the annual payment for existing benefits can be estimated at approximately CZK 2 billion. Total premiums received in 2004 are estimated at CZK 4,509 million for both insurance companies, which is 4.94 % more than in 2003. The growth in the volume of premiums received can be attributed primarily to an increase in premium rates as of 1 January 2002 and a rise in wages in the Czech Republic. Česká pojišťovna a.s. insures only those employers who were insured prior to 1993. The discontinuance of business by many of these employers has pushed down the number of insured payers, which has been reflected in a disparate development in basic indicators compared to Kooperativa pojišťovna, a.s. Premiums received at Česká pojišťovna a.s. have climbed by 0.80 %. At Kooperativa pojišťovna, a.s., on the other hand, there has been a surge in the number of new employers insured and the rise in premiums received in 2004 was 6.40 %. This year, as in others, there were a number of premium payers who registered the existence of this statutory insurance late and paid premiums in arrears. An improvement in the system used to register insured employers and check their payment discipline was reflected in the higher growth of premiums received. Revenues from premiums received (interest on deposited funds) are forecast to remain at the same percentage as the previous year because they reflect the low interest rates offered by the banks. - 121 - Insurance payments made in cases of damage are estimated at CZK 2,561.9 million, which is 6.04 % higher in the previous year comparison. The rise in payments is 1.10 of a percentage point faster than the rise in premiums received. The total increase in compensation payments is influenced by the higher average costs per insured event, especially by the higher average wages in respect of which compensation is paid for loss of earnings over periods of inability to work; another factor is the higher top-up payments for drugs, treatment, rehabilitation, and health aids. The number of compensation claims for loss of earnings (which are continuously revalued) managed by the insurance companies is steadily rising. In 1995, the insurance companies managed just 2,693 benefits, a mere 20.98 % of the number recorded in the following year. In 2004, the number of cases of compensation for loss of earnings during a period of inability to work again rose, this time by 728 (from 12,107 in 2003 to 12,835 in 2004), which is a 6.01 % increase. Insurance payments for benefits amounted to CZK 1,498.2 million, a year-on-year increase by 13.29 %. The share of benefits in overall insurance payments climbed to 58.48 % (having stood at 54.74 % in the previous year), and we can assume that, given the rise in the number of benefits and their absolute amount, the liabilities of the insurance companies – in respect of which the State assumes responsibility – will continue to expand in the future. With statutory insurance, no technical reserves are created for liabilities which have already occurred but are payable in the future; claimants are entitled to benefit until they are 65, unless they have new opportunities to change their social standing. Current legislative arrangements for statutory insurance of employer’s liability for damage do not include certain important positive elements, which exist in similar legislation in other countries. For example, current legislation provide preferential treatment to employers for preventive activities intended to reduce the number of accidents at work and occupational diseases in their workplace, does not contain accident rehabilitation, and does not permit social partners to help tackle problems and conceptual issues in contemporary insurance. The current insurance system does not allow insurance companies to become involved in the prevention of accidents at work and occupational diseases or to finance this prevention with a designated share of the collected premiums. The sole objective is to guarantee due financial compensation for aggrieved parties, not to facilitate their return to employment. The level of compensation awarded in cases of an accident at work or occupational disease does not motivate claimants to return to the employment process. A key demotivating factor is the high level of compensation for loss of earnings during a period of inability to work or in cases where partial disability is acknowledged, which falls as earnings rise. Therefore claimants are not particularly interested in participating in any rehabilitation programme that could facilitate their return to employment. Planned reform of compensation for accidents at work or occupational diseases As part of EU membership negotiations, in its Additional Information to Chapter 6 – Competition Law, the Czech Republic stated in December 1999 that by the time the country acceded to the European Union the exclusive rights of the two insurance companies in the field of statutory insurance of employer’s liability for damage would be cancelled by means of a new accident insurance act. The Government of the Czech Republic is now belatedly discussing an accident insurance bill which, if passed by Parliament, will change the hitherto concept of the provision and legislation of statutory insurance of employer’s liability for damage in line with the position adopted by the Czech Republic in - 122 - negotiations on the conditions of the Czech Republic’s accession to the European Union related to accident insurance, which will be a complementary part of the State social security system. This bill should rectify the above-mentioned irregularities in current provisions of the Labour Code. The bill is expected to enter into effect on 1 July next year at the earliest. In terms of content and time, there are essentially only two viable solutions in the Czech Republic. 1. Modification of current legislation and elimination of the monopoly of the insurance companies stipulated in the law so that free competition exists among all insurance companies operating on the Czech market, including foreign insurers. It is also possible to keep the current pay-as-you-go system for the payment of premiums and the relationship between insurance companies and the national budget. 2. Change of current statutory insurance to social accident insurance managed by the Czech Social Security Administration. A second approach is contained in the accident insurance bill. The current system of statutory insurance of employer’s liability for damage is transformed into social insurance with its own system of benefits, which are linked, materially and conceptually, to certain changes in current compensation. Accident insurance will be entrusted to the already existing bearer of social insurance, i.e. the Czech Social Security Administration, a public authority falling within the competence of the Ministry of Labour and Social Affairs. This solution will ensure that current compensation payments and the related agenda are taken over by an experienced provider of similar services and that the risk of providing prohibited State aid, existing under current legislation with the unacceptable privileged position of two commercial insurance companies, is removed. There are serious economic and legal reasons, especially the above-mentioned grounds connected with the Czech Republic’s accession to the European Union, for the introduction of accident insurance as a social system. On economic grounds, it is worth mentioning the much lower economic demands of the pay-asyou-go funding of accident insurance as a social system rather than the commercial system of insurance, which is advantageous both for the State (lower demands are placed on the state budget) and for employers (potentially lower premiums) and, by extension, for employees. The most significant economic factor in terms of the State’s decision-making on the type of reform is the need for commercial insurance to create technical reserves for insurance payments. It is estimated that the creation of these reserves in the current situation would entail a further rise in current premium rates by 50%, considering the implicit internal debt of the statutory insurance system. If the commercial accident insurance is chosen, between 2006 and 2033 it would be necessary to secure, within the expenditure of the national budget, the fulfilment of long-term liabilities related to compensation for loss of earnings during a period of inability to work and the compensation of the cost of maintaining survivors incurred under the current statutory insurance of employer’s liability for damage in accordance with the existing Labour Code; these long-term payables amount to approximately CZK 54 billion. If these long-term payables under statutory insurance were to be covered by creating reserves from commercial insurance premiums, for example over a period of ten years, the existing rate would have to be increased by more than 80%. If the reform is postponed, the economic impacts would become even more severe. - 123 - Main principles of the proposed legislation The accident insurance act contains new provisions on the insurance of employees for cases of personal injury in the event of an accident at work or occupational disease. These provisions entail a fundamental systemic change that transfers responsibility for the implementation of accident insurance to the State, changes the nature of insurance, introduces elements that are employed as standard features in the accident insurance system in developed countries, reinforces the legal certainty of employees and their employers, and forms the basis for the long-term stability of accident insurance under affordable conditions, from the view of both the State and employers. The new accident insurance system will take over the liabilities in the system of statutory insurance of employer’s liability for damage, and will cover similar compensation already provided to employees of the State’s organizational components, as well as old claims, i.e. compensation for damage incurred in accidents at work and occupational diseases which occurred prior to 1 January 1993 and where the obligation to settle these claims has already passed (or will pass) to the State. Only professional soldiers and members of the security corps, who have their own specific regulations on compensation for accidents sustained on duty and for occupational diseases, will remain outside the accident insurance system in the future; the incorporation of the regulations for these persons into the accident insurance act would make accident insurance unbalanced. Therefore statutory insurance of employer’s liability for damage, i.e. the insurance of the employer’s liability for damage sustained in an occupational accident or occupational disease, will not exist as such and will be replaced by a form of social insurance of employees with its own system of benefits. The complementary nature of the insurance is preserved, meaning that accident insurance, like the previous statutory insurance, will be complementary to health, sickness, and pension insurance. The Czech Social Security Administration, as an organizational unit of the State responsible for implementing other types of social insurance, will be entrusted with the running of accident insurance (hereinafter referred to as ‘insurance’). The bearer of insurance must ensure the active collection of premiums based on a continuous comparison of the list of premium payers with the business register, evaluations of the course of insurance with a view to establishing a balanced regime, and payments of benefits. This will significantly lighten the burden placed on employers by this agenda and will reduce their financial expenses connected with the implementation of the insurance. Employers will not appoint and pay out the amount of individual cases of compensation; they will only cooperate with the insurance bearer in a scope similar to that required for other systems of social insurance. The current system if compensation for accidents at work and occupational diseases and the concept of compensation for loss of earnings will be ditched. The objective liability of employers for damage in these cases, which is unique in Europe, will be removed. A benefit system similar to that in use in social security is to be introduced; from the point of view of employees, the current situation – where employees are not required to prove that the employer is at fault for the occurrence of an occupational accident or occupational disease – will remain. - 124 - Depending on the personal injury sustained by the employee, the following pecuniary accident insurance benefits will be provided: a) accident allowance, b) accident settlement, c) accident annuity, d) pain allowance, e) contribution for aggravation of social self-assertion (usefulness), f) reimbursement of treatment costs, g) reimbursement of funeral costs, h) lump-sum contribution to a survivor, i) survivor’s accident annuity. Under the conditions laid down by the accident insurance act, benefits in kind, in the form of rehabilitation, may optionally be provided in the scope of accident insurance. The position of employees will not deteriorate compared to the current situation because, as is the case now, employees will not bear the burden of proof; they will continue to have ‘objective’ claims based on the fulfilment of conditions laid down by law. In fact, the legal certainty of the acquisition of entitlement to benefits will be higher because the public authority responsible for making decisions on claims will have no tangible interest of its own in the decisions it makes. Any disputes – as now – will centre solely on the issue of whether an accident is an occupational accident, the causal nexus of the employee’s personal injury with an occupational accident, and assessments of the extent of the damage to the employee’s health. Compared to existing legal provisions, the drafted legislation adjusts the conditions for the appointment of the amount of the benefits awarded, with consideration for the conceptual change connected with the discontinuance of the principle of compensation for loss of earnings and the introduction of the social benefit system of accident insurance. Therefore the amount of the ‘old’ and ‘new’ fulfilment will not and cannot be the same in individual cases. In certain cases, the amount of fulfilment received by a policyholder under accident insurance will be reduced compared to the current situation, while in other cases the benefit available under accident insurance will increase. The reduction mainly concerns repeating benefits, where the disproportionately high amount of compensation under present legislation does not motivate the beneficiary to return to work. This occurs primarily in cases with a low level of personal injury, where there is an objective opportunity for the beneficiary to return to employment. Certain benefits or forms of compensation will remain at their current level (e.g. compensation for pain, contributions for aggravation of social self-assertion (usefulness)); in other cases the drafted legislation is more advantageous for the beneficiary (especially in cases where, prior to the occupational accident, the beneficiary had low earnings and the compensation fell in value when there was a subsequent rise in the beneficiary’s new earnings). Compared to the current situation, repeating benefits (annuities) will motivate injured employees to return to work and will substantially restrict the possibility of abusing insurance. - 125 - Under current legislation, if an employee with average earnings of CZK 16,920 has an accident and is awarded a partial invalidity benefit (e.g. CZK 2,281), and his wage subsequently slips to CZK 7,500, his total ‘net’ income will rise from the original CZK 12,920 to CZK 14,582, i.e. by CZK 1,662. Under the proposed legislation, in the same situation where an employee is set a level of personal injury at 42%, his overall ‘net’ income will fall to CZK 12,325, i.e. by CZK 595 compared to his ‘net’ income before the event. On the other hand, an increase in the current lump-sum survivors’ compensation is proposed. Under the current legislation, if an employee suffers a fatal occupational accident, the spouse is entitled to lump-sum compensation of CZK 50,000 and a child to CZK 80,000. In the proposed legislation, the spouse will be entitled to a survivor’s contribution of CZK 117,383 and a child to CZK 167,690, i.e. seven times or ten times the general assessment base (e.g. CZK 16,769). The implementation of accident rehabilitation as new benefits in kind in the scope of accident insurance is a significant step forward, especially for employees, who will recover sooner and will be able to return to work earlier. As is the case with other benefits, accident rehabilitation will complement the rehabilitation provided under sickness and health insurance and in the scope of the employment policy. From the aspect of international experience and the practical requirements of employees and employers, the incorporation of the prevention of accidents at work and occupational diseases into the drafted legislation is essential. Prevention provided by the insurance bearer will not replace the obligations of individual employers in the field of risk prevention as laid down by the Labour Code; instead, it will be applied as a blanket measure to prevent personal injury at work. In individual years, 6% of the total volume of benefits paid in the previous year will be earmarked for this accident prevention. Another just as significant new element of accident insurance that should motivate employers to increase the level of safety and health protection at work is the introduction of a bonus/malus system as economic instruments (a mark-up or discount on premiums) affecting the amount of the premium corresponding to developments in the number and seriousness of accidents at work and occupational diseases. The purpose of the proposed legislation is also to harmonize the accident insurance regime with other social insurance systems that permit significant synergic effects for the insurance bearer, and ensure the higher effectiveness of the system especially in the field of the collection of premiums and its lower operating expenses. This will also reduce the administrative burden of employers and will simplify the way employees file accident-insurance claims. The proposed legislation is based consistently on the principles of the equal treatment of men and women in the field of accident insurance and on the prohibition of discrimination. The same rules, the same set of benefits, and the same rights and obligations will apply to employees of both sexes. - 126 - Conclusion The accident insurance act which is currently being prepared has the economic goal of limiting the longterm negative economic impacts arising due to personal injury sustained in accidents at work or occupational diseases by changing the current unsatisfactory system. As a result of accidents at work and occupational diseases in the Czech Republic in 2003, society as a whole incurred insured costs and losses totalling CZK 9,863 million and uninsured losses of approximately CZK 14,651 million. On aggregate, then, accidents at work and occupational diseases currently cost the Czech Republic CZK 25 billion in costs and losses every year. The aim of the proposed accident insurance is not only to tackle an acute economic problem, but also to establish a successful system permitting reductions in losses and thus making a significant contribution to the improved occupational protection of employee safety and health at work, which is actually the primary objective. - 127 - - 128 - The Regulation and state of insurance against accidents at work and occupational diseases in Slovenia Martin Toth I. Introduction The Slovenian social insurance system has a long-standing tradition which can be traced as far back as the 1880s. The main motives for establishing social insurance schemes (i.e. health, pension and disability insurance) were injuries at the workplace and the ensuing need for social security among workers as well as their families. In this way, social insurance schemes were originally fashioned after the Bismarck model and at first only included workers and their families. Later on, additional groups were added, such as workers in trades and crafts, the self-employed, farmers, pensioners and others. As a result, the entire population of Slovenia is now covered by the social insurance system. One important component of this system is insurance against accidents at work and occupational diseases. Insurance against accidents at work and occupational diseases is closely linked to the field of health and safety at work. Slovenia even has a special law governing this field, which – along with other provisions and legal regulations – requires employers to take measures to ensure the health and safety of employees at the workplace and to create a working environment which is conducive to health. Under this requirement, the employer bears the primary responsibility for preventing injuries at the workplace as well as occupational diseases, and for covering the costs resulting from these problems. In Slovenia, insurance against accidents at work and occupational diseases is governed according to this general principle. The relevant regulations specifically delineate the employers' obligations in this respect from the duties and rights of insured persons under the solidarity-based systems of health insurance and pension and disability insurance. Under the applicable legal regulations, the employer is obligated not only to ensure a safe and healthy working employment for employees but also to ensure that protective equipment is provided and first aid is administered at the workplace, and injured employees are transported to the hospital by ambulance. In addition, employers are also required to have an in-house or contractually authorized physician (usually an occupational health specialist) who is responsible for performing workplace analyses and employee risk analyses, and who submits proposals the management on the appropriate changes in organization, production and ergonomic solutions. In addition, this physician is also responsible for carrying out targeted preventive examinations and screening examinations in order to identify any potentially unfavorable influences the working environment has on the health of the workers. These examinations are financed out of the employer's own funds. Employers are also required to pay workers' compensation to employees who are temporary incapacitated due to work-related injuries or occupational diseases; this applies to the first 30 working days for any kind of disability arising from a work-related injury or disease. In addition, employers are obligated to pay a special contribution for insurance against accidents at work and occupational diseases for the benefits provided under compulsory health insurance. - 129 - II. Providers and Types of Insurance against Accidents at Work and Occupational Diseases In Slovenia, there are two providers of insurance against accidents at work and occupational diseases: the Health Insurance Institute and the Pension and Disability Insurance Institute. These two institutions are responsible for insurance against accidents at work and occupational diseases. The first institution covers the risks of accidents at work and occupational diseases with regard to treatment, required medications, medical remedies/aids, rehabilitation and various monetary benefits. The latter institution is responsible for workers' compensation in the case of temporary inability to work, for reimbursing travel costs, and for administering death and funeral allowances. The Pension and Disability Insurance Institute guarantees that persons affected by accidents at work or occupational diseases are able to exercise their rights under disability insurance. These rights differ essentially from those of other insured persons. Within the framework of compulsory health insurance, there is a special form of insurance for accidents at work and occupational diseases. In the case of accidents at work or occupational diseases, compulsory health insurance regulations govern the special rights of insured persons. Under compulsory health insurance, insured persons affected by an accident at work or an occupational disease are guaranteed coverage for all medical expenses, from diagnosis and treatment to medical rehabilitation. For this purpose, a special contribution was established for insurance against accidents at work and occupational diseases provided within the framework of compulsory health insurance. However, the revenues from these contributions are not earmarked strictly for this purpose, that is, they are commingled with other contributions paid for compulsory health insurance. Slovenian pension and disability insurance guarantees the rights of insured persons in the case of partial or long-term disabilities resulting from accidents at work or occupational diseases. There is no specific contribution for these benefits; the expenditures arising from this type of insurance are covered by general contributions for pension and disability insurance. Slovenia's compulsory health insurance as well as its pension and disability insurance are provided by public institutions based on the principle of solidarity. In both cases, the insurance provider per se is the Slovenian government, but the insurance institutions do have some degree of autonomy within the applicable legal framework. Both types of insurance are designed according to the Bismarck model. They cover the entire population of Slovenia, thus leaving relatively little space for private insurance providers alongside these fairly comprehensive benefits. Private insurance schemes against accidents at work and occupational diseases are not found in Slovenia. Several commercial insurance institutions offer workers' compensation insurance for periods of hospitalization or for a temporary inability to work (regardless of the reason). Thus these insurance providers also offer certain benefits in connection with accidents at work and occupational diseases. III. Funding Insurance against Accidents at Work and Occupational Diseases In Slovenia, insurance against accidents at work and occupational diseases is financed in the same way as compulsory health insurance and pension and disability insurance, that is, using the contributions paid to the insurance providers (i.e. the Health Insurance Institute and the Pension and Disability Insurance Institute). In this context, there is a separate contribution for accidents at work and occupational diseases - 130 - which is paid only by organizers or employers of public service workers and temporary workers, rescue workers and various other activities which may lead to injury or disease. For employed persons, this contribution amounts to 0.53% of gross remuneration or workers' compensation, whereas other categories of work are subject to flat-rate contributions defined by the Health Insurance Institute. Selfemployed workers also pay contributions for insurance against accidents at work and occupational diseases. These contributions ensure the right to coverage of the costs of medical treatment and reimbursement of travel expenses, workers' compensation for absences from work, and various other monetary benefits. Farmers who are covered by pension and disability insurance also pay contributions for these benefits. Under Slovenian law, the government is also obligated to pay for employees of the Slovenian army from the budget for insurance against accidents at work and occupational diseases. Flatrate contributions for insured persons who only perform occasional work activities or are not regularly employed depend on the extent of these parties' rights. These contributions range from €21.00 to €91.00 per month; in some cases (persons involved in public-sector services, voluntary firefighters, mountain rescue service workers and several others), the contribution is reduced to approximately €4.00 per year. These insurance contributions are not paid by the workers themselves. The contribution indicated is uniform for all persons subject to the insurance requirement, although the relevant law stipulates that the contribution amount could also be differentiated for specific business areas on the basis of average costs per insured person. To date, however, this provision has not been put into practice. There are several reasons for this, the most important of which is the different approach taken in financing this area of pension and disability insurance. Slovenian pension and disability insurance does not call for a separate contribution to cover accidents at work and occupational diseases; instead, the funds for covering these risks are included in the general contributions for pension and disability insurance. The Slovenian Pension and Disability Insurance Act does mention the introduction of a special contribution for accidents at work and occupational diseases, to be paid by employers and differentiated by areas of business activity. However, implementation of these provisions was postponed to the end of 2005. According to the relevant evaluations, a contribution rate of approximately 0.27% of gross remuneration would be required for this purpose; this contribution would be paid by employers only. IV. Persons Covered by Insurance against Accidents at Work and Occupational Diseases In Slovenia, insurance against accidents at work and occupational diseases is provided for all persons who are employed, including those sent abroad for the purpose of work, education/training or continuing education, those who are self-employed in the Republic of Slovenia as their sole or primary occupation, the owners of companies and other businesses, professional athletes, farmers (who also have pension and disability insurance), employees of the Slovenian army as well as prison inmates during periods of employment. Insurance against accidents at work and occupational diseases is also provided for pupils and students in work placement programs, persons with physical or mental disabilities in practical training classes or work placements, persons with disabilities during occupational rehabilitation, persons in voluntary work placement programs after completing their education, pupils and students performing temporary work organized by authorized students' hiring service organizations, and unemployed persons performing public services. This type of insurance is also provided for persons who engage in business or professional activities and for persons who work for remuneration in a legal relationship. Finally, insurance against accidents at work and occupational diseases also covers persons who work in public - 131 - services and rescue missions, persons who perform public or social functions, volunteer firefighters, members of the mountain rescue service, and several other groups. V. Insured Events and Conditions Slovenian insurance against accidents at work and occupational diseases covers the health risks and consequences of partial or permanent disabilities resulting from an accident at work or an occupational disease. An accident at work (or work-related injury) refers to any injury sustained due to a direct and short-term mechanical, physical or chemical effect, due to a sudden movement of the body, sudden physical strain or other changes in the physiological state of the body, provided this injury was sustained due to work or the performance of activities on the grounds of which the person is insured. Under Slovenian regulations, injuries arising from accidents which occur on the insured person's way to work (or home from work) or on a business trip are also considered work-related injuries. Moreover, the law stipulates that accidents at work also include afflictions which arise as a direct and exclusive consequence of an unfortunate coincidence or force majeure while the insured person performs the activities on the grounds of which s/he is insured. Finally, accidents at work also include injuries sustained on the insured party's regular trip from home or the workplace to a medical examination, during treatment in a health institution, during medical rehabilitation or on the way to the Health Insurance Institute if the insured party is summoned in connection with the assertion or justification of rights arising from compulsory health insurance. Occupational diseases for which people are specifically insured include illnesses suffered as a result of sustained and direct exposure to the effects of the working environment and work process on the worker while performing the activities on the grounds of which s/he is insured. In this regard, a special list of occupational diseases is compiled by the Slovenian Minister of Labor in cooperation with the minister responsible for health affairs. At present, occupational diseases do not include those illnesses related to work, as is the case in several other countries. The list of occupational diseases is also fairly outdated and poorly adapted, which creates certain difficulties in their detection and identification. VI. Rights Arising from Insurance against Accidents at Work and Occupational Diseases In Slovenia, insurance against accidents at work and occupational diseases provides coverage for various risks which may be incurred in this area. Employers are required to ensure that their employees are provided with preventive examinations prior to employment as well as preventive care benefits. With regard to health insurance, employees have the right to professional health care in the areas of treatment and medical rehabilitation. Health benefits refer to the right to examination and treatment or medical rehabilitation with selected physicians at the primary care level, with specialists and in hospitals as well as other providers of health services, and in certain cases also the right to rehabilitation in spa facilities. The Slovenian system of insurance against accidents at work and occupational diseases also guarantees that insured persons receive the medications included on the positive list as well as medical aids according to the standards defined by the Health Insurance Institute. In claiming these benefits or asserting these rights, insured persons are not required to make co-payments; all costs are covered by compulsory insurance. As regards co-payments in connection with health care claims, Slovenia has a special regulation - 132 - on accidents at work and occupational diseases. Insured persons who have reached a certain age usually have to reimburse the insurance institution for a certain percentage of health care costs; however, this is not the case in the diagnosis and treatment of several work-related injuries and occupational diseases. Insured persons also have the right to reimbursement of travel expenses if they are required to travel to a doctor or health facility outside their hometown for the purpose of receiving treatment or rehabilitation therapy. Another important part of insurance against accidents at work and occupational diseases is the right to workers' compensation in the case of temporary incapacity, or (in the worst case) the right to a death and funeral allowance. On the basis of this insurance, insured persons have a right to workers' compensation after 30 days of absence from work; until that time, the employer is required to provide this benefit. Workers' compensation payments amount to 100% of the average pay and workers' compensation received in the year leading up to the work-related injury or incapacitation due to the occupational disease. The compensation level is lower (80 to 90%) for other cases of absence, such as sickness, injuries sustained outside the workplace, or the provision of care for a family member. All of these rights are guaranteed for insured persons (or their family members) by the Health Insurance Institute. Another unique characteristic of Slovenian insurance regulations is the fact that workers' compensation is not subject to a time limit for temporary absences from work. In addition to the relevant provisions under Slovenian law, the general regulations passed by the board of the Health Insurance Institute also specify these rights. For insured persons in certain categories, compulsory insurance only provides health benefits and the reimbursement of travel costs during treatment and rehabilitation in the case of accidents at work and occupational diseases. These categories include unemployed persons performing public services or other organized work activities; pensioners; farmers not covered by pension insurance; school pupils and persons attending continuing education/training courses; students performing temporary work organized by authorized students' hiring service organizations; prison inmates; and several other groups of insured persons. Insured persons also enjoy special rights from disability insurance in cases where their disability results from an accident at work or an occupational disease and the person suffers a partial or complete disability for an extended period of time. First, insured persons are entitled to occupational rehabilitation; this must be guaranteed for insured persons suffering from a Category II disability, meaning that they are partially disabled and therefore can not perform their (previous) work but could take on a new form of employment. Insured persons who are under the age of 50 and could take on a different form of full-time employment have the right to occupational rehabilitation. During this rehabilitation, Slovenian disability insurance also guarantees that the relevant rooms and workplace will be adapted as necessary. Insured persons are also entitled to these benefits in cases where the workplace is adapted and they take on a new position. Occupational rehabilitation can involve education at an appropriate educational institution, an internship or a part-time education/training course attended alongside work activities. During the occupational rehabilitation period, the employee is entitled to accommodation if s/he is required to travel to another town for rehabilitation purposes and no transportation is arranged for him/her. Furthermore, during occupational rehabilitation the insured person is entitled to compensation equaling 100% of the disability pension for which s/he was eligible at the onset of the disability. The insured person is also entitled to this compensation for the period from the completion of the rehabilitation program until s/he commences work in a new job; after starting the new job, the insured person receives pay compensation amounting to 20% of the base value. Another important entitlement under disability insurance is the right to a disability pension. According to the relevant regulations, persons with Category I disabilities (i.e. those who can no longer perform any - 133 - kind of work), persons with Category II disabilities who are over 50 and can not take on other forms of employment without occupational rehabilitation, as well as persons with Category II and III disabilities who are not guaranteed another job and are over 63 (for men) or 61 (for women) years of age are entitled to a disability pension. If the requirements listed above are fulfilled and the person's disability is the result of an accident at work or an occupational disease, s/he is granted this pension regardless of pensionable age requirements. In other cases, the requirements regarding pensionable age also have to be fulfilled. Disability pensions which are guaranteed on the basis of disability insurance are granted in the case of disabilities resulting from accidents at work or from occupational diseases. These pensions are calculated using the assessment basis for a pensionable age of at least 40 years for men and 38 years for women. Regardless of pensionable age requirements, Slovenian pension and disability insurance regulations entitle an insured person's survivors (widows, widowers or other family members) to the pension of the deceased if the person died as a result of an accident at work or an occupational disease. One special entitlement under disability insurance is the right to compensation for the loss of earning capacity. This is a special monetary benefit which an insured person can claim in cases where s/he suffers a severe injury or a substantial loss of functions (organs or body parts) during the insurance period. The list of qualifying afflictions is maintained by the Minister of Labor. This entitlement is granted to persons with afflictions resulting from an accident at work or an occupational disease in cases where the level of impairment is at least 30%. VII. Conclusion With regard to accidents at work and occupational diseases, Slovenia is still in the process of developing its insurance system. This depiction of the current state of affairs has made it clear that this form of insurance has not yet been established as a special branch of the social security system, although insured persons do enjoy certain entitlements under compulsory health insurance as well as pension and disability insurance in the case of accidents at work or occupational diseases. Both types of insurance guarantee that insured persons enjoy greater benefits than in the case of non-occupational diseases or injuries. Slovenia's regulations with regard to these rights are comparable to those of other countries in the European Union. However, the issue of prevention is largely neglected in the insurance field. Employers would have to increase their efforts to ensure more effective prevention measures. This has been realized successfully in large companies, but not as effectively in small and medium-sized enterprises. Several years ago, the Slovenian government entertained the idea of establishing a separate insurance scheme for accidents at work and occupational diseases which would support and finance prevention in addition to covering the risks arising from those injuries and diseases. Such an insurance scheme would perform the relevant tasks currently assigned to compulsory health insurance as well as pension and disability insurance and at the same time assist employers and insured persons in their efforts to implement consistent health and safety measures at work. This insurance would be accompanied by employer contributions which are differentiated according to the specific costs of treatment for accidents at work and occupational diseases (as well as their consequences) in comparison to the average costs in Slovenia. The system would also include a system of bonuses and penalties for contributions as a financial incentive for employers. An extensive preparatory project was carried out for this insurance scheme, but the idea still has not been realized. - 134 - Regelung und Stand auf dem Gebiet der Arbeitsunfall- und Berufskrankheitsversicherung in der Republik Slowenien Martin Toth I. Einleitung Slowenien hat auf dem Gebiet der sozialen Versicherungen eine lange Tradition, da ihre Anfänge in die achtziger Jahre des 19. Jahrhunderts zurück zu verfolgen sind. Hauptgründe zur Gründung von sozialen Versicherungen (Gesundheitsversicherung, Rentenversicherung und Invaliditätsversicherung) waren die Verletzungen der Arbeitnehmer an ihren Arbeitsplätzen und die damit verbundene soziale Sicherheit der Arbeitnehmer selbst, aber auch die ihrer Familien. Auf diese Weise entstanden soziale Versicherungen nach dem Bismarckmodell, in die am Anfang nur die Arbeitnehmer und ihre Familienmitglieder einbezogen wurden. Zu einem späteren Zeitpunkt kamen auch andere Kategorien der Versicherten, zum Beispiel Handwerker, Selbstständige, Bauern, Rentner und andere dazu. Heute ist so die gesamte Bevölkerung der Republik Slowenien in diese Versicherungen einbezogen. Einen wesentlichen Bestandteil dieser Versicherungen stellt auch die Arbeitsunfall- und Berufskrankheitsversicherung dar. Die Arbeitsunfall- und der Berufskrankheitsversicherung ist eng mit dem Gebiet Sicherheit und Gesundheitsschutz am Arbeitsplatz verbunden. In Bezug auf dieses verfügen wir in Slowenien sogar über ein besonderes Gesetz, das neben anderen Bestimmungen und rechtlichen Normen ganz besonders den Arbeitgeber zur Ausübung von Maßnahmen für Sicherheit und Gesundheitsschutz am Arbeitsplatz und zur Schaffung einer gesundheitsfreundlichen Arbeitsumgebung verpflichtet. Dieser Vorschrift nach trägt der Arbeitgeber die größte Verantwortung und Verpflichtung zur Vorbeugung von Verletzungen am Arbeitsplatz und Berufskrankheiten, als auch beim Finanzieren deren Folgen. Gemäß dieser Einstellung ist auch die Arbeitsunfall- und Berufskrankheitsversicherung geregelt. Vorschriften grenzen nämlich die Pflichten des Arbeitgebers auf diesem Gebiet von den Verpflichtungen und Rechten der versicherten Personen in den Solidaritätssystemen der Gesundheitsversicherung und Renten- bzw. Invaliditätsversicherung ab. Laut der geltenden rechtlichen Regulative zählt zu den Pflichten des Arbeitgebers nicht nur die Zusicherung einer sicheren und freundlichen Arbeitsumgebung für seine Arbeitnehmer, sondern auch die Zusicherung einer Schutzausrüstung, der Erste-Hilfe-Leistung am Arbeitsplatz und der Rettungsfahrt des Verletzten zum Krankenhaus. Dazu muss jeder Arbeitgeber auch über einen eigenen oder einen vertraglich bevollmächtigten Arzt verfügen (in der Regel ein Arbeitsmediziner), der für die Erstellung von Arbeitsplatzanalysen und Analysen ihrer Risiken zuständig ist und der dem Management entsprechende Veränderungen in der Organisation, Produktion und bei den ergonomischen Lösungen vorschlägt, aber der auch gezielte präventive Untersuchungen bzw. »Screening« Untersuchungen zur Feststellung von möglichen ungünstigen Einflüssen der Arbeitsumgebung auf die Gesundheit der Arbeitnehmer durchführt. All diese Untersuchungen werden vom Arbeitgeber aus eigenen Mitteln bezahlt. Sie sind auch verpflichtet, ihren Arbeitnehmern, die wegen Arbeitsverletzungen und Berufskrankheiten vorübergehend arbeitsunfähig sind, den Lohnersatz zu bezahlen und zwar für die ersten 30 Arbeitstage für jede Art Arbeitsunfähigkeit aus den angeführten Gründen. Dazu müssen sie auch einen Sonderbeitrag für Arbeitsunfall- und Berufskrankheitsversicherung für den Teil, der im Rahmen der Pflichtkrankenversicherung verwirklicht wird, bezahlen. - 135 - II. Träger und Typen der Arbeitsunfall- und Berufskrankheitenversicherung In der Republik Slowenien gibt es zwei Träger der Arbeitsunfall- und Berufskrankheitsversicherung und zwar die Krankenversicherungsanstalt und die Renten- und Invaliditätsversicherungsanstalt Sloweniens. Diese zwei Anstalten sind auch für die Arbeitsunfall- und Berufskrankheitsversicherung verantwortlich. Die erste Anstalt deckt die Arbeitsunfall- und Berufskrankheitsrisiken, die sich auf Behandlungen, nötige Medikamente, medizinische Heilmittel und medizinische Rehabilitation, so wie einige Geldleistungen beziehen. Zum letzteren zählen auch der Lohnersatz für vorübergehende Arbeitsunfähigkeit, Rückerstattung der Reisekosten und des Sterbegelds. Die Renten- und Invaliditätsversicherungsanstalt gewährleistet den Arbeitsunfallverletzten und den Berufskrankheitserkrankten die Rechte aus der Invaliditätsversicherung, die sich in ihrem Wesen von anderen Versicherungsrechten, über die die Versicherten verfügen, unterscheiden. Im Rahmen der Pflichtkrankenversicherung gibt es eine besondere Arbeitsunfall- und Berufskrankheitsversicherung. In Fällen von Arbeitsunfällen bzw. Berufskrankheiten bestimmen die Vorschriften der Pflichtkrankenversicherung die Sonderrechte der Versicherten. Den Versicherten, die einen Arbeitsunfall oder eine Berufserkrankung erlitten haben, ist auf Grund der Pflichtkrankenversicherung die Gesamtkostendeckung für alle medizinischen Behandlungen, von der Diagnose und Behandlung bis zur medizinischen Rehabilitation, gewährleistet. Dazu wurde für die Arbeitsunfall- und Berufskrankheitsversicherung, die im Rahmen der Pflichtkrankenversicherung ausgeübt wird, ein Sonderbeitragssatz errichtet. Die mit diesem Satz gewonnenen Mittel sind aber nicht streng zweckgebunden und mischen sich mit anderen, für die Pflichtkrankenversicherung einbezahlten Beträgen. Die Renten- und Invaliditätsversicherung gewährleistet den Versicherten die Rechte im Falle einer verringerten oder nachhaltigen Arbeitsunfähigkeit, die Folge eines Arbeitsunfalls bzw. einer Berufskrankheit ist. Für diese Rechte gibt es keinen Sonderbeitragssatz, sondern es werden die Ausgaben dafür mit dem einheitlichen Beitragssatz für die Renten- und Invaliditätsversicherung gedeckt. Die Pflichtkrankenversicherung wie auch die Renten- und Invaliditätsversicherung sind öffentlich und gemeinnützig und beruhen auf den Solidaritätsgrundsätzen. Träger beider Versicherungen ist zwar der Staat, aber im gesetzlich bestimmten Rahmen verfügen die Versicherungen über eine bestimmte Autonomie. In beiden Fällen handelt es sich um Sozialversicherungen des Bismarckmodells. In beide genannten Versicherungen ist die gesamte Bevölkerung eingeschlossen und es gibt deswegen an der Seite der ziemlich ausgreifenden Rechten der Versicherten nur relativ wenig Platz für Privatversicherungen. Privatversicherungen für den Bereich Arbeitsunfälle und Berufserkrankungen kennen wir in Slowenien nicht. Einige kommerzielle Versicherungsanstalten bieten zwar Ersatzgeldversicherungen während eines Krankenhausaufenthalts, oder im Falle einer, ohne Hinsicht auf den Grund, vorläufigen Arbeitsverhinderung, an. Also kann es mit diesen Versicherungen auch bestimmte Bonitäten geben, die aus den Arbeitsunfällen und Berufserkrankungen hervorgehen. - 136 - III. Finanzierung der Arbeitsunfall- und Berufskrankheitsversicherung In Slowenien wird die Arbeitsunfall- und Berufskrankheitsverscherung auf die gleiche Art wie die Pflichtkrankenversicherung, aber auch die Renten- und Invaliditätsversicherung finanziert und zwar mit den von den Versicherungspflichtigen auf das Konto der Versicherungsträger, dass sind die Krankenversicherungsanstalt und die Renten- und Invaliditätsversicherungsanstalt, einbezahlten Beträgen. Dabei besteht innerhalb der Krankenversicherung ein getrennter Beitragssatz für Arbeitsunfälle und Berufskrankheiten, der nur von Arbeitgebern bzw. Organisatoren der öffentlichen und gelegentlichen Arbeiten, Rettungsaktivitäten und unterschiedlichen anderen Aktivitäten, die zu möglichen Verletzungen oder Erkrankungen führen könnten, bezahlt wird. Für die Berufstätigen beträgt dieser Satz 0,53 % des Brutto-Arbeitsentgelts oder Ersatzgeldes, für andere Kategorien müssen die von der Krankenversicherungsanstalt festgelegten Pauschalbeträge bezahlt werden. Beiträge für Arbeitsunfälle und Berufskrankheiten werden auch von Selbstständigen bezahlt. Dabei handelt es sich um einen Beitrag, mit dem die Rechte zur Kostendeckung der medizinischen Behandlung und Rückerstattung der Reisekosten, Lohnersatzes für die Zeit der Arbeitsabwesenheit und einige anderen Geldleistungen der Versicherten gewährleistet werden. Für die gleichen Rechte bezahlen auch die Bauern, die sich entschieden haben, sich auch für die Rechte aus der Renten- und Invaliditätsversicherung zu versichern, ihre Beiträge. Laut dem Gesetz ist auch der Staat verpflichtet, aus dem Haushalt die Arbeitsunfall- und Berufskrankheitsversicherung für die Beschäftigten in der slowenischen Armee zu bezahlen. Pauschalbeiträge für die Versicherten, die nur gelegentliche Arbeiten ausüben bzw. nicht fest angestellt sind, hängen vom Ausmaß ihrer Rechte ab und betragen zwischen 21 und 91 € im Monat, in einigen Fällen (Beteiligte an öffentlicher Arbeit, freiwillige Feuerwehrmänner/frauen, Mitglieder des Bergrettungsdiensts und einige Andere) aber auch ungefähr 4 € im Jahr. Beiträge für diese Versicherung werden nicht von Arbeitnehmern bezahlt. Der angeführte Beitragssatz ist einheitlich und für alle Versicherungspflichtigen gleich, obwohl das Gesetz festlegt, dass der, in Hinsicht auf durchschnittliche Kosten pro Versichertem, nach einzelnen Wirtschaftsbereichen hätte unterschiedlich sein können. Aber bisher wurde diese Bestimmung nie realisiert. Dafür gibt es mehrere Gründe. Der wichtigste Grund liegt in einem anderen Ansatz zur Finanzierung dieses Gebietes in der Renten- und Invaliditätsversicherung. In der Renten- und Invaliditätsversicherung gibt es keinen besonderen Satz für Arbeitsunfälle und Berufskrankheiten, sondern die Mittel zur Deckung dieser Risiken sind in den durchschnittlichen Beitragssatz für die Renten- und Invaliditätsversicherung einbezogen. Mit dem Gesetz über Renten- und Invaliditätsversicherung ist zwar festgelegt, dass ein Sondersatz für Arbeitsunfälle und Berufskrankheiten, der von den Arbeitgebern zu bezahlen und auch nach den Tätigkeitsbereichen zu differenzieren wäre, eingeführt werden müsste. Aber die Durchführung dieser Bestimmungen wurde auf das Jahresende 2005 verschoben. Den Bewertungen nach wäre für dieses Gebiet ein Beitragssatz in Höhe von ungefähr 0,27 % des BruttoArbeitsentgelts nötig und den würden ebenfalls nur die Arbeitgeber bezahlen. - 137 - IV. Die Arbeitsunfall- und Berufskrankheitsversicherten Eine Arbeitsunfall- und Berufskrankheitspflichtversicherung haben in Slowenien alle Personen, die ein Arbeitsverhältnis haben, auch die, die zum Außendienst, zur Ausbildung oder zur Weiterbildung ins Ausland entsandt sind, die auf dem Gebiet der Republik Slowenien eine selbstständige berufliche oder wirtschaftliche Tätigkeit als ihren einzigen oder Hauptberuf ausüben, Gesellschafts- und Unternehmenseigentümer, Leistungssportler, Bauern (diese sind auch renten- und invaliditätsversichert), in der slowenischen Armee beschäftigte Personen und Häftlinge beim Strafvollzug für die Zeit, wo sie Arbeiten. Arbeitsunfallund berufskrankheitsversichert sind auch die Gesundheitsrisiken der Schüler und Studenten beim Praktikum, körperlich oder geistig behinderte Personen beim praktischen Unterricht oder beim Praktikum, Behinderte bei der Berufsrehabilitation, Personen beim freiwilligen Praktikum nach der abgeschlossenen Ausbildung, Schüler und Studenten bei der einstweiligen Arbeit, die im Rahmen der bevollmächtigten Sonderorganisationen organisiert wird, und die Arbeitslosen bei der öffentlichen Arbeiten. Arbeitsunfallund berufskrankheitspflichtversichert sind aber auch jene Personen, die Erwerbs- oder Berufstätigkeit ausüben, und die Personen, die im Rahmen eines Rechtsverhältnisses gegen Entgelt arbeiten. Arbeitsunfall- und berufskrankheitsversicherte Personen sind auch diejenigen, die bei den öffentlichen Arbeiten und Rettungsaktionen mitarbeiten, öffentliche und gesellschaftliche Funktionen ausüben, Mitglieder der freiwilligen Feuerwehr oder des Bergsrettungsdienstes sind, aber auch einige anderen Personen. V. Versicherungsgegenstand Die Arbeitsunfall- und Berufskrankheitsversicherung deckt die Gesundheitsrisiken bzw. Folgen einer verringerten Arbeitsfähigkeit oder den Verlust der Arbeitsfähigkeit ab, die eine Folge eines Arbeitsunfalls bzw. einer Berufskrankheit sind. Als Arbeitsunfall gilt jede Verletzung, zu der es aufgrund eines direkten und kurzzeitigen mechanischen, physikalischen oder chemischen Effekts oder eines schnellen Wechsels der Körperlage, plötzlicher Körperbelastung oder anderer Veränderungen des physiologischen Organismuszustandes gekommen ist und falls diese Verletzung im Ursachenzusammenhang mit der Arbeit oder Ausübung der Tätigkeit, in dessen Zusammenhang der Versicherte versichert ist, steht. Laut den Vorschriften der Republik Slowenien gelten auch diejenigen Verletzungen als Folge eines Arbeitsunfalls, die der Versicherte auf dem täglichen Weg zur Arbeit oder nach Hause, oder auf der Dienstreise erleidet. Das Gesetz legt auch fest, dass dazu auch die Erkrankungen zählen, die eine direkte und ausschließliche Folge eines unglücklichen Zufalls oder der höheren Gewalt während der Ausübung der Tätigkeit, auf dessen Grundlage der Versicherte versichert ist, sind. Zu den Arbeitsunfällen zählen auch die Verletzungen, die man folgender Weisen erleiden kann und zwar auf dem regelmäßigen Weg von Zuhause oder vom Arbeitsplatz zur medizinischen Untersuchung, während der Behandlung in der Gesundheitsanstalt, bei der medizinischen Rehabilitation oder auf dem Weg zur Stelle der Krankenversicherungsanstalt, falls der Versicherte wegen der Geltendmachung bzw. Überprüfung der Begründetheit seiner Rechte aus der Pflichtkrankenversicherung, eingeladen worden ist. Zu den Berufskrankheiten, für die die Versicherten speziell versichert sind, zählen die Erkrankungen, die als Folge einer lang andauernden unmittelbaren Einwirkung der Arbeitsverhältnisse und des Arbeitsprozesses auf die tätige Person, die die Tätigkeit oder Arbeit vollbringt, auf dessen Grundlage sie auch versichert ist, hervorgerufen sind. - 138 - Diesbezüglich besteht auch eine Sonderliste der Berufskrankheiten, die vom Minister für Arbeit in Zusammenarbeit mit dem für Gesundheitsschutz verantwortlichen Minister festgelegt wird. Zurzeit zählen zu den Berufskrankheiten nicht die Krankheiten, die mit der Arbeit in Verbindung stehen, wie das in einigen anderen Ländern der Fall ist. Die Liste der Berufskrankheiten ist auch schon ziemlich überholt und ungeeignet, was zu bestimmten Schwierigkeiten bei ihrer Erkennung und Feststellung führt. VI. Arbeitsunfall- und Berufskrankheitsversicherungsrechte Die Arbeitsunfall- und Berufskrankheitsversicherung gewährleistet Deckung für mehrere Risiken, die auf diesem Gebiet auftreten können. Vorsorgeuntersuchungen vor der Beschäftigung und andere präventive Leistungen müssen die Arbeitgeber gegenüber ihren Arbeitnehmer gewährleisten. Als Rechte gelten im Rahmen der Krankenversicherung die fachlich begründeten Gesundheitsleistungen aus dem Gebiet der Behandlung und der medizinischen Rehabilitation. Bei den Gesundheitsleistungen handelt es sich um das Recht auf Untersuchung und Behandlung bzw. auf medizinische Rehabilitation bei ausgewählten Ärzten auf der primären Ebene des Gesundheitsdienstes, bei den Spezialisten und in den Krankenhäusern, aber auch bei den anderen Anbietern der Gesundheitsleistungen, in bestimmten Fällen auch um das Recht auf Rehabilitation in Kurorten. Die Arbeitsunfall- und Berufskrankheitsversicherung gewährleistet den Versicherten auch Medikamente, die auf der positiven Medikamentenliste stehen und medizinische Hilfsmittel, gemäß den von der Krankenversicherungsanstalt festgelegten Standards. Bei der Geltendmachung dieser Leistungen bzw. der Rechte ist für die Versicherten keine Zuzahlung vorgeschrieben und alle Kosten werden ganz aus der Pflichtversicherung gedeckt. Was die Zuzahlungen bei der Geltendmachung des Bedarfs an Gesundheitsdiensten betrifft, gilt bei den Arbeitsunfällen und Berufskrankheiten sogar eine Sonderregelung. Die Versicherten, die ein bestimmtes Alter vollendet haben, müssen nämlich einen bestimmten Prozentsatz des Leistungspreises nachzahlen, das ist aber bei einigen Diagnosen und Behandlungen von Arbeitsverletzungen und Berufskrankheiten nicht der Fall. Zu den Versicherungsrechten zählt auch die Rückerstattung von Reisekosten, wenn der Versicherte wegen Behandlung oder Rehabilitation zum Arzt oder in die Gesundheitsanstalt außerhalb seines Heimatortes reisen muss. Einen wichtigen Bestandteil der Versicherungsrechte stellt auch der Lohnersatz im Falle einer vorübergehenden Arbeitsunfähigkeit bzw. schlimmstenfalls (der Tod) auch das Sterbegeld dar. Auf der Grundlage der Versicherung haben die Versicherten nach Ablauf von dreißig Arbeitstagen der Arbeitsabwesenheit den Anspruch auf Lohnersatz, bis dahin muss ihnen aber der Arbeitgeber den Lohnersatz rückerstatten. Das Ersatzgeld beträgt 100 % des Grundwertes, den der Durchschnitt des Lohns und des Ersatzgeldes die im Jahre vor Arbeitsverletzung oder Berufskrankheit erhalten wurde, darstellt. Für andere Fälle der Arbeitsabwesenheit, wie zum Beispiel wegen der Krankheit, der Verletzungen außerhalb der Arbeitsstelle oder wegen der Pflege eines Familienmitglieds, ist der Ersatzgeldbetrag niedriger (liegt zwischen 80 und 90 %). All das sind Rechte die von der Krankenversicherungsanstalt den Versicherten (oder ihren Familienmitgliedern) gewährleistet werden. Die slowenische Regelung ist auch deswegen besonders, weil der Lohnersatz zum Zeitpunkt einer vorübergehenden Arbeitsabwesenheit nicht zeitlich begrenzt ist. All diese Rechte sind außer im Gesetz auch in den allgemeinen Akten der Krankenversicherungsanstalt, die von der Seite seiner Versammlung verabschiedet sind, näher definiert. - 139 - Die Versicherten einiger Versicherungskategorien haben im Rahmen der Pflichtkrankenversicherung bei Arbeitsunfällen und Berufskrankheiten nur das Recht auf Gesundheitsleistungen und auf Rückerstattung der Reisekosten während ihrer Behandlung und Rehabilitation. In diese Kategorien gehören Arbeitslose, die öffentliche Arbeiten oder andere organisierte Arbeiten vollbringen, Rentner, Bauern, die nicht rentenversichert sind, Schüler und Personen, die zur Weiterbildung angetreten sind, Studenten, die Gelegenheitsarbeiten bei den bevollmächtigten Organisationen vollbringen, Häftlinge und noch einige weiteren Gruppen der Versicherten. Die Versicherten haben auch Sonderrechte aus der Invaliditätsversicherung und zwar im Falle, dass ihre Behinderung die Folge eines Arbeitsunfalls oder Berufskrankheit ist und sie aus diesen Gründen nachhaltig arbeitsunfähig sind oder bei ihnen eine nachhaltige verringerte Arbeitsfähigkeit aufgetreten ist. An erster Stelle steht das Recht zur beruflichen Rehabilitation, die dem Versicherten gewährleistet werden muss, der eine Behinderung der II. Kategorie erlitten hat und daher in seiner Arbeitsfähigkeit verringert und unfähig ist, seine Arbeit zu vollbringen, aber fähig wäre, eine andere Arbeit zu vollbringen. Das Recht auf berufliche Rehabilitation haben diejenigen Versicherten, die bei der Entstehung der Behinderung jünger als 50 Jahre sind und fähig wären, eine andere Vollzeitarbeit wahrzunehmen. Während der Dauer der beruflichen Rehabilitation gewährleistet die Invaliditätsversicherung eine Umgestaltung der Räumlichkeiten und des Arbeitsplatzes, dazu sind die Versicherten auch im Falle einer Neuanordnung und Belegung einer neuen Arbeitsstelle berechtigt. Berufliche Rehabilitation wird mit Ausbildung an entsprechenden Bildungsanstalten, mit einem Praktikum oder einer nebenberuflichen Ausbildung durchgeführt. Der Arbeitnehmer hat während der beruflichen Rehabilitationszeit das Recht auf eine Unterkunft im anderen Ort, falls er wegen der Rehabilitation in den anderen Ort reisen müsste, aber keine Fahrgelegenheit für ihn organisiert wurde. Während der beruflichen Rehabilitationszeit hat der Versicherte den Anspruch auf das Ersatzgeld in Höhe von 100 % der Behindertenrente, die ihm am Tag der Entstehung der Behinderung zugehören würde. Dieses Ersatzgeld steht ihm auch in der Zeit von dem Abschluss der Rehabilitation bis zum Antreten einer neuen Arbeitsstelle zu und nach dem Antreten neuer Arbeitsstelle bekommt er Ersatzgeld in Höhe von 20 % dieses Grundwertes. Ein wichtiger Bestandteil der Invaliditätsversicherungsrechte ist auch der Anspruch auf die Behindertenrente. Laut slowenischen Vorschriften haben Anspruch auf Behindertenrente die Behinderten der I. Kategorie (Personen die keine Arbeit mehr vollbringen können), Behinderten der II. Kategorie, die das 50 Altersjahr vollendet haben und ohne einer beruflichen Rehabilitation andere Arbeiten nicht vollbringen können, und auch die Behinderten der II. und III. Kategorie, denen keine andere Arbeitsstelle gewährleistet ist und sind Männer beziehungsweise Frauen die das 63. beziehungsweise 61. Altersjahr vollendet haben. Falls sie die angeführten Bedingungen erfüllen und ihre Behinderung eine Folge eines Arbeitsunfalls oder Berufskrankheit ist, erlangen sie diesen Anspruch ohne Rücksicht auf das Rentenalter, während in anderen Fällen auch die Bedingungen hinsichtlich des Rentenalters erfüllt werden müssen. Eine Behindertenrente, die auf Grund der Invaliditätsversicherung gewährleistet wird, gilt in den Fällen einer Behinderung als Folge eines Arbeitsunfalls oder Berufskrankheit und wird auf der Grundlage der Rentenbemessungsgrundlage für mindestens 40 Jahre Rentenalter für Männer und für 38 Jahre Rentenalter für Frauen festgelegt. Die Witwe, der Witwer oder andere Familienmitglieder des Versicherten haben laut den Vorschriften der Renten- und Invaliditätsversicherung, ohne Rücksicht auf das vollendete Rentenalter, einen Anspruch auf die Rente des verstorbenen Versicherten, falls dieser auf Grund der Folgen eines Arbeitsunfalls oder Berufskrankheit verstorben ist. - 140 - Ein Sonderrecht, das aus der Invaliditätsversicherung hervorgeht ist, auch die Erwerbsunfähigkeitsentschädigung. Das ist eine Sondergeldleistung, die ein Versicherter zur Geltung bringen kann, wenn es bei ihm während der Versicherungsdauer zur schweren Verletzung oder zum wesentlichen Funktionsausfall einzelner Organe oder Körperteile gekommen ist. Die Liste dieser Schäden wird vom Minister für Arbeit verabschiedet. Im Falle eines solchen Schadens, der als Folge eines Arbeitsunfalls oder Berufskrankheit entstanden ist, wird der Person dieses Recht gewährleistet, wenn der Schaden mindestens 30 % beträgt. VII. Schlusswort In Slowenien sind wir bei der Errichtung der Arbeitsunfall- und Berufskrankheitsversicherung erst auf halbem Wege. Durch die Schilderung des Zustandes wird es deutlich klar, dass diese Versicherung als ein Sonderzweig der sozialen Sicherheit noch nicht vorhanden ist, obwohl die Versicherten im Rahmen der Pflichtkrankenversicherung und der Renten- und Invaliditätsversicherung Sonderrechte haben, falls sie einen Arbeitsunfall oder Berufskrankheit erleiden. Mittels beider Versicherungsformen haben die Versicherten bessere Rechte als wenn es sich um Krankheit oder Verletzung außerhalb der Arbeitsstelle handelt. Die Regelung der Rechte ist mit anderen Staaten der Europäischen Union vergleichbar und im Rahmen der Versicherungen wird aber die Prävention missachtet. Für das letztere müssten sich die Arbeitgeber einsetzen, was in den Großunternehmen erfolgreich realisiert wird, in kleinen und mittleren Unternehmen jedoch aber schlechter. Vor Jahren gab es die Idee der Einführung einer besonderen Arbeitsunfall- und Berufskrankheitsversicherung, die neben der Deckung der Risiken, die aus diesen Situationen hervorgehen, auch die Prävention betreuen und finanzieren würde. Diese sollte alle Aufgaben übernehmen, die jetzt auf diesem Gebiet der Pflichtkrankenversicherung und der Renten- und Invaliditätsversicherung zustehen und sollte gleichzeitig den Arbeitgebern und den Versicherten bei ihren Anstrengungen zur konsequenten Verwirklichung der Sicherheits- und Gesundheitsmaßnahmen bei der Arbeit behilflich sein. Mit dieser Versicherung sollten auch die differenzierten Beitragssätze für die Arbeitgeber eingeführt werden, die von den Arbeitnehmerkosten für Arbeitsunfall- und Berufskrankheitbehandlung und deren Folgen im Vergleich mit dem slowenischen Durchschnitt abhängen. Im Rahmen dieser Versicherung sollte für die finanzielle Anregung der Arbeitgeber ein Bonus-Malus-System für die Beitragssätze eingeführt werden. Zur Vorbereitung dieser Versicherung wurde ein weitgreifendes Projekt durchgeführt, aber bislang wurde die Idee noch nicht verwirklicht. - 141 - - 142 - Accident insurance in Poland Anna Serafinska The social security system is implemented by public bodies which organisationally are separate, government-owned unities; Social Insurance Institution ( ZUS ) Agricultural Social Insurance Institution ( KRUS ) Both the Social Insurance Institution ZUS with 12,800,000 registered insured persons (by the end of 2004) and the Agricultural Social Insurance Institution KRUS with 1,540,000 insured persons implement their tasks in the fields of old age pension, disability and survivors’ pension insurance, sickness insurance and occupational accident insurance. The Polish social security system covers all working persons, thus both employees and self-employed persons. According to the regulations in effect the accident insurance covers ( with certain exceptions) all those who are subject to compulsory old-age pension and disability pension insurance (i.e. employees, persons who carry out activities outside of agriculture (ZUS) as well as farmers and their family members working on the farm (KRUS). With regard to the number of persons insured, the present examples for preventive measures will be presented according to the data supplied by ZUS, one of the biggest polish social security institutions. ZUS pays compensation in the case of accidents at work and occupational diseases from a special accident insurance fund. The amount of the contribution is fixed for each year and depends on the number of employed persons in the respective area and the risk rate (i.e. the frequency of accidents at work and occupational diseases) in the respective work environment. For the purpose of differentiating the contribution to accident insurance the legislator has determined two groups of contributors: - applicants for accident insurance who register a maximum of 9 insurants or are not subjected to obligatory registration in the register of economic units REGON; as well as - applicants for accident insurance who register a minimum of 10 insurants and are subjected to obligatory registration in the register of economic units REGON. With regard to the type of economic activity these contributors were incorporated into one of 29 groups of economic activity for which the respective percentage of the rate of contribution was determined on a value basis (between 0.97 % and 3.86 %). These values hold for three years. For the first group of contributors the fixed rate of contribution is 50 % of the highest rate of contribution which is determined for the groups of economic activity in the respective year. - 143 - For the second group the percentage of the rate is determined in two stages. In the first stage, the percentage of the rate was the same as the rate fixed for the group of economic activity to which the contributor belongs. In the second stage, ZUS determines the percentage depending on the risk category the contributor belongs to. ZUS determines the risk category on the basis of the data of three subsequent years, submitted by the contributor, concerning - the total number of victims of accidents at work; - the number of fatal accidents as well as the number of victims of serious accidents; - the number of workers who are exposed to accident risks. For a thorough and correct implementation of the new accident insurance system the differentiation of the accident insurance rates is realized in stages. The accident insurance covers accidents at work and occupational diseases. Accidents on the way to and from the workplace are excluded from the accident insurance. Accidents on the way to and from the workplace are covered by the health fund and the disability pension fund of ZUS. In the context of the measures taken by ZUS to prevent payment of pensions, the medical rehabilitation of persons after an accident on their way to or from the workplace or those with a certified occupational disease is paid for by the ZUS disability pension fund. In the case an accident at work or an occupational disease is assessed, the person concerned is entitled to payments that are being paid from the accident fund, in particular - sickness benefit - rehabilitation benefit - one-time compensation payment (in case of permanent or long-term damage to the health of the insured person or the family of the deceased) - work disability pension for the insured person and surviving pension for the family of the deceased - financing of the costs of dental treatment and immunizations as well as of the purchasing of orthopaedic devices which are not covered by the National Health Fund. Only since January 1, 2003, ZUS has taken measures to prevent payment of pensions from the accident fund which is part of the social fund. For these preventive measures ZUS can use up to 1 % of the contributions allotted to the accident insurance in the budget. With this money ZUS finances - the analysis of causes and effects of accidents at work, especially of fatal accidents, serious accidents, group accidents and occupational diseases - general dissemination of knowledge of accident risks at work and of occupational diseases as well as of countermeasures - scientific research for the elimination and containment of causes of accidents at work and occupational diseases So far ZUS has only taken preventive measures against accidents which concerned about 70,000 insured persons every year. Implementing such measures for years has brought numerically measurable results, - 144 - both social and economical. Through information and education measures concerning health promotion and medical rehabilitation which offers insured persons who are exposed to health risks a chance to resume their profession and to become totally socially integrated again. These measures will be continued and expanded. ZUS' preventive measures against accidents include: organising training courses for employers to teach them about accident risks in the working environment, taking into special consideration the industrial sectors where most accidents at work or occupational diseases are registered; disseminating and deepening the knowledge of workers concerning a safe working environment; cooperating with institutions and organisations to prevent accidents at work and occupational diseases taking into special consideration the elimination of accident risks and causes for accidents at work. The measures for accident prevention that have been elaborated so far have contributed to reducing the number of accidents and thus compensation payments. According to KRUS, in 2004 the number of accidents decreased by 20 % in comparison to 2003, compensation payments decreased by approximately 11.5 %. According to ZUS, however, the number of work-related diseases decreased by more than 13 %, and thus also the payments of disability pensions and the compensation payments decreased. The principles and forms of the implementation of measures for accident prevention in Poland shall be enlarged and continued consistently, regard being had to the changes in the Polish market economy. - 145 - - 146 - Unfallversicherungen in Polen Anna Serafinska Das System der Sozialversicherungen wird durch öffentliche Einrichtungen realisiert, die organisatorisch separate staatseigene Einheiten sind; Sozialversicherungsanstalt ( ZUS ) Sozialversicherungskasse für Landwirte ( KRUS ) Sowohl die Sozialversicherungsanstalt ZUS mit (Ende 2004) 12 800 000 registrierten Versicherten als auch die Sozialversicherungskasse für Landwirte KRUS mit entsprechend 1 540 000 Versicherten realisieren ihre Aufgaben im Bereich der Altersrentenversicherung, Rentenversicherung, Krankenversicherung und Unfallversicherung. Das polnische Sozialversicherungssystem umfasst alle Berufstätigen, demnach sowohl die Arbeitnehmer als auch Selbständige, die auf eigene Rechnung arbeiten. Nach den geltenden Rechtsvorschriften gilt die Unfallversicherung mit gewissen Ausnahmen für alle, die altersrenteversicherungs- und renteversicherungspflichtig sind (d.h. Arbeitnehmer, Personen die eine ausserlandwirtschaftliche Tätigkeit ausüben oder Arbeitsaufträge aufnehmen (ZUS) sowie die Landwirte samt den mit ihnen arbeitenden Haushaltsangehörigen (KRUS). Im Hinblick auf die Anzahl der Versicherten, werden die gegenständlichen Beispiele für präventive Massnahmen gegen Unfälle anhand der Angaben von ZUS, einer der grössten polnischen Sozialversicherungsanstalt präsentiert. ZUS leistet den Schadenersatz bei Arbeitsunfällen und Berufskrankheiten aus Mitteln eines gesonderten Arbeitsunfallfonds. Die Höhe des Versicherungsbeitrags wird jeweils für das Beitragsjahr festgelegt und richtet sich nach der Beschäftigtenzahl im gegebenen Betrieb und dem Berufsrisikograd (d.i. Häufigkeit der Arbeitsunfälle und Berufskrankheiten) in der jeweiligen Arbeitsumwelt. Zwecks Differenzierung des Arbeitsunfallversicherungsbeitrags hat der Gesetzgeber zwei Zahlergruppen bestimmt: - Arbeitsunfallversicherungsantragsteller, die nicht mehr als 9 Versicherungsnehmer anmelden oder nicht der Pflicht der Eintragung ins Register der Wirtschaftssubjekte REGON unterliegen sowie - Arbeitsunfallversicherungsantragsteller, die mindestens 10 Versicherungsnehmer anmelden und der Pflicht der Eintragung ins Register der Wirtschaftssubjekte REGON unterliegen. Im Hinblick auf die Art der ausgeübten gewerblichen Tätigkeit wurden diese Zahler in eine der 29 Gruppen der Wirtschaftstätigkeiten eingegliedert, für welche man jeweils prozentualen Anteil des Beitragssatzes wertmässig ermittelt hat (von 0,97% bis 3,86%). Diese Werte gelten jeweils für drei Jahre. In Bezug auf die erste Zahlergruppe liegt der feste Beitragssatz bei 50% des höchsten Beitragssatzes, der für die Gruppen der Wirtschaftstätigkeit in jeweiligem Beitragsjahr festgelegt ist. - 147 - In Bezug auf die zweite Zahlergruppe wird der prozentuale Anteil des Beitragssatzes in zwei Etappen ermittelt. In der ersten Etappe war der prozentuale Anteil des Beitragssatzes gleich dem, der für der Gruppe der Wirtschaftstätigkeit des Zahlers je nach Art. der von ihm ausgeübten Wirtschaftstätigkeit festgelegt war. In der zweiten Etappe wird der Beitragssatz von ZUS in Abhängigkeit von der für diesen Zahler ermittelten Risikokategorie festgelegt werden. ZUS wird die Risikokategorie bestimmen auf Grund der vom Zahler übermittelten Daten aus drei nacheinander folgenden Kalenderjahren in Bezug auf: - die Geschädigtenzahl infolge der Arbeitsunfälle insgesamt, - die Zahl der Unfälle mit Todesfolge sowie Geschädigtenzahl infolge schwerer Unfälle, - die Zahl der Werktätigen, die Unfallgefahren ausgesetzt sind. Im Hinblick auf die gründliche und richtige Umsetzung des neuen Systems der Unfallversicherungen, wird die Differenzierung der Unfallversicherungsbeiträge etappenweise realisiert. Die Unfallversicherung gilt für Arbeitsunfälle und Berufskrankheiten. Unfälle auf dem Hin- und Rückweg zur Arbeit werden aus der Unfallversicherung ausgeklammert. Alle Unfälle auf dem Hin- und Rückweg zur Arbeit werden aus Mitteln des Krankenfonds und des Rentenfonds von ZUS gedeckt. Auch die medizinische Rehabilitation der Personen nach einem Unfall auf dem Hin- und Rückweg zur Arbeit oder derer mit einer attestierten Berufskrankheit wird im Rahmen der von ZUS getroffenen präventiven Massnahmen zur Vermeidung der Rentenzahlung aus Mitteln des Rentenfonds von ZUS finanziert. Bei Feststellung eines Arbeitsunfalls oder einer Berufskrankheit stehen Leistungen zu, die aus Mitteln des Unfallfonds finanziert werden, insbesondere: - Krankengeld - Rehabilitationsgeld - einmaliger Schadenersatz (bei dauerhafter oder langfristiger Schädigung der Gesundheit für den Versicherten oder für die Familie des Verstorbenen) - Arbeitsunfähigkeitsrente für den Versicherten und die Hinterbliebenenrente für die Familienangehörigen des Verstorbenen - Finanzierung der Kosten zahnärztlicher Behandlungen und Schutzimpfungen sowie der Beschaffung von orthopädischen Geräten, welche nicht durch den Nationalen Gesundheitsfonds gedeckt werden. Die Aufgaben auf dem Gebiet präventiver Massnahmen zur Vermeidung der Rentenzahlung aus Mitteln des Unfallfonds, der zu den Sozialfonds gehört, werden von der Sozialversicherungsanstalt ZUS erst seit dem 1. Januar 2003 wahrgenommen. Zu diesem Zweck kann ZUS bis zu 1% der im Finanzplan für die Unfallversicherung vorgesehenen Beitragszahlungen verwenden. Aus vorgenannten finanziellen Mitteln können finanziert werden: - - die Analyse von Ursachen und Folgen der Arbeitsunfälle, insbesondere der Unfälle mit Todesfolge, schwerer Unfälle, Gruppenunfälle und der Berufskrankheiten; allgemeine Verbreitung des Wissens über Unfallgefahren bei der Arbeit und über Berufskrankheiten ferner auch über die Gegenmassnahmen; wissenschaftliche Forschungen zwecks Beseitigung und Begrenzung von Ursachen der Unfälle bei der Arbeit sowie der Berufskrankheiten. - 148 - Die Sozialversicherungsanstalt ZUS hat bis jetzt nur präventive Massnahmen gegen Unfälle ergriffen, jedes Jahr galten diese ca. 70 000 Versicherten. Jahrelange Umsetzung brachte zahlenmässig erfassbare Erfolge sowohl soziale als auch wirtschaftliche. Es waren sowohl Informations- als auch Bildungsmassnahmen in Bezug auf die Gesundheitsförderung, medizinische Rehabilitation, wodurch den gesundheitlich gefährdeten Versicherten eine Chance geboten wurde, ihre Arbeit und berufliche Aktivitäten wieder aufzunehmen sowie die volle soziale Integrierung zu bewerkstelligen. Diese Massnahmen werden fortgesetzt und erweitert. Im Rahmen präventiver Massnahmen gegen Unfälle sorgt die Sozialversicherungsanstalt ZUS für: die Organisierung der Schulungen für Arbeitgeber, zwecks ihnen das Wissen über Unfallgefahren in der Arbeitsumwelt zu ermitteln unter besonderer Berücksichtigung der Branchen (Wirtschaftszweige), wo die meisten Unfälle bei der Arbeit oder die meisten Berufskrankheiten verzeichnet werden, die Verbreitung und Vertiefung des Wissens unter den Arbeitnehmern in Bezug auf eine sichere Arbeitsumwelt, die Zusammenarbeit mit Einrichtungen und Organisationen, zwecks Vorbeugung gegen Arbeitsunfälle und Berufskrankheiten unter besonderer Berücksichtigung der Beseitigung der Unfallgefahren sowie der Ursachen der Unfälle bei der Arbeit. Die bis jetzt ausgearbeiteten Formen präventiver Massnahmen gegen Unfälle trugen zur Senkung der Unfälle und somit zur Senkung der Schadenersatzzahlungen an Sozialversicherte bei. Nach Angaben von KRUS sank 2004 die Unfallzahl gegenüber dem Vorjahr um 20%, die Schadenersatzzahlungen sanken um ca. 11,5 % Nach Angaben von ZUS sank dagegen die Zahl der Erkrankungen durch arbeitsbedingte Einflüsse um mehr als 13 %, folglich sanken auch die ausgezahlten Arbeitsunfähigeitsrenten samt den einmaligen Schadenersatzzahlungen. Die Grundsätze und Formen der Umsetzung präventiver Massnahmen gegen Unfälle in Polen sollen unter Berücksichtigung der Umwandlungen der polnischen Marktwirtschaft konsequent erweitert und fortgeführt werden. - 149 - - 150 - Insurance against accidents at work and occupational diseases in Hungary Ferenc Móricz At the present time there is not available a separate insurance institution for accidents at work and occupational diseases in Hungary. These cases are handled in the framework of the obligatory health insurance system, which is managed by the National Health Insurance Fund Administration. (NHIFA, OEP) (The scheme of the nowadays Hungarian social security is showed by the attached presentation in figure 1.) We have to mention that according to the decision of Parliament and Government, issued in 2001, the involved different Ministries have to elaborate a plan till 2008 about the conditions and possibilities of the organization of a separate Accident Insurance System. Hungary’s population and its health status The Republic of Hungary has 10.117 million inhabitants of which 1.811 million live in the capital. Almost half of the country’s population resides in communities of less than 20,000 inhabitants each. While life expectancy in Western European countries improved during the 1980’s partly due to dropping rates of cardiovascular diseases, this tendency continued to worsen in Hungary as did deaths from cancer, liver cirrhosis and external causes such as accidents and suicide. Hungary has thus far completed an epidemiological transition. However, a special policy of health care for an ageing population is to be implemented. Life expectancy at birth in Hungary in 1997 was 75.1 years for women and 66.1 years for men compared to 80.9 years and 74.6 years in the European Union. Mortality and morbidity due to unhealthy lifestyle, such as increasing rate of smoking and high fat and sugar diet or high consumption of alcohol are thought to be important causative factors. HUNGARY (2004) Area: 93,030 square km Population: 10,117,000 (16 percent under 14 and 63 percent between 15-59) Density of population: 109 (per square km) Form of government: Republic (parliamentary democracy - 4 year election periods) Capital: Budapest (1.8 million inhabitants) Number of counties: 19, Number of towns: 256 Number of villages: 2,889 Urban population ratio: 60 percent Population increment: -3,7 percent More interesting data are showed by the presentation (figure 2-6). According to the latest Government’s programme the improvement of health insurance; the health care service and the employment take priority in the near future. - 151 - Transition in the hungarian health Insurance system (historic background) We can find the footsteps of the social insurance even before introduction of the obligatory sickness insurance in Hungary. The early background was developed in the spirit of self-help and taking common risk in the 13th–14th centuries (A.C.). The increasing danger derived from working conditions and the solidarity made miners to form associations. From the middle of XIX Century (A.C.) because of the dynamical growing number of industrial workers many, different kind of voluntary mutual benefit societies were established based on the principle of collective support. The famous “General Labour Charity and Pay-desk for Sick and Disabled Workers” was established in 1870 and it became the fundamental organization of the Hungarian Health Insurance System. Following the introduction of Germany’s sickness insurance system effected by Chancellor Bismarck, the first Act on mandatory sickness insurance for Hungary’s factory workers was introduced in 1892. In chronological order Hungary is the third state in Europe where the insurance obligatory in case of sickness was enacted by law on 1 April 1892. Sick-relief funds provided healthcare services, medicines, medical aids, sick pay, maternity benefit and funeral allowance. The year of 1907 was the next milestone in the development of sickness insurance, when employers' liability insurance for industrial and commercial workers was introduced. The Act on sickness and employers' liability insurance enforced in 1928 regulated the services provided by OTI (National Social Insurance Institute) for decades. Back then, the centralized system of national sickness insurance was laid down for the 20th century. Before World War II, both the services provided by the insurance system and the group of the insured had been extended. Unfortunately the considerable property of the Insurance Companies was damaged during the World War II. After the World War II. the Insurance Companies were fused and socialized similarly to the other sector of Hungarian economy. The “care-taking-state” was the idea of the socialist regime, which means to provide free health service, free education and culture, free accommodation and guaranteed job with equal minimal wage for every citizen without the payment of any contribution or tax. From the year of 1950 the Hungarian Trade Union Council ordered the Hungarian Security Centre as the “Social Security Centre of the Trade Union (SZTK). The obligatory collective insurance for workers at craftsmen's cooperatives was introduced in 1951. KSZKBI (Collective Insurance Institute for Members of Craftsmen's Cooperatives) operated from 1953 to 1964. This institute provided sickness benefit, maternity benefit and funeral allowance for members. The circle of the insured was widened gradually. The insurance was extended as far as students, then craftsmen in 1962, and shopkeepers in 1970. Act No. II of 1975, which regulated both the health and pension insurance schemes, defined the health insurance system. As a result of a long codification, Act II of 1975 on Social Insurance enacted on 1 July 1975 regulated material and legal rules of social insurance on the basis of principles unified. At the same time, healthcare services were separated from social insurance and every citizen became authorized to use them. But this act did not change the sickness and maternity benefits for the insured. The sick pay in case of accident became the total daily average wage from 1 January 1981. - 152 - Influenced by the worldwide recession of economy from the years of early 1980 the problems of the Hungarian economy increased dramatically as well and the probation of the stabilization affected the Social Insurance System. The changes were the following: 1984. The ruling of the Social Insurance System was taken back from the Trade Union. OTF (National Social Insurance Directorate-General) became the central organisation for the social insurance; its regional organizations were county social insurance directorates and their agencies. Both agricultural and craftsmen’s cooperatives had to establish funds operating at the places of work if the number of the insured exceeded one hundred. 1989. The Fund of the Social Insurance System was separated from the Central Budget. The essential reform of health care system was proclaimed. 1990. The financing of the services of the health care system and the family allowance was changed between the Fund of Social Insurance System and the Central Budget. (The later gone to the Central Budget) The local governments (municipalities) became the owner of the health care institutes. 1991. The Law LXXXIV. Ordered to separate the Social Security System into two parts namely as Health Insurance System and Pension Provision System, each one of them ruled by elected SelfGovernment. (300 billion Hungarian forints were guaranteed from the State property to compensate the damage of the former socialization, but it is realised only partly.) 1992. Sickness Insurance Card was introduced. It links the use of healthcare services with being benefited by social insurance, in other words, the title to insurance. Introduction of the card made choosing physicians possible for patients. The free health care services were guaranteed only for the insured citizens if there contribution was paid. The organization of family doctor services started, with the later possibility of privatisation of the practice. 1993. The Self-Government of the Health Insurance and Pension Insurance were elected and there separation was performed. Health and Pension Insurance Authority was set up on 18 June 1993. There were 60 people on the staff of the Health Insurance Authority, where employers and employees were represented equally. Each of the representatives was admitted to the Health Insurance Authority by election, and it also served the aim of choosing between trade unions. The organs of the Health Insurance Authority were as follows: general meeting, presidency, inspection board, sections, committees and local boards. The Fundamental Rules of Health Insurance Authority – in the sphere of inspection – was approved by Parliament. The new authorities founded in summer of 1997 were wound up on 23 July 1998 by Parliament, which ordered state control again over social insurance. The new financial supply of the health services started on 01.07.1993. The system of payment has become more performance based and payment mechanisms are determined of the type of services. The National Health Insurance Fund introduced the per capita system for family doctors, a fee-for-service system for outpatient health care services. Hospitals are financed through Diagnosis Related Groups (DRG). In case of chronic in-patient care the number of days spent in hospital is the underlying basis for payments. In 1995 Social Insurance Number (TAJ) was initiated. It identifies people entitled to services provided by health insurance, and ensures healthcare services for them this way. The owner of the database of social insurance numbers is the National Health Insurance Fund (OEP). - 153 - In 1997 a package of acts have been enacted in order to restructure and redefine the social insurance system. Acts No. LXXX - LXXXIII of 1997 define the scope of citizens eligible to social insurance services, private pension, the financing of the above benefits, and the benefits of mandatory health insurance. In 1999 the newly elected Parliament decided upon the supervision of the social insurance funds by a State Secretary. On 1 January 1999 Tax Control Office (APEH) took over collection and executive tasks connected with the contribution to social insurance that had approximately 2 million current accounts. Since that time APEH has been responsible for collecting and administrating contributions. At the moment Hungary’s Health Insurance Fund is a separated monetary fund within the State Budget. The budget of this fund is approved by the Parliament usually for one calendar year. The National Health Insurance Fund (NHIF) is a separate administrative organization as well under the supervision of the competent ministry. The National Health Insurance Fund directs the administrative functions of the health insurance branch and controls the calculation and payment of sickness and maternity benefits. A brief presentation of the National Health Insurance Fund Administration (NHIFA) The following three fundamental acts regulate the processes of entitlement, eligibility and the different kinds of benefits in the case of workplace accidents: Act LXXX of 1997 on person entitled to social security benefit and private pensions, as well as the coverage of the service Act LXXXI of 1997 on the social insurance pension Act LXXXIII of 1997 on the benefits of mandatory health insurance. In Hungary the compulsory health insurance operates as an independent branch of the social security system, based on the principle of solidarity. On the basis of Act LXXX of 1997 the insured are as follows: Employees, civil servants and clerks, employees of the administration of justice professional adoptive parents, members of the armed forces including law enforcement bodies as well as civil national security services, regardless of whether they are employed full-time or part-time. Members of co-operatives, excluding full-time student members of school co-operatives if they participate in the activity of the co-operative within the framework of economic enterprises. Apprentices on vocational training under a study contract. Individuals receiving income supplementing benefits unemployment benefits, pre-pension unemployment benefits. Self employed persons whose activity is not to be qualified as supplementary. Additionally the scope of Act LXXXIII of 1997 on mandatory health insurance extends to the following groups of individuals: The persons insured by virtue of Act LXXX of 1997 as well as individuals under a special health insurance contract. Persons and organizations paying social insurance contributions. The providers of health services on the basis of contract. - 154 - To cover the expenses of social security services The insured person (employee) has to pay health insurance and pension contribution (4 % and 8.5 %) on his monthly income. The employer has to pay health insurance and pension contribution (11 % and 18 %) on the monthly salary of his employee (hereafter both referred to as social security contribution) and shall also contribute to illness benefits, which is a monthly fixed sum (3450 Hungarian forint/employee). There is no different rate of contribution according to the activity of a given company. Private entrepreneurs shall declare and pay social security contribution and health insurance and pension contribution on the basis of their incomes or on the basis of the minimal wage. Employed pensioners shall pay accident contribution, which is 5 % of their salary. In the Hungarian obligatory health insurance system there are two main categories according to the eligibility for the different benefits: The insured person covered by contribution is eligible for all type of benefits, included the different cash transfers as well. The other part of the population (dependent family members, pensioners, students) is eligible for the health care services only. The benefit package under the statutory health insurance Benefits in kind (health services provided by the suppliers financed by NHIF) and benefits in cash provided by the NHIF are as follows: Health services provided free of charge according to the “in nature” (in kind) principle: Preventive medical examinations. Medical care by family physicians (primary health care services). Dental care. Outpatient care. In-patient care. Delivery care. Medical rehabilitation. Patient transportation. Accident health supply. Cost allowances to health care services: Drug cost allowance. Medical aids cost allowances. Travel cost reimbursement. International medical cost reimbursement. Co-payment is charged in the following instances: Orthodontic treatment under the age of 18. Tooth keeping and replacement above the age of 18. Extra meal and accommodation for in-patients. Sanatorium treatment. - 155 - Benefits in cash delivered by the Fund are: Sick pay. Pregnancy and confinement benefit. Childcare fee. Disability benefits. Accident benefits. Accident pension Some principles of the health insurance benefits: Health care services can be used up to the extent as required (necessitated) by the health status. Cash benefits can be received in proportion with the health insurance contribution obligation (the accident related sick pay is the same as the salary). Health care services are due to the persons eligible to health care services with the same technical contents. The State guarantees the provision of the benefits, defined by the acts noted above, even if the Health Fund cannot cover the expenses necessary for them. According to the law, students are eligible for accident related health care services. The health insurance management board is obliged to inform the insured about their rights and obligations, and provide them with help to enforce their rights. According to Act on compulsory healthcare benefits, cares related to accidents such as healthcare services provided due to accidents, accident sick pay and accident allowance belong to health insurance services. At the moment the pension insurance division fixes and pays out the accident allowance. Medicines taken and medical aids used by the insured due to deteriorated health caused either by occupation disease or works accident are free. The tasks of National Medical Expert Institute (OOSZI) are to give professional opinions about the partial disability to work and the degree of disability necessary for qualifying deficiency; fixing social insurance benefits, social and family allowances. In addition, OOSZI has given opinions about suitability, since rules commissioned OOSZI to work in this field. Medical committees of first and second instance examine approximately 350 thousand people every year. The depression, backache and the different kind of complains with psychosocial aspect are the most difficult cases to make a correct judgement. More details are showed by the attached presentation (figure 7-15) The system of sick pay was not changed too much in the latest years, however a couple of small modifications were made, and a vast majority of them were depended on the bearing capacity of the economy. Since 1996 employers have covered one-third of the sickness benefit, and the sick leave increased up to 15 days a year. The level of sick pay has become 60% or 70% of the daily average salary. Averagely 107 thousand people a day receive sick-allowance. The calculation of the accident sick pay is not based on general rules, it is equal to the daily average wage. Family doctor and specialist assess the title for sick leave or sick pay and physician of National Health Insurance Fund supervises the all process. By the implementation a new guidelines for the medical assessment of sick pay, we made a considerable save of the expenses in the year of 2004. More details are showed by the attached presentation (figure 16-23) - 156 - The tasks of National Health Insurance Fund are as follows: Purchasing health care services for the insured. Directing the regional and other administrative bodies. Operating the health insurance branch system. Getting involved in preparation of legislation. Preparing and implementing the interstate agreements regarding health insurance. Developing and operating the database of the health insurance system. Collecting, processing and analyzing the statistical data of the health insurance system. The obligatory process of the application for industrial accident benefit. Method of the assessing the occupational injuries in Hungary The first step is to get a report from the working place with all the circumstances of the injury, including the nomination of any person who is responsible for the accident. Secondly the injured person has to apply for an industrial accident entitlement, To gain a right for any special benefit, the Health Insurance Fund has to accept the case as an industrial accident, or occupational disease. The decision is based on the report of the working place and the opinion of the medical institute, which first treated the injured person. The claim is dismissed if: The worker was drunk and that fact alone was the cause of his accident, The cause of the accident was that activity, which was not the part of the given task, or was not allowed to do (including using a car without permission, or some kind of trouble making activity in the working place), It was a meaningful self injury, or the offered medical treatment was not accepted, The injured person did not chose the direct and shorter route to reach his working place or home, There is not a cause-effect relationship between the accident and the medical status of the injured person, or there is not any objective finding or symptoms. If there is any argument or disagreement between the three parts (employer, employee, Health Insurance Fund Administration) on the acceptance, the Court gives a judgement, which is a final decision. The benefits of kind or benefits in cash for occupational injuries and diseases differ from the regular attendance, which mean that these cases get more compensation, than the usual. There are special Acts to help the returning of the person to the active life after an industrial injury. It means, that a complex (medical and occupational) rehabilitation possibilities and preferential employment for disabled or handicapped person as well are available. But if we want to be honest we have to tell that this system should be more effective than it is now. More details are showed by the attached presentation (figure 24-32) Recording, notification, and statistical analysis of occupational diseases in Hungary. Legal regulations of notifying and recording process. Every medical doctor who recognises occupational disease or symptoms of higher chemical/ mechanical exposition at his/her patient is obliged to notify National Public Health and Medical Officer’s Service (NPHMOS, State Health Authority), within 24 hours. (If the diagnosis isn’t clear the National Institute of Occupational Health of Fodor József National Centre for Public Health (OKK-OMFI) carries out further investigations.) - 157 - Requirements of information to be recorded: Name of the patient and the doctor. Diagnosis Name and identity codes of workplace Scope of activities Working circumstances Expositional time Data are registered by the local branch of NPHMOS (State Health Authority), which has to clear up working circumstances too. It is the right authority that gives the final report and assigns verification needed to the sickness or disability supply. Data collection and analysis Occupational Health Services and NPHMOS inform Hungarian Central Statistical Office about data on occupational diseases monthly. Statistical Office analyses the data and publishes them yearly as the following. Main turnover data, Main data on reported occupational diseases (total number, percentage), Reported occupational diseases by type, Number of reported occupational diseases by branches of national economy, (all branches are covered), Number of reported occupational diseases by causes of disease and ability to earn, Number of reported occupational diseases by regions. According to the actual acts not all job related and notified health damages can be compensated in Hungary. At this moment there are two lists of the occupational diseases: List of diseases which obligatory have to report to NPHMOS (90) List of diseases which obligatory have to compensate as occupational diseases (35) by the obligatory insurance system. Good example for the inappropriate regulation that the skin conditions brought on by contact with chemicals are not compensated now. This policy should be changed soon. Our other problem that we haven’t enough correct data because of the under-reporting occupational diseases. It may be a problem of private sector’s employee (fear of dismissing). More details are showed by the attached presentation (figure 33-41). Investigation-Prevention State Health Authority with the National Institute of Occupational Health is responsible for measuring exposition and for prevention of the occupational diseases as well. There are standards specifying the limits of expositions requiring arrangements. The National Inspectorate of Labour Safety and Mining Bureau of Hungary control safety of labour. These authorities help the employers to provide a safe work environment for their employees, but they have the right to inflict a punishment on them if it is necessary. Physicians of the obligatory Occupational Health Service provide occupational care in every workplace. - 158 - The National Health Insurance Fund has the right to make repay the cost of the medical services and sick pay of the injured worker from the employer, if it has been found that the employer is responsible for the accident or occupational disease. (Presentation figure 42.) To change the current Hungarian insurance system, as it was mentioned before, there is a Resolution of Parliament about the implementation of a separate accident insurance branch. In the new formation accident prevention should be emphasised by the company’s risk related contribution and with the “bonus-malus” regulation. Occupational and medical rehabilitation should get more attention in this planned system also. To help the realization of the new insurance formation in Hungary, there is a National Conciliation Committee in which are delegated the representatives of the employers, the employees and the Government as well. (Presentation figure 43.) - 159 - - 160 - Main data of demographical trends (1950-2004) THE HUNGARIAN SOCIAL SECURITY SYSTEM 22 20 INSURANCE SYSTEM SOCIAL INSURANCE PRIVAT INSURANCE WELFARE SYSTEM UNEMPLOYMENT 18 SOCIAL 16 ALLOWANCE 14 BENEFIT 12 10 Health insurance From: Government Municipality old age disability Other: churches, caritative organisations 1 National Health Insurance Fund Administration Population number by sex and age in 2004 8 19 50 19 60 19 70 19 80 19 90 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 Pension provision Death for 1000 inhabitants Live birth for 1000 inhabitants 2 National Health Insurance Fund Administration Estimated population number WOMAN by sex and age in 2050 MAN Age-pyramed Age-pyramed Source: Hungarian Central Statistical Office Source: Hungarian Central Statistical Office National Health Insurance Fund Administration 3 4 National Health Insurance Fund Administration Number of the unemployed people (1989-2004) The rates of the 60 years old and over thousand 600,0 25,0 518,9 500,0 20,0 400,0 15,0 451,2 416,5 400,1 444,2 406,1 348,8 313,0 284,0 238,8 262,5 250,4 241,6 232,9 300,0 10,0 200,0 5,0 100,0 79,5 28,5 National Health Insurance Fund Administration 5 National Health Insurance Fund Administration 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991* 0,0 1990* 1869 1880 1890 1900 1910 1920 1930 1941 1949 1960 1970 1980 1990 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 1989* - 6 Number of insurees and disability pensioners (1990-2004) Number of disability pensioners (1990-2004) thousand Number of disability pensioners 900 745,4 800 630,9 700 600 542,8 658,5 690,4 718 789,5 799,9 806,5 762,5 766,6 777,6 772,3 758,7 Number of insurees (thousand) 6 000 5 000 575,1 5 146 4 804 4 672 4 396 4 362 4 232 4 000 4 080 3 889 3 886 3 811 3 789 3 859 3 870 3 921 3 900 500 3 000 400 300 2 000 200 1 000 745,4 690,4 718,0 630,9 766,6 777,6 772,3 800,0 799,9 806,5 758,7 762,5 658,5 575,1 100 542,8 7 National Health Insurance Fund Administration Disabled persons Reintier 2004 2003 2002 2001 2000 1999 1998 1996 1995 1994 1993 1997 8 National Health Insurance Fund Administration New disabled pensioners for 10 000 working aged people in the regions 2004 Result of evaluation of disability in 2004 Evaluation of new claimants 1992 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1991 1990 0 0 1200 1100 1000 900 800 700 600 500 400 300 Reevaluation of previously disabled persons 39 191 Disabled persons 1 388 86 263 Reintier 1 419 Dismissed claimants 61 552 Dismissed claimants 9 988 All All 102 131 97 670 88,3% 38,4% Disabled persons Reintier National avarage: Dismissed claimants 60,3% 1,3% 59,9 10,2% 1,5% 9 National Health Insurance Fund Administration Number of persons receiving pension, pension-like benefit by type of benefita), January Distribution of the new disabled pensioners according to the cause 2004 a) 2.3. Number of persons receiving pension, pension-like benefit by type of benefit , January 2005 Diseases of the circulatory system Mental and behaviour disorders Neoplasm's Diseases of the musculoskeletal system and connective tissue Other Type of benefit 25,5 28,9 9,9 19,6 16,1 Number of new disabled 1. O ld-age pensions old-age pension miners' and early retirement pensions 2. Disability and accident disability pensions disability pension (disabled category I-II) disability pension (disabled category III) accident disability pension (disabled category I-II) accident disability pension (disabled category III) PENSIONS BY OW N RIGH T TOTAL (1+2) 3. Survivor's pensions widow's pension temporary widow's pension parent's pension 4. O rphan's benefit Survivor's benefits (3+4) b) PENSION BENEFITS TOTAL (1+2+3+4) 5. Accident rent 6. Rent of persons w ith reduced capacity to work c) 7. Disability rent 8. M arital supplement 9. Rent of agricultural co-operatives 10. O ther rents RENTS TOTAL (5+6+7+8+9+10) PENSIO N BENEFITS, RENTS TO TAL a) 39 191 National Health Insurance Fund Administration 10 National Health Insurance Fund Administration 631,3 622,4 9,0 418,7 1 050,0 6,2 4,6 1,6 0,0 55,2 61,4 1 111,4 12,5 87,4 15,4 0,2 1,3 1,0 117,7 1 229,1 M ale of which: under above the age-limit 94,9 536,4 85,9 536,4 9,0 251,7 167,0 346,6 703,4 number, thousands 1 021,1 1 021,1 0,0 389,4 1 410,5 169,5 159,2 10,1 0,2 56,7 226,2 1 636,7 2,6 135,8 13,4 35,3 8,3 2,2 197,5 1 834,3 Female of which: under above the age-limit 90,4 930,7 90,4 930,7 0,0 214,1 175,3 304,5 1 106,0 number, thousands 1 652,4 1 643,4 9,0 808,1 121,0 679,1 1,8 6,2 2 460,6 175,7 163,8 11,7 0,2 111,9 287,6 2 748,2 15,0 223,1 28,7 35,5 9,6 3,2 315,2 3 063,3 Benefits financed jointly by the insurance branches. The miners' and early retirem ent pensions and the item s 6-10 are financed by not the social insurance fund. b) c) number, thousands B enefits are paid from the Health Insurance Fund for 2,1% of those receiving survivor's m ain benefit. Tem porary rent, regular social rent, m iners' health deterioration rent. Source: National Pension Insurance Directorate 11 National Health Insurance Fund Administration 12 Accidental benefit Accidental disability pension Paid if the capacity for work has been reduced by at least 16 % due to occupational accidents or diseases but reducing is less than 67 %. Qualifying conditions: The benefit is granted: • up to 25 % - for two years • more than 25% - without any time restriction • The insured person has lost more than 67 % of his/her capacity for work predominantly due to a work accident /occupational disease Rates of benefits by degrees: 1. degree: 16 – 25 % = 8 % of monthly income 2. degree: 26 – 35 % = 10 % of monthly income 3. degree: 36 – 49 % = 15 % of monthly income 4. degree: 50-66 % = 30 % of monthly income • he/she doesn’t work regulary or there is a significant reducing in his/her income • capacity for work has been lost by 50 % as a consequence of silicosis 13 National Health Insurance Fund Administration 14 National Health Insurance Fund Administration Distribution of expenses of Health Insurance Fund, 2004 The sum of accidental disability pension (It is more favourable than the disability pension) Sum of the accidental pension depends on degree of disability and service-time Calculation scheme: 1. rates of average monthly income in accordance with degrees of disability: degree III. 60 % 2. degree II. 65 % degree I. 70 % The above rates rise by 1 % (yearly) in accordance with the servicetime (till maximum 100 %) e.g.25 years service time: the accidental disability pension 85 % e.g. 25 years service time: the disability pension 63 % 15 National Health Insurance Fund Administration Summary sick-pay data Sick-pay 4.4. Sick-pay data by legal titlea), 2004 a) 4.1. Sick-pay data of employees, self-employed persons and members of companies 4.1.1. Summary sick-pay data Year 1970 1975 1980 1985 1990 1995 2000 2002 2003 2004 Daily average Number of persons number of persons entitled on b) to sick-pay , sick-pay, thousands thousands 3 949 214 4 219 259 4 230 244 4 164 254 4 540 272 3 827 173 3 465 112 3 480 122 3 521 124 3 485 107 Proprotion of persons on sick-pay, % Number of sick-pay days, millions 5,4 6,1 5,8 6,0 6,0 4,5 3,2 3,5 3,5 3,1 64,8 78,4 75,2 66,5 99,4 63,1 41,2 44,4 45,2 39,2 16 National Health Insurance Fund Administration Expenses on sick-pay, million HUF Expenses on sick-pay per day, HUF 3 750 5 983 7 395 9 982 24 319 39 805 56 140 80 864 98 936 96 240 57 75 98 150 245 631 1 364 1 823 2 189 2 458 a) Including data of Railway Workers' Social Insurance Administration, up to 1995 excluding data of those main organizations which contracted with NHIF. From 2000 excluding data of professional staff of armed forces, security organizations and civil national security services. The sick-pay data include the data of accident sick-pay. Employee: who is not self-employed person or member of company and is employed with the obligation of health insurance contribution. (Act of LXXX of 1997 section 4, i). The number of entitled persons is estimated for the years of 2000-2004. b) Number of Number of Sick-pay days sick-pay cases, sick-pay days, per case thousands thousands Legal title Child-nursing sick-pay Occupational accidents and diseases Sick-pay utilized after the cessation of insurance Other sick-pay Total 212 43 81 898 1 233 1 225 1 957 4 724 31 249 39 155 6 46 59 35 32 Expenses on sick-pay, million HUF 2 721 6 403 11 204 75 912 96 240 Expense on sick-pay per day, HUF 2 221 3 272 2 372 2 429 2 458 Distribution, % Legal title Child-nursing sick-pay Occupational accidents and diseases Sick-pay utilized after the cessation of insurance Other sick-pay Total Sick-pay cases 17,2 3,5 6,5 72,8 100,0 Sick-pay days 3,1 5,0 12,1 79,8 100,0 Expenses on sick-pay 2,8 6,7 11,6 78,9 100,0 a) Excluding data of professional staff of armed forces, security organizations and civil national security services. National Health Insurance Fund Administration 17 National Health Insurance Fund Administration 18 Main sick-pay data showed in the rate of 1990 % 1 100 2 458 The numbers show real data 900 2 184 1 823 700 1 507 1 173 500 -100 245 24,3 99,4 19 Distribution of the sick-pay days according to the cause Other: O: 8% 396 27,4 29 72,9 35,3 73,2 40,8 73,9 39,8 63,1 32,9 45,2 36,1 1992 1993 1994 1995 1996 41,3 41,7 41,9 3,2 3,3 56,1 41,1 64,2 96,2 42,7 44,4 45,3 39,2 3,5 3,5 3,1 80,9 43,3 4,5 1991 49,2 1997 1998 3,2 1999 2000 3,4 2001 2002 2003 Sick-pay days (Million per day) Sick-pay expense per day average Sick-pay expense (B Ft per year) Percentage of pensions on sick-pay 2004 20 National Health Insurance Fund Administration The average duration of one sick leave case in days* M: 21% 27% F: 7% 316 91,8 552 481 835 730 631 6,0 1990 National Health Insurance Fund Administration 98,9 989 300 100 1 365 J: 16% S: 11% I: 10% M: Diseases of the musculoskeletal system and connective tissue J: Disease of the respiratory system S: Injury, poisoning I: Diseases of the circulatory system O: Pregnancy, childbirth and the puerperium F: Mental and behavioural disorders * enclosed cases at 2004 21 National Health Insurance Fund Administration Economic activity of population aged 15-74 (2000-2003. in thousands) The Hungarian sickness absence compensation rates (according to the previous income) Compensation rate % Paid by Duration of the payment 4 500,0 Employer The first 15 sickness days in the given year 80 * 4 000,0 70 * + o 60 * 100 *# 22 National Health Insurance Fund Administration 4 119,9 3 500,0 th NHIFA From the 16 sickness day maximum for one year 4 102,4 3868,3 3856,2 4 109,4 3870,6 4 166,4 3921,9 3 000,0 NHIFA From the 1st sickness day till one or two years 2 500,0 2 000,0 1 500,0 NHIFA = National Health Insurance Fund Administration * = Written certificate by medical doctors is mandatory. (Earlier, 3 days self 2000 + = The employer has to contribute by 3o % o = Short previous insured period or during Hospitalisation 2001 2002 economic activity of population aged 15-74 # = Work injury or occupational diseases National Health Insurance Fund Administration 1 000,0 500,0 certification) 23 2003 of which employed National Health Insurance Fund Administration -National Labour and Labour Safety Inspectorate 24 Changes in the numbers of accidents at work sustained at work 2003-2004 Persons killed or injured on accidents at work 1990-2004 90 000 Y ear/distribution 88 684 80 000 altogether SERIOUS* FATAL of this WITH TRAUMATIC AMPUTATION 70 000 60 000 50 000 of this 40 000 WITH TRAUMATIC AMPUTATION** 30 000 28 220 20 000 26 369 26 072 (+483) 26 392 2003. 25 745 216 133 2004. 23 872 282 160 % (Percentage) of previous year 93% 131% 120% 46 53 115% 259 325 125% 23 872 10 000 * Serious occupational injury = fatal + serious with traumatic amputation + other serious (according to Mvt.) 1990 2000 2001 2002 2003 ** 2004 National Health Insurance Fund Administration -National Labour and Labour Safety Inspectorate 25 26 National Health Insurance Fund Administration -National Labour and Labour Safety Inspectorate Distribution of accidents at work according to seriousness 1985-2004 Formation of the total and fatal accidents at work events 1999-2004 Number Frequency of Year occupati index to 1000 employees onal injuries Occupational injuries with traumatic amputation = serious with traumatic amputation+ other with traumatic amputation Number of employees Frequency Total fatal (data occupational index to 100 000 employees provided by injuries KSH) 1999. 28 116 7,4 161 4,2 3 811 500 2000. 27 214 7,2 151 4 3 789 300 2001. 25 536 6,6 124 3,2 3 859 500 2002. 25 284 6,5 163 4,2 3 870 600 2003. 25 745 6,6 133 3,4 3 921 900 2004. 23 872 6,1 160 4,1 3 900 400 Serious with traumatic amputation Fatal All traumatic amputation All serious 27 28 National Health Insurance Fund Administration -National Labour and Labour Safety Inspectorate National Health Insurance Fund Administration -National Labour and Labour Safety Inspectorate Distribution of fatal accidents at work I. 2004 Distribution of accidents at work according to nationality 2004 Permanent Not serious Loss of sense, injury Perilous/ Recovery Serious with with ability of Endangering impeding the beyond 3 Fatal traumatic traumatic independent reproduction one’s life days amputation amputation life-leading Altogether Hungarian citizen 23 094 153 50 58 2 6 262 23 625 Not native, still coming from EU member-state 48 0 1 0 0 0 1 50 Not native, outside of EU member-state 154 7 2 2 0 0 7 172 22 0 0 1 0 0 2 25 23 318 160 53 61 2 6 272 23 872 Other Altogether 1. TRANSPORT 2. FALL 3. 4. 5. 6. 7. 29 National Health Insurance Fund Administration -National Labour and Labour Safety Inspectorate 8. 9. NUMBER OF 2003. 2004. TYPE OF INJURY Road vehicle accident 34 52 Road (works road) 1 1 Street accident of pedestrian and 12 16 cyclist Vehicle transport within factory 3 1 Air transport 0 0 Railway vehicle accident 0 2 25 27 Fall from high (falling in-, down) Fall on the same level 4 4 During performing work on railway 1 1 track, by track Conveyance of materials (mechanical, 5 7 manual) Falling objects from high (not during conveyance of materials, e.g. felling) Burying (e.g. due to landslide, substance in bulk) Drowning (e.g. into liquid) Electric shock (burn caused by electric arc) Burning, explosion % * % ** 153 32,5 100 0,6 133 33 0 108 100 10 0,6 0 1,3 16,9 2,5 100 0,6 140 4,4 13 7 54 4,4 5 3 0 5 0 167 0 3,1 10 3 6 14 60 467 3,8 8,8 30 National Health Insurance Fund Administration -National Labour and Labour Safety Inspectorate Distribution of fatal accidents at work II. 2004 POISONING 11. 12. 13. 14. 15. 16. 17. ALTOGETHER NUMBER OF 2003. 2004. % * % ** 0 1 0,6 0 0 0 0 0 0 TYPE OF INJURY Liquid Solid substance (e.g. food) Alcohol Crushing caused by moving object (not conveyance of materials) Unexpected starting of a machine Machine part getting out of control (e.g. explosion of grindstone) Injury caused by rotating, moving machine part Effect of natural elements Assault of people Assault of animals 2 2 7 2 350 100 0 1 2 0 4 2 133 2 1 1 2 160 25 100 Közúti (üzemiroad) úti) Road (works Gyalogos és kerékpáros Street accident of pedestriangázolása and cyclist Üzemen belül gépjármű közlekedés Vehicle transport within factory Vasúti jármű karambol Railway vehicle accident Esés magasból (be-, Fall from high (falling in-,leesés) down) Esés azonos szinten Fall on the same level 4,4 1,3 14 1 7 Vasúti vágányon, közelében On railway track, by vágány track 2 1 2 11 2 Anyagmozgatás (gépi,(mechanical, kézi) Conveyance of materials manual) 52 6 5 0,6 100 Közúti jármű accident karambol Road vehicle Distribution of fatal accidents at work 2004 Tárgyak esésefrom magasból fadöntés) Falling objects high (e.g.(pl. felling) Fulladás folyadékba) Drowning(pl. (e.g. into liquid) Áramütés (villamos ív okozta égés) Electric shock (burn caused by electric arc) Égés, robbanás Burning, explosion 1,3 0,6 0,6 1,3 100 Folyadék Liquid 7 7 1 14 21 27 16 Elmozduló tárgy by okozta Crushing caused movingösszenyomatás object Gép váratlanstarting beindulása Unexpected of a machine Gépalkatrész elszabadulása Machine part getting out of control Forgó, mozgó gépalkatrész Rotating, moving machine part Természeti tényezők hatása Effect of natural elements Emberek Assault oftámadása people Állatok Assaulttámadása of animals 31 National Health Insurance Fund Administration -National Labour and Labour Safety Inspectorate Formation of occupational diseases and cases of increased exposures 1985-2004 Data of activity of Occupational Health Service Denomination 2000 2001 2002 2003 Units provided by occupational health service 82 122 83 454 93 453 94 154 Physicians providing occupational health care full time 3 400 3 324 3 251 3 395 Number of patients, thousands 4 534 4 413 4 272 4 566 Of which: aptitude medical examinations and screening tests, thousands first aid, thousands 2 578 206 2 512 178 2 571 167 2 742 161 405 402 464 465 Registered paients in care, thousands 32 National Health Insurance Fund Administration-National Labour and Labour Safety Inspectorate Occupational injury National Health Insurance Fund Administration – OKK-OMFI 33 Distribution of reported cases according to gender 1993-2003 Increased exposure National Health Insurance Fund Administration – OKK-OMFI 34 Distribution of reported cases according to age groups 2004 male male Age (year) year year year year female year female Occupational diseases Increased exposure Occupational disease Increased exposure National Health Insurance Fund Administration – (OKK-OMFI) National Health Insurance Fund Administration – OKK-OMFI 35 36 Numbers of reported cases according to branches of national economy 2004 Agriculture and Forestry Mining industry Processing industry Electric power, Water supply Building industry Trade/Catering industry Shipping, Post, Telecom. Medical and Social service Other Occupational disease Increased exposure National Health Insurance Fund Administration – OKK-OMFI Distribution of cases of numerous exposure according to gender and disease-cause factors 2004 Factor of disease cause of multiple exposure Male Female Together Lead Nickel benzol toluol xilol dimetilformamidal Stirol Carbon monoxide Altogether 11 10 11 12 0 6 1 10 61 5 0 4 3 6 0 4 0 22 16 10 15 15 6 6 5 10 83 National Health Insurance Fund Administration – OKK-OMFI 37 Formation of reported occupational diseases, main forms of disease 2003-2004 38 Distribution of occupational diseases according to disease-form among men and women 2004 Male Female Noise Infectious Respiratory Poisoning (chemical) Skin Impaired hearing due to noise Other National Health Insurance Fund Administration - OKK-OMFI Infectious disease Respiratory Poisoning due to Skin-disease disease chemical substance Other disease Disease due to vibration National Health Insurance Fund Administration – OKK-OMFI 39 Distribution of occupational diseases according to main groups of disease-cause factors 2004 Biological Other 40 PREVENTION, INVESTIGATION OF THE ACCIDENTS AT WORK AND OCCUPATIONAL DISESASES ACCIDENTS AT WORK NATIONAL INSPECTORATE OF LABOUR SAFETY MINING BUREAU OF HUNGARY Chemical Physical OCCUPATIONAL DISEASES STATE HEALTH AUTHORITY NATIONAL INSTITUTE OF OCCUPATIONAL HEALTH NATIONAL HEALTH INSURANCE FUND ADMINISTRATION National Health Insurance Fund Administration – OKK-OMFI 41 42 National Health Insurance Fund Administration PRINCIPALS OF THE PLAN ACCIDENT INSURANCE SYSTEM 1.) PREVENTION - company’s risk related contribution - qualified bonus-malus regulation 2.) HIGH MEDICAL TREATMENT - in accredited institutes 3.) COMPLEX REHABILITATION ( medical, occupational) 4.) FULL COMPENSATION OF THE LOST INCOME NATIONAL CONCILIATION COMMITTEE with the representation of - employers - employees - gouvernment National Health Insurance Fund Administration 43 43 Insurance against accidents at work and occupational diseases in Malta Frank Micallef “In 1929, the first-ever Social Security contributory scheme according short-term coverage to all workers on the island in respect of injury at work was introduced. This became possible through the enactment of the 'Workmen's Compensation Act' which granted the payment of injury benefit to those workers who were injured on duty as a result of their employment. Contributions towards this scheme were compulsory and were made on a tripartite basis, with employers, employees and the State each paying an equal part into the fund so that the scheme would remain viable. The concept of social insurance was thus introduced into our islands for the first time”. Since then, like everywhere else, the Welfare State in Malta evolved and today we have a comprehensive act, on our statute that covers all contingencies that our citizens may encounter throughout their lifetime. The Social Security Act (Chapter 318 of the Laws of Malta) provides such protection. As an aside, our system is not a funded system, but pay as you go. The said Act provides that every person who is sixteen years and over (up to retiring age) shall become insured under this act as an employed or self occupied person. Therefore from the start of his employment or self occupation a person shall be covered under this act. The private sector has also ventured into the market of insuring against accidents and industrial diseases. Mostly employers do so to shed their liabilities if and when the employee sues them for damages. Companies where accidents occur and who also have a large workforce (500+) like ship-repair have realised that if they are held liable for injury, they might as well become bankrupt if they are not insured. Moreover we have not as yet made it compulsory for all employers to insure their employees against accidents at work and against industrial diseases with private insurance providers. Here there are different opinions whether it should be obligatory or not. This overview therefore deals only with the state obligation towards its contributors that is the employed and self occupied persons. Subject to the provisions of this Act where an insured person suffers personal injury caused by accident arising out of or in the course of his employment or self occupation, or has developed any of the diseases specified in the relevant schedule of the said act, then Injury Benefit shall be payable to him, if within a period of twelve months from the accident or onset of the disease, he is incapable of work. Public service employees are not entitled to any benefit whilst in receipt of full pay and injury leave. The contributions paid under the Social Security Act are composite contributions and an insured person is covered for short term and long term benefits. Obviously injury benefit and benefits for occupational diseases are also included with the short term benefits. - 169 - The rate of contributions vary but on average an employed person pays 10% of his basic salary, whilst his employer pays another 10% and the state pays 50% of the sum that the employee and employer pay into the system. Minimum Lm2.84 or € 6.61 per week up to a maximum of Lm 13.16 € 30.64 each. (1 Euro = Maltese lira .42944) It is pertinent to point out that the rates are rather on the low side compared to other EU member states, but one has to keep in mind our annual income on which the rates of contributions are based, i.e. between Lm 3000 or € 6736 per annum and Lm 6841 or € 15930 per annum. The self-occupied person pays on average 15% of his net income and the State forks out the same amount. Minimum Lm9.86 or 22.96 per week up to a maximum of Lm19.73 or € 45.94 each Both categories of insured persons are entitled to claim injury benefits or claim benefits arising out of industrial diseases. When a claim is submitted, the injured person is requested to attend a medical examination by a specially appointed Medical Panel. If the panel decides that the injury is severe enough that it renders the injured person incapable to attend his duties, the department is notified by the panel of the probable length of incapacity, and payment effected accordingly. Injury benefit are Lm9.80 or €22,82 per diem for a married or a single parent that has children under 18. A single person will receive Lm7.38 or €17,19 per diem, If after review by the medical Panel, the insured person is found that he is suffering from permanent mental/physical aftereffect as a result of his injury he is awarded: A disablement gratuity if his disablement is calculated of up to 19%, Minimum of Lm80.08 or €186.47 up to a maximum of Lm1521.40 or €3542.75 (lump sum) A disablement pension if the incapacity is calculated as from 20% up to 89%, Minimum of LmLm5.02 or €11.69 per week up to a maximum of Lm23.08 or €53.77 An invalidity pension (totally incapacity for work) is paid if the incapacity is 90% and over. A single person gets Lm40.28 or €93.80 per week whilst a married person maintaining a spouse Lm46.56 or €108.42 weekly It is imperative at this stage to point out that in Malta we all enjoy a free national health scheme, therefore medical treatment and rehabilitation is done at the state local hospital. Also if the injured person dies as a result of personal injury/industrial disease in the course of his duties his spouse is entitled to a full pension for widowhood. In order to prevent accidents at work and industrial diseases, in 2002, the Occupational Health and Safety Authority was set up. This authority has its own personnel to inspect all places of work and if it is found that the work environment is not healthy and safe the factory or working site is closed, until it is made safe enough to continue with its activity. - 170 - The Department of Social Security is duty bound to inform the said Authority with all accidents at work. In turn investigations are specifically carried out and if it has been proven that a person has acted negligently he is disqualified from receiving the benefit due. Provided that where it is proven that the employer was in breach of any of the provisions of the Occupational Health and Safety Authority, the Director of Social Security may claim from the employer any benefit paid to the insured person relating to such accident. Therefore all employees have to be kitted out with all the safety clothing available and all machinery equipped with the necessary safety gadgets. Unfortunately with all good intentions and precautions accidents do happen and I am attaching some statistics to indicate what has happened in Malta during last year. Accidents at Work in 2004 by Gender Sex Number % Males 3611 87.8 Females 500 12.2 Total 4111 100.0 - 171 - Accidents at work in 2004 by economic activity of enterprise Economic Activity Males Number Agriculture, Hunting and Forestry 53 Fishing 12 Mining and Quarrying 22 Manufacturing 1300 Electricity, Gas and Water Supply 153 Construction 626 Wholesale and retail trade 264 Hotels and Restaurants 289 Transport, storage and Communication 348 Financial Intermediation 8 Real Estate, Renting and Business Activities 147 Public Administration and Defense 177 Education 31 Health and Social Work 98 Other Community, Social and Personal Social Services 46 Private Households Extraterritorial 2 Unknown 35 Total 3611 % 1.5 0.3 0.6 36.0 4.2 17.3 7.3 8.0 9.6 0.2 4.1 4.9 0.9 2.7 Females Number 2 123 1 1 25 95 35 4 28 21 31 120 1.3 0.1 1.0 100.0 10 2 2 500 % 0.4 24.6 0.2 0.2 5.0 19.0 7.0 0.8 5.6 4.2 6.2 24.0 Total Number 55 12 22 1423 154 627 289 384 383 12 175 198 62 218 % 1.3 0.3 0.5 34.6 3.7 15.3 7.0 9.3 9.3 0.3 4.3 4.8 1.5 5.3 2.0 0.4 0.4 100.0 56 4 37 4111 1.4 0.1 0.9 100.0 % 2.0 14.4 1.4 7.2 Total No 79 146 147 116 % 1.9 3.6 3.6 2.8 Accidents at work in 2004 by occupation of victims Occupations Legislators, senior officials and managers Professionals Technicians and associate professionals Clerks Service workers and market and sales workers Skilled agricultural and fishery workers Craft and related trades workers Plant and machine operators and assemblers Elementary occupations Armed Forces Total Males No 69 74 140 80 % 1.9 2.0 3.9 2.2 Females No 10 72 7 36 276 44 897 7.6 1.2 24.8 57 4 11.4 0.8 333 44 901 8.1 1.1 21.9 303 1715 13 3611 8.4 47.5 0.4 100.0 56 257 1 500 11.2 51.4 0.2 100.0 359 1972 14 4111 8.7 48.0 0.3 100.0 - 172 - Accidents at work in 2004 by age group of victims Age Groups 15-24 25-34 35-44 45-54 55 + Total Males Females No % No % 687 19.0 177 35.4 1028 28.5 119 23.8 777 21.5 79 15.8 783 21.7 84 16.8 336 9.3 41 8.2 3611 100.0 500 100 Total No 864 1147 856 867 377 4111 % 21.0 27.9 20.8 21.1 9.2 100.0 Part of body injured in 2004 in accidents at work Part of Body Injured, not specified Head Neck, inclusive of spine and vertebra in the neck Back, including spine and vertebra in the back Torso and Organs Upper Extremities Lower Extremities Whole Body and Multiple Sites Other Parts of Body Injured, not mentioned above Total Males No 40 363 % 1.1 10.1 Females No 5 42 108 253 140 1773 819 112 3.0 7.0 3.9 49.1 22.7 3.1 3 3611 0.1 100.0 - 173 - % 1.0 8.4 Total No 45 405 % 1.1 9.9 26 30 15 265 95 21 5.2 6.0 3.0 53.0 19.0 4.2 134 283 155 2038 914 133 3.3 6.9 3.8 49.6 22.2 3.2 1 500 0.2 100.0 4 4111 0.1 100.0 Accidents at Work in 2004 by Type of Injury Type of Injury Type of Injury Unknown Wounds and superficial injuries Bone fractures Dislocations, Sprains and Strains Traumatic Amputations Concussions and Internal Injuries Burns, scalds, and frostbites Poisonings and Infections Drowning and asphyxiation Effects of sound and vibration Effects of temperature extremes, light, and radiation Shock Multiple Injuries Other specified injuries not included under other headings Total Accidents at work in 2004 by district of enterprise District Southern Harbour District Southern Eastern District Northern Harbour District Western District Northern District Gozo and Comino Total Males No 220 1572 395 1131 50 40 145 11 8 1 % 6.1 43.5 10.9 31.3 1.4 1.1 4.0 0.3 0.2 0.0 Females No 57 209 46 146 6 8 18 2 1 - 6 9 22 0.2 0.2 0.6 1 5 1 1 3611 0.0 100.0 500 Males No 1372 475 952 306 434 72 3611 - 174 - % 38.0 13.2 26.4 8.5 12.0 2.0 100.0 Females No 207 61 164 22 41 5 500 % 11.4 41.8 9.2 29.2 1.2 1.6 3.6 0.4 0.2 - Total No 277 1781 441 1277 56 48 163 13 9 1 % 6.7 43.3 10.7 31.1 1.4 1.2 4.0 0.3 0.2 0.0 0.2 1.0 0.2 7 14 23 0.2 0.3 0.6 1 0.0 100.0 4111 100.0 % 41.4 12.2 32.8 4.4 8.2 1.0 100.0 Total No 1579 536 1116 328 475 77 4111 % 38.4 13.0 27.1 8.0 11.6 1.9 100.0 Size of Enterprise Where the Accidents Occurred in 2004 Employment Size Males No Self-employed without employees 176 1-9 employees 388 10-49 employees 584 50-249 employees 782 250-499 employees 419 500 employees or more 1227 Unknown size 35 Total 3611 Employment Status of the Victims in 2004 Employment Status Self-employed Full-time employees Part-time employees Total Males No 288 3274 49 3611 % 4.9 10.7 16.2 21.7 11.6 34.0 1.0 100.0 Females No 3 17 51 159 74 191 5 500 % 0.6 3.4 10.2 31.8 14.8 38.2 1.0 100.0 Total No % 179 4.4 405 9.9 635 15.4 941 22.9 493 12.0 1418 34.5 40 1.0 4111 100.0 % 8.0 90.7 1.4 100.0 Females No 2 451 47 500 % 0.4 90.2 9.4 100.0 Total No % 290 7.1 3725 90.6 96 2.3 4111 100.0 Fatalities 2004 Case Number 1 2 3 4 5 6 7 8 9 10 11 NACE Section F F F K K F A K F F F NACE 2digit 45 45 45 74 74 45 1 74 45 45 45 Sex M M M M M M F M M M M - 175 - Age 60 48 53 17 40 57 47 23 16 23 47 NACE Sections A B C D E F G H I J K Agriculture, hunting and forestry Fishing Mining and quarrying Manufacturing Electricity, gas and water supply Construction Wholesale and retail trade, repairs Hotels and restaurants Transport, storage and communication Financial intermediation Real estate, renting and business activities Public admin and defense; compulsory social L security M Education N Health and social work Other community, social and personal service O activities P Private households with employed persons Q Extra-territorial organizations and bodies Finally, I would like to point out, that apart from the lovely memories of Vienna, I will be taking with me the experiences of the “old” EU member states and also those of the new ones. These experiences will help me and my colleagues back home in our difficult task, in reviewing our social security legislation. I have included two Maltese words in my last slide of my power point presentation. Grazzi u Sahha. The first one means thank you from the romantic Italian language (grazie) and the other one typically Maltese from its Semitic origin meaning “good health”. The last one is very appropriate, due to the nature of the Conference on accidents at work and industrial diseases. So Sahha to you all. - 176 - Social insurance against accidents at work and occupational diseases in Latvia Jevgenija Brike 1. Introduction The law ‘’on Compulsory Social Insurance Against Accidents at Work and Occupational Diseases’’came into a force on 1 January, 1997. The objectives of the law are as follows: - to compensate the loss of income in the event of an accident at work or occupational disease, - to provide a set of services in order to integrate the affected person into society, - to ensure the implementation of preventive measures in order to improve the working environment, educate employers and employees, prevent accidents at work and the contracting of occupational diseases, - to guarantee material support to the family members – survivors of the insured person. The previous system based on the civil liability of the individual employer toward the victim was replaced with a system based on the insurance principle. It means all accidents at work and professional diseases that have happened after the new law came into force fall under the state compulsory social insurance system. The State Social Insurance Agency is a state institution under supervision of the Ministry of Welfare, performing the public administration function in the area of social insurance and social services including the insurance against work accidents and occupational diseases. 2. Coverage The compulsory social insurance against work accidents and occupational diseases applies to all employees and civil servants who have reached the age of 15 and are employed (have a labour contract or are in civil service) by an employer – domestic taxpayer. The family members are entitled to receive insurance compensation in the case the death of the insured person has resulted from work accident or occupational disease. The dependent family members are those family members of the insured person who are incapable of working and who were supported by this deceased person (children up to age 18, spouse, and other family members who bring up deceased person’s child up to age 8). The self-employed persons are not covered by employment injuries insurance. There is no possibility to join the insurance on a voluntary basis. - 177 - Contingencies covered Accident at work The definition provided in the Law "On compulsory social insurance against accidents at work and occupational diseases" for the accidents at work is the following: "injury to health or death of the insured person caused by an accident which has occurred while carrying out work duties within one working day". The accident occurring on the way to the work in a means of transport of the employer is considered a work accident, but the accident during the journey made from home to the work place is not considered a work accident. The employer has the duty to ensure the investigation of the accident at work in accordance with the provisions of the legislation and based on the investigation materials draw up the relevant document. The insurance event is the fact of an accident at work proved by this document. Occupational diseases Occupational diseases are "diseases characteristic of certain categories of employees which are caused by physical, chemical, biological, psychological factors of the working environment". The list of occupational diseases is approved by the government of Latvia. If the disease is not listed it might not be qualified as an occupational disease. Nevertheless if the Special Commission on Occupational Diseases determines that a connection between a certain illness and working conditions exists, the Association of Specialists on Professional Diseases might submit a proposal to the Government in order to complete the list of occupational diseases. Cases of occupational diseases are the responsibility of Occupational Diseases Centre at the State Clinic Hospital, and a Consultative Committee decides on the specific occupational disease. 3. Financing Payments related to work injuries and occupational diseases are financed by social insurance contributions paid only by the employers. The employees do not pay social insurance contributions for this type of insurance. The Government establishes the rate of social insurance contributions for every year. The Law on compulsory insurance against work accidents and professional diseases stipulates that this rate is estimated according to the degree of risk such as working environment, danger of the work, the number of work accidents and occupational diseases. Nevertheless until the list of risk groups and respective rates of contribution is established there is a common social insurance contribution rate for accident at work insurance. In the years 1999- 2005 the work accident contribution rate was determined to be an amount of 0.09 % of the contribution object (personal income of work). It is supposed that the contribution rate will increase in the next year. Social insurance contributions are made and the social insurance services in the case of accidents and occupational diseases are provided by the work injury special budget administrated by the State Social Insurance Agency. The State Revenue Service collects social insurance contributions. - 178 - 4. Insurance compensation Insurance compensation includes payments in cash. The following compensations in cash are available to the insured persons: - sickness benefit in case of temporary incapacity for work (short-term benefit); - compensation for the loss of capacity for work (long-term benefit); - lump sum benefit which can be substituted by insurance compensation for the loss of capacity for work if the Medical and Labour Experts Commission has established a permanent loss of capacity for work within the range of 10 to 24 %. The State Social Insurance Agency reimburses additional expenses that have been incurred due to work accidents or occupational diseases, compensates expenses for prosthetic appliances, disbursement for an escort, travel expenses to medical treatment institutions, expenses for the purchase of technical assistance equipment and repair of it as well as pay for a person's medical treatment, care, medical and occupational rehabilitation, retraining - if these expenditures are not covered by health care State programme or social assistance State programme (if they have not been provided free of charge). The following payments are available to the dependent family members: - survivor’s compensation; - funeral grant. Sickness benefit (short-term benefit) The sickness benefit is paid to the insured person for a period not exceeding 52 calendar weeks. If the recovery period of the ability to work lasts longer than 16 calendar weeks for the insured person, the decision for further medical treatment of such a person shall be made by the State Medical and Labour Experts Commission. The sickness benefit is paid to the insured person in the amount of 80 per cent, based on the average monthly earnings. In case an accident at work has occurred the sickness benefit is paid according to the following: for the first 14 days of the work disability the sickness benefit is paid by the employer from his own resources, but for the remaining period of the work disability until the recovery of the ability to work, or until the time when insurance compensation for a level of work disability are payable by the State Social Insurance Agency. In case of an occupational disease the sickness benefit is paid by social insurance system starting from the day of work disability when a special medical commission has determined the occupational disease until the day of recovery, or until the day when a level for the loss of ability to work is determined. Compensation for the loss of capacity for work (long- term benefit) The compensation is granted by the state social insurance system to the person for the loss of capacity for work based on a statement of a medical institution. Compensation for the loss of ability to work is paid to the insured person for every month, starting with the day when the loss of ability to work was determined. - 179 - The degree of loss of capacity for work and the period of time associated with it is determined by the State Medical and Labour Examination Commission (institution under the supervision of Ministry of Welfare). The amount of compensation depends on previous income of insured person as well as the degree of capacity for work. The amount of compensation is determined as a certain percentage of the average monthly earnings of the insured person. If the loss of ability to work is 100 %, the amount of compensation is determined as 80 % of the average monthly earnings. If the insured person who receives compensation for the loss of ability to work, in accordance with the opinion of the State Medical Commission, is unable to take care of himself or herself and is in need of assistance from another person, the State Social Insurance Agency is entitled to increase compensation for the loss of ability to work granted to such person up to 50 % of the compensation the person is entitled to. Persons with a disability resulting from a work accident or occupational disease are granted disability pension (compensation) only in accordance with the law ‘’On Compulsory Social Insurance against Work Accidents and Occupational Diseases’’. If an accident has occurred with a person who already receives a disability pension due to another illness then the benefits are paid from two schemes. As soon as the insured person is eligible for old-age pension the compensation under accident insurance is reduced by 20 %. Lump sum benefit If the State Medical Commission has determined a permanent loss of ability to work in the range of 10 – 24 % for an insured person, the State Social Insurance Agency may instead of compensation for the loss of ability to work, pay to the insured person a lump sum benefit calculated as the amount from 3 and up to 18 average monthly earnings of the insured person. Benefits for dependent family members The survivor’s compensation In case a work accident or occupational disease results in the death of the insured person the family members of the person who were entirely or partly supported by the person (children, surviving spouse, parents) are entitled to a survivor’s compensation. The amount of the survivor’s compensation is calculated as a certain percentage of the average monthly earnings of the insured person. The amount of the survivor’s compensation cannot exceed 80 % of the average monthly earnings of insured person. Funeral grant If an accident at work, a disease caused by an accident at work, or an occupational disease has resulted in the death of an insured person, a funeral benefit is granted to the parents of the insured person, the surviving spouse and children, or another person who has undertaken to arrange the funeral. A funeral benefit is granted and paid in the amount of twice the average monthly earnings of the deceased. - 180 - 5. Rehabilitation Rehabilitation measures (medical and social) for the persons who have suffered an accident at work or an occupational disease are provided under the general health and social care system. There are no separate rehabilitation programs within the social insurance system. The health care in Latvia is a residence-based scheme that covers all residents and is financed from the state health care budget. The central organ of the state health care administration is the Ministry of Health. The administration of the health care budget is fulfilled by the Health Compulsory Insurance State Agency and regional sickness funds. The Agency makes annual contracts with the providers of medical services, and covers expenses of the medical care of persons to the service providers under these contracts. In the case a person’s needs exceed those that are covered by the basic health care and rehabilitation programs work injury special budget administrated by the State Social Insurance Agency refunds the expences. Each case is looked at individually. The attending doctor (health care institution) determines the need for medical rehabilitation, but social assistance service – the need for social rehabilitation of a person suffered from accident at work or occupational disease. 6. Prevention The State Social Insurance Agency is responsible to facilitate the organization of preventive measures in accordance with the recommendations of the State Labour Inspectorate. The State Labour Inspectorate is a institution under the supervision of the Ministry of Welfare that ensures monitoring and control in the area of labour protection. It has a responsibility for statistics of accidents at work and occupational diseases as well as analysis and evaluation of the situation in the area of labour protection. There are no separate prevention programs within the social insurance system. Nevertheless the State Social Insurance Agency provides in close cooperation with the State Labour Inspectorate activities in order to prevent the work accidents as well as occupational diseases. Every year in cooperation with the State Labour Inspectorate the activity plan for preventive measures is worked out. The main preventive activity is to inform employees of certain risk groups about safety at work measures. The preventive activities are financed by the work injury special budget. - 181 - - 182 - Social insurance against occupational accidents and professional diseases in the Republic of Lithuania Vaidotas Kalinauskas In Lithuania, state social insurance is the largest and the most important part of the system of social security. It is applied to almost all residents of the country: hired employees, civil servants and selfemployed persons pay the state social insurance contributions and in case of insurable occurrence, they receive social insurance benefits (pensions, allowances, indemnity payments). Like in most countries in the world, in Lithuania the following traditional types of social insurance have been legalized: pension insurance, insurance for sickness and maternity, health, unemployment, occupational accidents and professional diseases. From the very beginning, it was tried that the system of social insurance would be as independent as possible. The system of management of the state social insurance includes: The Ministry of Social Security and Labour that determines prospective and current tasks regarding state social insurance; The State Social Insurance Fund Council under the Ministry of Social Security and Labour. The Council mentioned consists of 15 members that are controlling the State Social Insurance Fund’s activity. It is formed of an equal number of members with equal rights representing the interests of the insured in appropriate organizations and state managements institutions. The State Social Insurance Fund Board that is the state social insurance executive institution. Territorial departments of the State Social Insurance Fund Board established in towns and regions that perform the social insurance functions. State Labour Inspectorate is responsible for exercising control of the implementation of the legal acts on employee protection and health in enterprises. The financial basis of the state social insurance is the State Social Insurance Fund’s budget that has not been considered in budgets of the state and municipalities. It means that it shall be used for social insurance benefits specified in the Law on State Social Insurance only. The main and the most considerable source of income of the State Social Insurance Fund’s budget shall be the social insurance contributions paid by insurers and the insured. This amount is equal to 98 percent of total income amount. The Law on Occupational Accidents and Professional Diseases of the Republic of Lithuania came into force on the 1st of January 2000. The Law mentioned is an independent legal act the obligatory state social insurance against occupational accidents and professional diseases is regulated upon. The aforementioned law specifies the persons this type of social insurance is applied to, contains definitions related to insurable and non-insurable occurrences, and establishes conditions the state social insurance contributions to be made upon as well as their amounts and calculations procedure. According to the Law mentioned, employers are obligated to insure their employees by state social insurance against occupational accidents and occupational diseases. Insurance against occupational accidents or professional diseases is administered by the State Social Insurance Fund Board and the insurance benefits are fixed and paid by the State Insurance Fund Board Territorial Departments the insurers’ company, enterprise or organization has been registered at, where - 183 - the insured is employed (was employed) and where the occupational accident took place or professional disease was developed. Table 1. State social insurance contribution tariffs regarding insurance against occupational accidents and professional diseases for 2000 - 2005 Tariffs of contributions related to insurance against occupational accidents and professional diseases, percent 2000 2001 2002 2003 2004 2005 1,0 1,0 1,0 0,3 0,3 0,3 In case of occupational accidents, the social insurance, according to order established by laws, shall compensate the losses related to the income amount that was not received because of an occupational accident or professional disease payable in regard with the persons insured by this type of insurance. The following persons shall be obligatorily insured by the state social insurance against occupational accidents and professional diseases: 1. Persons employed by legal or natural persons according to the agreement on employment, candidates to notaries (assistants) as well as persons receiving wages and on membership basis have been appointed to elective positions in elective organizations and the persons receiving wages, who are appointed to positions in the province, town, region, district election and referendum commissions; 2. State politicians, judges, state officials and state servants mentioned in the Law on Wages of the State Politicians, Judges, State Officials and in the Law of Public Service (except for civil servants mentioned in the paragraph 2 of the Article 4 of the Law on State Social Insurance) and the persons receiving wages and appointed to posts by the Seimas, the Seimas Chairman, the President of the Republic or the Prime-Minister; 3. Students of professional schools, higher and high schools as well as persons sent for re-training by territorial departments of the Labour Exchange – for the period of training at professional educational enterprise or company; 4. Persons in social and psychological rehabilitation enterprises – for the period of work of the persons mentioned; 5. Convicted persons - for the period of work of the persons mentioned. The aforementioned persons shall be insured by their employer paying contributions to the State Social Insurance Fund in amount of 0.3 percent of the wages amount received. The contributions mentioned provide the rights to: a benefit for illness resulting from an occupational accident or professional disease; periodical payment of benefit for work disablement; one-time payment of benefit for work disablement; one-time insurance benefit payable in case of the death of the insured; periodical insurance benefit payable in case of the death of the insured. Benefits are paid to the persons that have a right to the benefits mentioned provided that the appropriate occupational accidents or professional disease have been properly investigated and notified as insurable occurrences. Serious and fatal occupational accidents shall be investigated by an inspector of the State - 184 - Labour Inspectorate with participation of a representative of the employer and the employees’ representative for safety and health issues. A representative of the insurance company can participate in the investigation concerned. Occupational accidents or professional diseases are to be recognized as insurable occurrences by the State Social Insurance Fund Board Territorial Department the appropriate insurer, director (deputy director) has been registered at. The decision on occupational accident or professional disease notification as the insurable occurrence shall be made by a director (deputy director) of the State Social Insurance Fund Board Territorial Department after having examined the investigation and confirmation reports on an occupational accident and professional disease developed as well as other documents containing data regarding the occupational accident or professional disease. Insurable occurrences Social insurance relations connected to occupational accidents and professional diseases, rights to benefits payable in regard with this type of insurance, shall be regulated by the Law on Social Insurance of Occupational Accidents and Professional Diseases as well as the regulations of benefits payable in regard with social insurance for occupational accidents and professional diseases. It has been determined in the legal acts mentioned that the appropriate occupational accidents and professional diseases that were identified in regard with the persons insured by social insurance, shall be treated as insurable occurrences provided that after having investigated the accidents and diseases concerned, it was detected that the events in question took place according to the following conditions: 1) while working within working hours fixed by the insurer including the period of business trips; 2) while performing working duties specified in the agreement on employment including preparation and putting in order the place of work; 3) while performing the work the salary is payable for and the appropriate social insurance contributions against occupational accidents and professional diseases are paid or have to be paid from. Professional diseases or occupational accidents that took place in regard with the persons insured by social insurance after proper investigation shall be considered as insurable occurrences provided that they have happened under the following circumstances: 1) within additional breaks, special breaks for rest or snacks when the employee in question was at his/her place of work, inside the company’s building or within its territory; 2) on the way to or from work on the employee’s working days (including traffic accidents on the way to or from work) between the place of work and the place of residence or in the place outside working premises where the employee in question is paid wages, or places outside working area where the employee in question may have a rest or lunch within a break; 3) when within a period of time the employee in question was informed about future termination of the Agreement on employment, he/she was given free time by the employer for the purpose of new job finding; 4) while the insured is fulfilling the state, social or civil duties he/she is paid wages or indemnity for and social insurance contributions in regard with occupational accidents and professional diseases are paid from. In regard with home workers that are working according to an agreement on employment, the accidents happened to them and acute professional diseases can be treated as insurable occurrences provided that - 185 - they occurred while working in favour of the appropriate employer and were caused by materials and working means provided by the employer concerned as well as because of the process of production. Chronic professional diseases shall be recognized as insurable occurrences when it has been determined since enforcement of the Law on Occupational Accidents and Professional Diseases Social Insurance that the persons regarding those the professional disease has been developed, prior to development of disease in question, were insured by the social insurance against occupational accidents and professional diseases. Non-insurable occurrences An occupational accident or professional disease shall not be considered as an insurable occurrence provided that they are not in accordance with conditions applicable to insurable occurrences. Also, the occupational accident or professional disease developed that occurred meeting the above mentioned conditions shall not be treated as an insurable occurrence because of one of the following circumstances available: 1) when the insured in question was drunk or inebriated of drugs, toxic or psychotropic substances and this inebriation did not relate to technological features of the work he/she was in charge according the employer's instructions; 2) when the insured suffered from his/her activity that had features of criminal actions or this activity was related to administration law breaches; 3) when the insured was deliberately trying to initiate the accident in question; 4) when the insured suffered from the disease not related to his/her occupational duties; 5) when the insured on his/her own (without keeping the employer informed) was working in his/her favour (for the purpose of his/her own interests); 6) in case of the use of violence against the insured provided that the circumstances and motives of this violence were not connected to occupational duties except for cases when the accident took place on the way to/from work. If the occupational accident or professional disease developed has not been recognized as insurable occurrence, it shall be possible to appeal against this decision to the State Social Insurance Fund Board and after then to the court. Table 2 Occupational accidents registered Occupational accidents Injured persons registered in 2003 Injured persons registered in 2004 Minor Serious Fatal Total: number 5064 216 156 5436 number 4725 217 151 5093 % 93,1 4,0 2,9 100 - 186 - % 92,8 4,2 3,0 100 Table 3 Accidents recognized as insurable occurrences Occupational accidents 2003 2004 Minor 92,5 % 89,8 % Serious 78,7 % 69,6 % Fatal 46,8 % 37,7 % Total: 90,6 % 87,4 % Table 4 Accidents recognized as insurable occurrences according to injury type Occupational accidents recognized as insurable occurrences within 2003 number % 4682 95,1 170 3,4 73 1,5 4925 100 Occupational accidents Minor Serious Fatal Total: Occupational accidents recognized as insurable occurrences within 2004 number % 4243 95,3 151 3,4 57 1,3 4451 100 Occupational accidents and professional diseases according to injury type (2004). 6000 5556 5000 855 4000 - 3000 - - a number of 2000 - events investigated 1000 - - recognized as insurable occurrences minor serious fatal prof.diseases - 187 - total Social insurance benefits payable in case of occupational accidents or professional diseases Sickness benefit A right to a benefit for illness resulting from an occupational accident or professional disease (hereinafter referred to as sickness benefit) have the insured persons (specified in paragraphs 1-3) provided that because of an occupational accident or professional disease that have been recognized as insurable occurrence, became temporary incapable for work and because of this reason they did not receive the income amount due. A right to sickness benefit the insured shall obtain irrespectively of the period the insured in question has been insured by the state social insurance. Sickness benefit shall be fixed and paid provided that a right to it has been originated within the period of work. Sickness benefit is payable in amount of 100 percent of the wages amount compensated commencing from the first day of incapacity for work up to work ability restoration or up to disability notification. The amount of wages to be compensated in regard with sickness benefit shall be calculated taking into consideration the income amount received by the insured within the calendar quarter before the month the temporary incapacity for work has been determined. The wages amount to be compensated shall be determined according to the appropriate person’s total income amount the state social insurance contributions have been paid from, including benefits received in regard with occupational accidents or professional disease, disease, occupational rehabilitation, maternity (paternity) benefits as well as unemployment insurance benefits and disease benefit paid by the employer for the first two days of the disease concerned. The monthly wages amount compensated the sickness benefit is calculated upon, cannot exceed a sum of three and a half amounts of the income amount insured approved by the Government for the current year (hereinafter referred to as the current year income amount insured), valid for the month the temporary incapacity for work has been determined and cannot be less than one-fourth of the current year income amount insured valid for the month the temporary incapacity for work has been determined. Sickness benefit is payable according to the medical certificate for calendar working days taking into consideration 5 days’ working week. The sickness benefit shall be fixed from the day of notification of temporary incapacity for work provided that one has applied for it not later than 3 years after temporary incapacity for work expiration term. - 188 - One-time payment of benefit for work disablement These payments shall be fixed in regard with the insured that because of the occupational accident or professional disease recognized as insurable occurrence have been disabled for work not less than 30 percent. The payments mentioned shall be fixed in amounts as follows: in case of disablement up to 20 percent (including) - in amount of 10 percent from the wages amount compensated payable for 24 months’ period, applicable to calculate the one-time payment of benefit for work disablement; in case of disablement from 21 up to 29 percent (including) - in amount of 20 percent from the wages amount compensated payable for 24 months’ period, applicable to calculate the onetime payment of benefit for work disablement; The payments mentioned are payable in case the Disability and Capacity for Work Determination Service (hereinafter referred to as DCDS) determines a temporary disablement for work. If an appropriate work disablement has been determined for an unlimited period of time, the person concerned shall be paid the one-time payment of benefit for work disablement in amount three times larger. A monthly wages amount compensated to calculate an amount of one-time payment shall be determined according to the insured income of the person in question, received within 12 months running, calculating back from the end of the calendar quarter before the previous month the insurable occurrence took place (i.e. the month when the occupational accident in question happened or professional disease was developed). The monthly wages amount compensated the one-time payment is calculated upon, cannot exceed a sum of three and a half amounts of the income amount insured, and cannot be less than one-fourth of the current year income amount insured valid for the month the insurable occurrence took place in. One-time payment of benefit for work disablement shall be fixed when one has applied for it not later than 3 years after the date the work disablement was determined by the DCDS. Periodical payment of benefit for work disablement This payment shall be fixed in regard with the insured persons in case of their 30 percent (including) and more work disablement caused by occupational accident or occupational disease. The periodical payment amount (K) shall be calculated according to the following formula: K = 0 , 5 * d * k * D , where: d – work disablement coefficient – an amount presented by unit parts that has been calculated as work disablement percent amount divided by 100; Indemnity coefficient (k) in case of accident on the way to or from work or in case of acute professional disease - it is a relation between the person’s average monthly income insured received within 12 months running, calculating back from the end of the calendar quarter before the previous month the accident at work, on the way to or from work took place or acute professional disease was developed, and the current year income amount insured valid for the period of time the accident at work, on the way to or from work took place or acute professional disease was developed. This coefficient shall be applied while calculating the periodical payment of benefit for work disablement - 189 - when a person in regard with whom a chronic professional disease has been recognized, has no right to retirement or disability pension according to the Law on State Social Insurance. The indemnity coefficient (k) regarding chronic professional disease depends on the person’s income amount insured and the period of pension insurance the state social insurance pension amount shall be calculated upon. The indemnity coefficient cannot be less than 0.25 and cannot be larger than 3. D – the insured income amount valid for the month the periodical payment of benefit for work disablement is paid for. Periodical payment is payable every month (for the previous month) and is re-calculated every time after the new income amount insured has been confirmed or when a new percentage of work disablement (not less than 30 percent) has been fixed by the DCDS. The periodical payment of benefit for work disablement shall be fixed from the date of the work disablement determination by the DCDS provided that one applied for it within 3 years’ period from the date the right to it had been originated. If the person concerned applied for the work disablement payment mentioned after 3 years, the indemnity in question would be fixed and paid for the previous 12 months calculating back from the day of applying. One-time insurance benefit payable in case of the death of the insured In case of the death of the insured caused by occupational accident or acute professional disease that have been recognized as insurable occurrences, the family of the insured lost shall be paid the one-time benefit in amount equal to 100 income amounts insured of the current year valid for the month of the death of the insured. At present, the one-time benefit amount payable in case of the death of the insured in equal to 108 400 Litas (€ 31 395). Family members of the insured lost shall be: a spouse, under-age children (adopted children) until they are 18 years old as well as the children studying at day departments of high, higher, professional, secondary education schools registered according to the order established until they are 24 years old, the children (adopted children) of the insured lost at age over 18 years old if they became disable before the age of 18, the children of the insured lost that were born after his death (born not later than 300 days after his death), a father (stepfather) and a mother (stepmother). One-time benefits payable because of the death of the insured shall be fixed within 3 months period of applying for it from the day the right to it has been originated. The benefit in question shall be divided by total number of receivers and is payable by equal portions to every benefit receiver (in case the receiver is one person, he/she shall be paid a total one-time benefit amount). - 190 - Periodical benefit payable in case of the death of the insured In case of the death of the insured caused by occupational accident or acute professional disease that have been recognized as insurable occurrence, a right to periodical benefit shall be granted to incapable for work persons that were supported by the insured lost or on the day of his/her death had a right to his/her support. A right to the benefit mentioned shall be provided to the following persons: children (and children born not later than 300 days after the death of the insured) and adopted children - up to 18 years old (independently on their studies); - up to 24 years old: o if they are studying at day departments of high, higher, professional, secondary education schools registered according to the order established; o if they became disable before the age of 18 - within a period of the work disablement (disability) a spouse, if he/she: o does not work (independently on age and capacity for work) and takes care of the children (adopted children) of the insured lost, grandchildren, brothers, sisters – up to they are 8 years old; o reached the pensionable age according to the Law on State Social Insurance Pensions of the Republic of Lithuania, - for life; o has been recognized as incapable for work or partly incapable – the benefit in question shall be payable for the period of incapacity for work or partial incapacity for work. The benefit mentioned is payable to the father (mother) of the insured lost, as well as to stepfather (stepmother) independently on their age and capacity for work in case they do not work and take care of the dead person’s children (adopted children), grandchildren, brothers, sisters, - until they are 8 years old. Other incapable or partly incapable for work persons that were supported by the insured lost or on the day of his/her death had a right to this support, shall prove the fact of the support in the court. Periodical benefit payable in case of the death of the insured shall be calculated by the same way as the periodical payment of benefit for work disablement (upon the formula K = 0,5*d*k*D), resuming that there is 100 percent incapacity for work (d= 1), i.e. an amount of this benefit shall depend on the insured income received by the insured lost. The amount of indemnity calculated shall be divided by a number of persons (plus one) that have a right to this benefit and the amount received shall be payable monthly to each person that have a right to it irrespectively of their other income. Periodical benefit payable in case of the death of the insured shall be fixed from the date the right to it has been originated provided that one applied for it within 3 years’ period after the right to it had been originated. If one applies for periodical benefit payable because of the death of the insured 3 years after the right to it was originated, the benefit mentioned would be paid for 12 months running, calculating back from the date of applying provided that the benefit concerned had not been fixed to any aforementioned person. When a person with a right to periodical benefit payable in case of the death of the insured applied for it after it had been fixed in regard with other persons with a right to it, the - 191 - periodical benefit in question would be re-calculated and paid to all this benefit receivers from the first day of the month that comes after the month the last application had been received in. Structure of Social Insurance benefits payable regarding occupational accidents and professional diseases for the year 2004 One-time payment of benefit for work disablement 4.7 % Sickness benefits caused by occupational accidents 34.3 % One-time benefits payable in case of the death of the insured 34.3 % Professional disease benefits 0.1 % Periodical payments of benefit for work disablement 23.2 % - 192 - Periodical benefits payable in case of the death of the insured 3.3 % A number of benefits as above are highly increasing every year: in 2000 - 9472.7 thousand Liras (743.5 thous.Eurosand), in 2001- 12466.1 thousand Litas (3610.4 thous. Euros) or 31,6 percent more, in 2002 - 16039,1 thousand Litas (4645,2 thous, Euros) or 28,7 percent more, in 2003. - 18323,0 thousand Litas (5306,7 thous.Euros) or 14,3 percent more. Table 5. Social insurance benefits payable in case of occupational accidents and professional diseases 2003 Sickness benefit One-time payment of benefit for work disablement Periodical payment of benefit for work disablement Periodical benefits payable in case of the death of the insured One-time benefits payable in case of the death of the insured Total: 2004 Thous. Litas Thous. Euros Thous. Litas Thous. Euros 7426,7 2150,9 7303,3 2115,2 664,5 192,5 1000,8 289,9 2466,2 714,3 4928,7 1427,5 500,2 144,9 709,8 205,6 7265,2 18322,8 2104,1 5306,6 7273,9 21216,5 2106,7 6144,7 Amendments In version of Law on the State Social Insurance of Occupational Accidents and Professional Diseases (hereinafter referred to as the Law) that came into force on the 1st of January 2004, the order of notification of insurable occurrences was specified more clearly and strictly, taking into consideration the regulations of obligatory social insurance of occupational accidents and professional diseases and the document determining labour relations and conditions. The new version of the Law more clearly specifies which occupational accidents and professional diseases can be recognized as insurable occurrences and which cannot. It is stated in the new version of the Law that the person insured by this type of insurance, shall be provided a right to receive the insurance benefits despite the fact that the professional disease in question was notified after the persons concerned had been dismissed. Besides, the accident that took place in regard with the person that has been warned about future termination of his/her employment agreement and who was looking for a new job in his/her free time and he/she was paid a salary for this period of time, shall be considered as insurable occurrence by this version of the Law. In the version of Law on the State Social Insurance of the Occupational Accidents and Professional Diseases that was valid before the 31st of December 2003, it was determined that the occupational accidents considered as insurable occurrences are those that happened at the place of work while performing the duties specifies in employment agreement only. There were no clear statements regarding the accidents that happened while performing other work according to the employer’s instructions, or the works performed when the working day is over, the works performed on days off, etc. Before the year 2003, it was determined that the person a professional disease has been diagnosed to, could receive the appropriate benefit provided that on the day of disease notification he/she is working. If a person was insured by social insurance for occupational accidents and professional diseases after the 1st of January 2000, the professional disease diagnosed in regard with this person, shall be considered as insurable - 193 - occurrence not requiring that the person concerned would be insured, i.e. the professional disease diagnosed to the person dismissed shall be considered as insurable occurrence. There were some changes in benefit calculation. According to the new Law, in case of periodical payment of benefit for work disablement calculated because of chronicle professional disease, a longer period of the income received shall be considered in the calculation mentioned. To calculate these benefits, the coefficients of the person’s income insured, applicable to social insurance pension calculations shall be used and they shall be calculated upon the person’s wages amount received within a considerably long period of time, for instance, for 15 years. Earlier, only 12 months’ period was taken into account prior to disability for work because of professional disease development. The Law specifies differences in social insurance contribution payable because of occupational accidents and professional diseases in order to increase the employers’ and employees’ personal interests and responsibility for ensuring and meeting the safe labour requirements. Regarding each insurer, this tariff shall be fixed taking into consideration a number of occupational accidents happened to him and the types of accidents as well. While differentiating contributions payable to the insurers, accidents to (from) work shall not be taken into consideration, because an employer cannot affect the employer’s safety on his/her way to (from) work. This provision is considered within the scope of social partners’ (employers and representative of the employees) demand. A number of social insurance contributions group tariffs related to occupational accidents and group tariffs according to methodical project are confirmed by Law on the State Social Insurance Funds Budget Indexes Approval. Identification of the insurers according to tariff group of social insurance contributions related to occupational accidents, taking into consideration the indexes of injuries and professional diseases and methods approved by the Government or its authorized institutions shall be confirmed by the State Social Insurance Fund Council. It is foreseen that since the 1st of January 2006, the insurers shall be divided into three groups according to a number of serious and fatal accidents that took place within the three recent years. The I insurers’ group shall include the enterprises where no serious and fatal accidents happened. For this group 0,28 percent contribution tariff shall be applied. The II insurers’ group shall include the insurers that had serious and fatal accidents. For this insurers’ group a tariff of 0,56 percent shall be applied. The III insurers’ group shall include the insurers that had the biggest number of serious and fatal accidents. In regard with this group, 1 percent contribution tariff shall be applied. - 194 - ACCIDENTS IDENTIFICATION ACCORDING TO TYPES OF COMPANIES’ ECONOMIC ACTIVITY IN 2004 Agriculture, forestry, fishery 3% Other social and Personal servicing 3% Health care and other social work 8% Mining and quarry exploitation 1% Public manag.. and protection; Education Social incurance 7% 4% Real estate, leasing and other business 3% activity Processing industry 34% financial mediation 1% transportation, storage and remote connections 9% hotels and restaurants 1% Electricity, gas, water supply 2% construction 15% Wholesale and retail. trading, pers. and goods for everyday use repair 9% The aforementioned Law specifies that means of the State social insurance against occupational accidents can be used for prevention of occupational accidents and diseases. At present, a procedure regarding occupational accidents and diseases prevention is being prepared. For further information, http://www.sodra.lt/en.php . visit the State Social - 195 - Insurance Fund Board’s web-site - 196 - Insurance against accidents at work and occupational diseases in Estonia Eveliyn Hallika Hereafter I would like to make a short overview of situation we have in Estonia concerning injuries or other health damage occurring in the course of fulfilling work duties. For the first I would like to point out the applicable basis for employment injuries and occupational diseases. They are: Health Insurance Act (Ravikindlustuse seadus) 2002; State Pension Insurance Act (Riikliku pensionikindlustuse seadus) 2001; Civil Code (tsiviilkoodeks) 1956; Government regulation No 172 on interim procedure of compensation (hüvitus) of injuries or other health damage occurring in the course of fulfilling work duties, 1992. Basic principle: there is no specific insurance against employment injuries and occupational diseases. These risks are covered by the health insurance (short-term benefits in kind and in cash) and the pension insurance (long-term benefits). Under the employer's civil liability, additional benefits are provided as compensation. All employees are the beneficiaries to the system. We do not have voluntary insurance. Employment injuries risks are covered for injury or health damage sustained as a result of an accident occurring in the course of fulfilling work duties. A list of occupational diseases is set by the regulation of the Minister of Social Affairs (sotsiaalminister). There are no conditions for employment injuries and occupational diseases. Temporary incapacity Estonian health insurance relies on the principle of solidarity. The Health Insurance Fund covers the costs of health services required by the person in case of illness regardless of the amount of social tax paid for the person concerned. The employers are required by the law to pay social tax for all persons employed, whereby the rate of this tax is 33 % of the taxable amount, and of which 20 % is allocated for pension insurance and 13 % for health insurance. The purpose of health insurance in Estonia is to cover the costs of health services provided to insured persons, prevent and cure diseases, finance the purchase of medicinal products and medicinal technical aids, and provide the benefits for temporary incapacity for work and other benefits. An insured person is a permanent resident of the Republic of Estonia or a person living in Estonia by virtue of a temporary residence permit, who pays the social tax for himself/herself or for whom the payer of social tax is required to pay social tax. - 197 - The amounts received by Health Insurance Fund – the health insurance part of the social tax – are used to pay for the health services and medical examinations made available under the signed contracts to persons benefiting from health insurance, for example: visits to the doctor; diagnostic examinations; treatment procedures; preventive procedures; surgeries; technical aids put in place during or after the surgery. On the basis of the certificate of incapacity for work, the Health Insurance Fund pays the benefit for temporary incapacity for work to the insured person, who loses income subject to individually registered social tax due to a temporary relief from the performance of duties of employment. The amount of the benefits: in case of work injury, occupational disease or other health impairment connected to work caused by the fault of the employer: 100 % of the reference wage. Reference wage: average gross daily wage over the previous calendar year calculated on the basis of income liable to Social Tax (sotsiaalmaks). There is no ceiling for it. Permanent incapacity Pension for Incapacity for work is given from 40 % reduction in working capacity. The minimum level of incapacity giving entitlement to compensation is 10 % reduction in capacity. The Medical Commission certifies the pension for incapacity for work and compensation by fixing the level of incapacity. Permanent work incapacity has 2 degrees: Total incapacity: serious functional impairment caused by illness or injury due to which a person is unable to work in order to support himself or herself. A loss of 100 % of working capacity is required for total incapacity for work. Partial incapacity: capable of working in order to support himself or herself, but due to a functional impairment caused by an illness or injury, a person is not able to perform suitable work corresponding to the general national working time (40 hours per week). A loss of 10 % to 90 % of working capacity is required for partial incapacity for work. It is payable between 16 years of age and pensionable age. The pension is granted for the period of work incapacity, which could be determined for 6 months, 1 year, 2 years, and 5 years or until attaining the pensionable age depending upon claimant's condition. This period is renewable. The pension ceases when the age for an Old-age Pension (vanaduspension) is attained. The qualification period depends on age at time of incapacity, ranging from 1 year of insurance for persons from 21 to 23 years of age to 14 years of insurance for persons from 60 to 62 years of age. - 198 - Age Contribution period: 16 - 20 years no requirement 21 - 23 years 1 year 24 - 26 years 2 years 27 - 29 years 3 years 30 - 32 years 4 years 33 - 35 years 5 years 36 - 38 years 6 years 39 - 41 years 7 years 42 - 44 years 8 years 45 - 47 years 9 years 48 - 50 years 10 years 51 - 53 years 11 years 54 - 56 years 12 years 57 - 59 years 13 years 60 - 62 years 14 years 63 years 15 years. In case of permanent incapacity for work that has emerged as the result of a labour injury or professional disease, the pension for incapacity for work is granted without a pensionable service period requirement. To a person having been declared to be permanently incapable for work, the pension for incapacity for work is granted for the whole period of incapacity for work, but not for longer than attaining the age of the old-age pension. The amount of the pension for incapacity for work is the bigger of the two of the sums above and the percentage of the loss of the capacity for work. For applying for the pension for incapacity for work it is required to submit the claim to the local pension office of the person's place of residence and present required documents. Permanent incapacity for work is ascertained: 1) generally in case of a person, being in the age of working ability, i.e. not less than 16 years of age until the old-age pension age, enacted by sections 1 or 2 of § 7 of the "State Pension Insurance Law"; 2) as an exception after the old-age pension age or before the age of 16 in case the health has been damaged as the result of a professional disease, a work injury or a crime of violence or in case the person is applying for a pension according to a contract, being concluded between the Republic of Estonia and some other state. - 199 - Percentage of the loss of the incapacity for work can be determined with the duration of - 6 months, - 1 year, - 2 years, - 5 years or - until reaching of the old-age pension age, enacted by sections 1 or 2 of § 7 of the Law. Medical examination for the permanent incapacity for work is executed by 1) The Commission of Examination of Disability that is a structural unit of the Pension Department according to the person's place of residence (generally) or location (in case a person is in a hospital); 2) An expert doctor, with whom the Social Insurance Board has concluded a labour contract (regarding people, whose main health disorder is being a psychiatric disease). For applying for a medical examination a person or his legal representative has to turn to the family doctor. In case a person requires because of his/her health condition regular assistance of a doctorspecialist at least six times a year, he/she may turn to the doctor-specialist for applying for a medical examination. The doctor fills in the form of a medical examination application, showing on it all diagnoses that the person is known to have, which presumably cause permanent incapacity for work. In case of need the person presents to the doctor additional documents that ascertain the cause of the permanent incapacity for work. These can be: - report of a work accident or professional disease or a notice of a work health care doctor, - certificate of the medical commission of the defence league, - certificate of the traffic police regarding a traffic accident, - a medical document of the damage to health due to a nuclear catastrophe, nuclear testing or breakdown of a nuclear power station, - certificate of a preliminary investigation establishment regarding a criminal case. The doctor presents the medical examination application together with the enclosed documents to the Commission of Examination of Disability of the Pension Department (addresses of the examination commissions can be found at the top of the homepage, under "Contact") or to the Social Insurance Board. By the date of a repeated examination, determined by the Commission of Examination of Disability or an expert-doctor, the doctor forwards upon the application of a person new documents of examination application. In case of changing of the health condition or cause of permanent incapacity for work a person may apply for a new examination before the arrival of the date of a repeated examination. Examination is done according to the application of a medical examination and the enclosed documents. Before passing of the examination decision of a disability in the rehabilitation establishmenta personal rehabilitation plan is compiled at the direction of the examiner: - 200 - 1) For each child, applying for determining of the degree of severity of the disability; 2) For a person, being 16 years old and older, in case in the examination application the information of the person's capacity to act or of the requirement for assistance, instruction or supervision is insufficient for determining the degree of severity and ascertaining of additional costs. For that purpose the examiner sends the person a formal covering letter, upon the receipt of which the person contacts the rehabilitation establishment and makes an appointment. The rehabilitation plan that has been compiled at the assistance of the person is sent by the rehabilitation establishment to the examiner, who after passing of the examination decision of the disability sends the confirmed copy of the plan with the decision to the person. The examiner forms and forwards a written decision of the results of the medical examination to the person and copy of the decision to the doctor, having presented examination application. In case a person does not agree with the decision of the medical examination, he/she can turn with the application within 3 months from the day of receiving of the decision to the dispute commission of the Social Insurance Board. In the application should be given the reasons, why the person does not agree with the decision. Permanent incapacity for work with the range of 40-100 % gives the right to apply for the pension for incapacity for work. Local authorities are responsible for the provision of social rehabilitation (e.g. special transportation for disabled persons, adaptation of the dwelling, personal assistant). Employer's civil liability The employee who has had an accident at work has a right to claim damages from the employer. Before making the claim must be stated that the employee has a permanent incapacity for work. And in addition the incapacity for work due to the accident at work had to happen because of the employers fault. The victim is compensated the loss percentage of the previous working capacity. Before compensation they reduce the sum of damages by the pension for incapacity for work. Additionally the employer has to compensate health impairment costs like prostheses, medical products, travel costs to the health institutions etc. And finally the State has to take over the claim of damages if the responsible employer is liquidated without legal successor. Then the damages and additional costs would be paid by local pension departments. And concerning the near future there have been some plans to develop new legislation on work accidents and occupational diseases. We are hoping to have first drafts on that in the beginning of 2006. - 201 - - 202 - Insurance against accidents at work and occupational diseases in the Republic of Bulgaria National Social Security Institute The insurance system against work accidents and occupational diseases is part of the compulsory state public social insurance Historical introduction The beginning of the workers’ social protection is related to the “Public administrative regulations on contracting and obligations which are imposed to entrepreneurs” since 1882. The establishment of a subsidiary fund is envisaged by the above-mentioned regulations. That fund shall assist sick persons and injured workers. The General Law on Public Social Insurance of 1918 passes for the first time the principle of mandatory insurance for all employed workers and employees in the private and other public enterprises and establishments. The law covers only accidents and sickness risks. “Accident” insurance financially is covered merely by employers’ contributions, i.e. by enterprises, according to workers and employees quantity, amounts of their paid wages and professional risk degree of the particular. The worker injured, due to a certain accident is entitled to medical assistance, cash benefits and personal pensions and in case of death, his/her survivors are to get a pension and some amount of funeral expenses. By the Law on Public Insurances of 1924, Bulgaria created a complete public social insurance, covering all categories of employed workers and all kinds of public insurances - accident and occupational disease, sickness and maternity, invalidity, old age and death. Each insurance is financially independent, autonomous in regard to property and accountability. Reorganization of insurance system was carried out in conformity with the Labour Code and the Decree on National Free Medical Aid of 1951 and under the Law on Pensions of 1958. Those normative acts enable social insurance funds to be included in the state budget. After 1995, a stage of broad reform related to insurance system’s legislation and institutional structure was carried out. Competent authorities According to the current national legislation (Social Insurance Code of 2000), the insurance in case of work accident and occupational disease is carried out by the mandatory state public social insurance. The Ministry of Labour and Social Policy develops, coordinates and implements state policy on state public social insurance and the body which runs (administers) public insurance funds, including the Work Accident and Occupational Disease Fund is the National Social Security Institute (NSSI). - 203 - The Institute is a public organization, which on the basis of a legal insurance obligation, guarantees citizens’ pensions and benefits rights. The Supervisory Board is the Supreme Body of its management, and is composed of state and national employers’ and trade-unions organizations’ representatives. NSSI is also entrusted with activities on work accidents establishment, investigation, registration and report, as well as occupational sicknesses’ investigation. Financial structure Financing of social security system in Bulgaria is based on the "Pay As You Go" principle. Work accident and Occupational Disease Insurance Funds are set up in “Work Accident and Occupational Disease Fund” (WAODF) of the State Public Insurance. The National Assembly adopts a Law on the State, Public Social Insurance Budget, which includes a consolidated budget of the state, public social insurance, funds’ budgets (e.g. WAODF budget) and NSSI budget and it is into effect for a period of one calendar year. Work Accident and Occupational Disease insurance contributions are determined as a percentage of the insured persons’ monthly insurance income and they are totally at the employers’ expense. Since January 2005, the insurance contributions rates are from 0.4 to 1.1 per cent, and they are differentiated by groups of economic activities, depending on short-term and long-term benefits’ expenditures, paid off by the WAODF, and depending on frequency and severity of occurred insurance cases in the relevant economic activity. Insured persons The compulsorily insured persons for “work accident” and “occupational disease” risks include all categories of employed persons under labour, service and equal legal terms (workers and employees, civil servants, military service - men). Self-insured persons are not insured for work accident and occupational disease. Insured social risks The “work accident” risk covers all cases of unexpected health injury, which has occurred during work process or with respect to labour process or performing work, as well as during each work, which is performed of interest to enterprise and this sudden injury has caused certain work incapacity or death. A work accident can also occur on the usual route when going to work place or coming back from work place. The “occupational disease” risk covers diseases, occurred under the labour environment or labour process harmful factors impact which should be included in the national list. The enumeration of occupational diseases is not complete and it is possible a non-existent occupational disease in the list, to be recognized in case of a reduced work capacity or death, caused by such occupational disease. Insurance payments - 204 - a) Temporary disability cash benefit Insured persons are entitled to a cash benefit in lieu of labour remuneration for the leave period, due to temporary disability. The benefit right does not require an insurance length of service before the insurance case occurrence. A benefit shall be paid from the first day of the disability occurrence until recovery or invalidity fact. The benefit amount due to work injury or occupational disease (90 per cent of the gross labour remuneration) is higher than benefit amount, due to general sickness or another accident (80 per cent of the net labour remuneration). Cash benefits for the first working day shall be paid at the employers’ expense and for the remaining period – shall be paid at the WAODF expense. b) Cash benefit in case of readjustment In case of a temporary reduced work capacity, resulting from work accident (injury) or occupational disease, one worker or employee can not perform their usual labour activity; then they shall be transferred to another suitable work place or shall perform the same labour activity under more comfortable conditions. The insured person receives a cash benefit, in case of his/her wage reduction at the new work place. The benefit amount represents the difference between the received remuneration before readjustment and that, after readjustment. The benefit shall be paid for the readjustment period for a period, no longer than six months. c) Invalidity (disability) pension Insured persons who have lost 50 or over 50 per cent of their work capacity in result of work accident or occupational disease, irrespective of their insurance length of service are enabled to invalidity pension. The invalidity pension amount due to work accident or occupational disease shall be not lower than the amount, calculated as an invalidity pension due to general sickness or other accident. d) Survivors' pensions and cash aid in case of death In case of insured person’s death his/her survivors (husband, spouse, children and parents) are enabled to get a survivor pension and a lump sum, amounting to two minimal wages. e) Prevention and rehabilitation cash aid Prevention and rehabilitation purpose is to reduce cash benefits and invalidity pensions expenditures from WAODF, by secondary prevention and rehabilitation of recurrences of work injuries victims and sick persons with chronic occupational diseases. The prevention and rehabilitation cash aid is a lump sum during a calendar year and it completely includes main medical services’ resources and sleeping accommodations, as well as a partial nutrition cash aid. Medical services and treatment Work injuries victims and those persons with occupational diseases receive a medical aid, medicines, medical goods and technical help supplies under the foreseen order in the General Health and Social Assistance System. - 205 - Insurance events prevention measures WAODF resources, foreseen under the fund budget are transferred each year into the “Work Conditions” Fund (WCF) at the Minister of Labour and Social Policy. WCF is set up according to the Law on Safe and Healthy Work Conditions and finances projects and programs, aiming at work conditions improvement; normative acts development, rules, norms and requirements; development and publication of educative and information materials in the work safety and health area. For more information: National Social Security Institute (NSSI) 62-64 “Al. Stambolijski”, Blvd. 1303- Sofia http://www.noi.bg e-mail: [email protected] Ministry of Labor and Social Policy 2 “Triaditza”, str. 1051 - Sofia http://www.mlsp.government.bg - 206 - Global challenges Globale Herausforderungen Défis globaux Sfide globali - 207 - Global challenges for the insurance against accidents at work and occupational diseases Joachim Breuer The challenges our branch of social security is facing at the beginning of the 21st century are unique and distinctive in their form. As far as the character of the challenges is concerned, however, they are historical constants which already came along with the earliest systems of Insurance against Accidents at Work and Occupational Diseases. These challenges have been and still are our constant companions in our efforts to 1. create security in an ever changing work environment 2. offer highly efficient health care 3. compensate individual loss occurrences in a socially adequate way 4. do all of this without leaving unaffordable burdens to future generations or currently overtax the premium payers. As we are trying to do our best in these four areas, we resemble a juggler who, while juggling with four balls, has to overcome an obstacle course. The obstacles, moats, and snares in this course – they are the concrete forms the challenges take and about which I would like to talk. This presentation will predominantly deal with examples of non-European countries. 1st Challenge: the identification of and the coping with new risks What, in fact, is a risk? The answer depends on your approach. In Chinese, the word 'risk' is made up of two signs, namely 'chance' and 'danger'. If you want one of them, you need to cope with the other one as well: in learning how to run you will fall; if you push your luck, sometimes you will lose; if you reach for the stars you may fall out of the window. Just as in daily life in general, also in our working life we cannot avoid risk. There is no such thing as a risk-free world – and there never will be. Therefore, the first challenge is not only the identification of new risks but also how you decide to cope with them. Technological progress will inevitably produce new risks. We will never succeed to totally eliminate all risks, which, anyway, would contradict the essence of progress. Even the mere attempt to totally eliminate a risk can create still more difficult consequences or new risks. Just think of the operating rooms which we have made ever more sterile over the last decades. And with what result? Today we are confronted with a growing number of resistant germs which make infections even more serious. In the area of medicine we are already considering changing the hygiene standards and allowing a certain germ exposure. Progress in its technological, economic, social and cultural dimension continuously produces new securities; but it also continuously overcomes them: - 209 - We develop new brakes – and keep less distance. We open up new energy sources – and consume more electricity. We develop a new unbeatable isolation material – only to find out that handling this material can lead to fatal diseases. Which risks will shape the 21st century? New health risks, like inappropriate psychic stress, which are being discussed right now? Nanotechnology? Many of the problems that are currently being discussed have two things in common: they are difficult to confine as working life risks the multi-causality of diseases connected to those risks Significant for these 'new' phenomena is the fact that their recognition is being accompanied by a broad social discourse on risks which is conducted in a totally different way at the beginning of the 21st century than it was done 20 years ago. The classic experts in the fields of safety at work, politics and economy are now being joined, more than ever, by NGOs like environmental organisations and organisations of insured persons as lawyers of the civil society. The example of the reorganisation of the European Chemicals Policy "REACH" shows that the influence of the NGOs has grown considerably. On European level their integration is being promoted and the trend towards a 'stakeholder democracy' is clearly visible. What does all of this mean for us, the 'original' experts? As I see it, we - those in charge of social compensation of health risks at work – are at a key position in the discussion of new risks. More than in the past we need to act and affect the public to influence the also growing public discourse on risks. It would be desirable if, on the common platform of the FORUM, we could make supra national proposals concerning these risks. This would strengthen our influence on European politics and it would definitely enhance our recognition and the acceptance of our stakeholders, insured persons and premium payers on the national level. Acceptance is gained if you communicate with credibility and transparency; if you disclose not only your success but also problems and doubts you might have; if you dare to act against the trend in the public discourse. 2nd Challenge: the preservation of social acceptance of social security We all know well that just pointing out the decreasing number of accidents will not save us from public criticism and attacks from the political corner. Yet, what else can we do but do our job successfully? International exchange can be an important factor when it comes to maintaining social acceptance. In 2003 we started a seminar series on occupational diseases worldwide. Gaining public and governmental acceptance will be one of the important focal points of the closing event in 2007 on the African continent. Recent seminars in Asia and Latin America have shown that it is easier to be recognized by the political elite by organizing international events than by just doing your business on a national level. On behalf of the technical committee I can promise our colleagues in the new EU member states, in the candidate countries and in the neighbouring countries that we will support them with our pool of international experts so that their concerns will not go unnoticed in their countries. - 210 - The experience that the prophet is not honoured as much in his own country as an expert from a foreign country is not unknown to us in Germany either. Of all things what got to the knowledge of our Chancellor was the fact that the Chinese insurance against accidents at work clearly oriented itself on the system of the Berufsgenossenschaften. Such facts sometimes make a greater impression than a positive annual balance. Irrespective of a good reputation in the world we need to do what originally is our job and find answers to concrete challenges. The privatization debate that comes up again and again is such a challenge, especially due to its undifferentiated nature. But even if it is renewed again and again, we can today argue against it more self-confident than ever and refer to examples on the international level. More and more developing countries go for a social coverage for accidents at work and occupational diseases. There are many reports about China right now, but also other Asian countries, i.e. Laos, are going on the same path. The latest example, most probably, is Malawi, Africa, which is changing its legislation to replace the individual (private) insurance of the companies with a legal insurance against accidents at work. These developments are highly welcome, they do, however, not automatically prove that a social security system is more the practical system. After all, developing countries are callow insurance markets, characterized by lack of legal security, deficiency in the loss management and in the reservation of loss events, and therefore not attractive for private insurance companies. No, the privatization debate is challenging and can only be led against the background of largely efficient and transparent markets in the industrialized nations. Yet, even here we gain interesting insights: at the beginning I referred to the phenomenon of the so-called "new" health risks and diseases which also financially and actuarially pose a considerable challenge. It is remarkable that the concepts which are being developed in this field in the private insurance sector present us solutions that we already know well. In a paper on the insurability of occupational diseases, the world's biggest reinsurer, for example, the Munich Reinsurer, argues for solidary pool solutions which – under national administration if necessary – should compensate the so-called 'long tail risks'. The share of the state in this pool would have to be very high in the beginning and could then – so the paper reads rather self-confidently – be reduced gradually. You could say now that also in the case of insolvency of a private insurance company that is in the pool someone takes over the debts, either a new solidary pool or directly the state. Thus, private insurance also has to admit that without governmentally enacted solidarity complex risks cannot be insured. The asbestos trust fund ($140 billion) which is currently being debated in the US senate is proof for that. The fund which is to compensate all pending asbestos claims in the USA precludes any further civil claims. The fund is to be financed by industry and insurers who would have to contribute to the fund over 27 years. The estimated number of the companies that are to participate is approximately 10,000. This procedure, comments the „New York Times“ on May 16, 2005, is similar to workers' compensation. So, after all, will we return to – governmentally enacted – solidarity, analogous to a public accident insurance system? Is this the end to the privatization debate? It would at least close the circle which leads back to the origins of the accident insurance in the late 19th century. - 211 - 3rd Challenge: extension and sustainability of social protection 3.a) Extension of social protection: In Europe, when we talk about extending social protection, the term "extension" carries a mostly negative connotation in the ongoing political debate, especially if it is understood as an extension of the scope of benefits in times when funds are in short supply. For the majority of the world population, however, formal social protection, even in its least coverage, is still an unsatisfied need. The International Labour Association (ILO) estimates that about 80 % of the world population are not being covered adequately by formal social protection. From a global perspective, in our branch we also still have a lot of work to do: According to the database "Social Security Worldwide" of the International Social Security Association (ISSA), in their 151 member states there are about 270 programs of insurance against accidents at work worldwide (not necessarily independent systems). This is an impressive number. However, even where formally there is a insurance against accidents at work and occupational diseases, this does not reveal anything about the percentage of the working population that is covered by this insurance. In Latin America the situation is especially precarious: On the one hand, the continent is clearly recovering economically. New workplaces are being created; and even crisis-ridden Argentine is rapidly progressing economically. Yet, a growing number of jobs does not automatically relate to a greater coverage by accident insurance. Seven out of ten new jobs in Latin America develop in the informal sector. And only two out of ten jobs in the informal sector offer at least a certain social protection. There is also positive news, as, for example, the ambitious expansion program of the Chinese insurance against accidents at work: presently, 70 million people are covered by the statutory accident insurance in the People's Republic of China. By 2007, the number of covered workers should reach 100 million and by 2010 120 million people. The ISSA and the German Insurance against Accidents at Work support this process on various levels. Last month, for example, we organized a seminar in China on prevention of traffic accidents, last year one on medical rehabilitation. The extension of coverage by social protection will only be sustainable if we can guarantee the efficiency of our systems for the next generations. The creation of the preconditions for sustainability, therefore, is another challenge we are facing, due to the demographic change. 3.b) Demographic change Let's take a look into the future: The People's Republic of China is one of the most outstanding examples worldwide for a population that is aging rapidly. In 2000, 10 % of the population were 60 years or older. 2025 this percentage will have risen to 20 % and in 2050 even 30 %. In 2010, the age group of 45 – 64 will represent about 50 % of the persons employed in Europe. The long range projection of a study that has been published only recently shows that not only is the average age of the labour force rising; with the declining population the number of employable people will also decrease. - 212 - In Germany, for instance, the labour force potential, which today is 44.5 million people, will decrease by about 1.4 million until 2020 and about 9 million until 2050 – even with rising female activity rate and a yearly immigration rate of 200,000 people. The number of working people of younger or middle age will go down dramatically while the percentage of older people will increase. This situation will have a threefold effect for the insurance against accidents at work: The demographic change confronts us with the need for specific prevention schemes for older workers; a change in the structure and quality of health care due to the increased demand of older people for health care; and, finally, it confronts us with the necessity to keep the generally decreasing labour force potential at the workplace through rehabilitation measures (like the „return to work“ program), even with a certain degree of physical disability. At any rate, the economy and the accident insurance will have to deal with the challenges put to them through the aging of the working population more closely than they have done so far. Special measures for older employees pay off as international experiences show. A Japanese car manufacturer, for example, increased the productivity by 10 % simply by allowing for different working speeds for different age groups. An American car manufacturer reports that he was able to keep several hundred workers at their workplace in a German manufacturing base alone due to successful „disability management“ and did not have to hire new staff instead. Through such measures companies can save money. In addition to such measures it is important to provide additional incentives to promote specific prevention measures. This will help the companies to decrease costs for rehabilitation and compensation payments. This will prove to be especially necessary considering the decreasing potential of labour force and thus of insured persons. For the insurance against accidents at work this is a vital prerequisite for the financial sustainability of the system. 4. Conclusion I have outlined three great challenges: 1. the recognition of and coping with new risks 2. the preservation of social acceptance of social security 3. the extension and sustainability of social protection considering the demographic change I consider all three aspects to be basic constants of our work. Even though they might change in their characteristics they have been with us ever since the beginning of the accident insurance system. And this will not change in the future: The technological progress will not only eliminate risks, but will also continue to create ever new risks. Being a pillar of the social security system, the insurance against accidents at work will always – especially in times of short national budgets and cyclical sideways movements – arouse political covetousness and will have to bid for social acceptance. The topic of generation spanning sustainability will have to be dealt with anew by each generation, depending on socio-economic and demographic constellations. - 213 - Therefore, the most important and central challenge is to find the adequate answer to these challenges, depending on the particular economic and social circumstances. I am convinced that the transnational exchange on these phenomena which are well known in many systems will lead to useful conclusions. To this aim bilateral cooperation and multilateral exchange of experiences in forums like ours will be helpful. If we succeed in not only using these synergies for our own work but also in communicating them to the opinion leaders in Europe, we will strengthen the voice of the European insurance against accidents at work. Common answers to common challenges: this is what I hope for our upcoming work. It is a great chance but also a chance to fail. In a word: a risk! - 214 - Globale Herausforderungen für die Versicherung gegen Arbeitsunfälle und Berufskrankheiten Joachim Breuer Die Herausforderungen, die unserem Zweig der sozialen Sicherung zu Beginn des 21. Jahrhunderts gegenüber stehen, sind in ihren konkreten Ausformungen einzigartig und unverwechselbar. Ihrem Wesen nach sind sie allerdings historische Kostanten, die schon die frühesten Systeme der Versicherung gegen Arbeitsunfälle und Berufskrankheiten von Beginn an begleitet haben. Diese Herausforderungen waren und sind unsere steten Begleiter bei dem Bemühen, 1. Sicherheit in einer sich wandelnden Arbeitswelt zu produzieren, 2. hocheffiziente medizinische Versorgung vorzuhalten, 3. individuelle Schadensereignisse sozial adäquat zu kompensieren, und 4. dies alles zu tun, ohne dabei künftigen Generationen eine unbezahlbare Bürde zu hinterlassen oder aktuell die Beitragszahler zu überfordern. Während wir in diesen vier Bereichen unsere Arbeit bestmöglich zu gestalten suchen, ähneln wir einem Jongleur, der – während er vier Bälle gleichzeitig in der Luft hält –einen Hindernisparcours bewältigen muss. Die Hürden, Wassergräben und Fallstricke auf diesem Parcours – das sind die konkreten Ausprägungen der Herausforderungen, von denen ich im Folgenden sprechen möchte. Über die aktuellen Trends und Entwicklungen auf unserem Kontinent haben wir im Rahmen diese Tagung bereits eine Fülle von Informationen, zum Teil aus erster Hand, bekommen. Erlauben Sie mir daher, meine Beispiele in erster Linie nicht aus europäischen Ländern zu wählen, sondern aus dem großen, außereuropäischen „Rest“ der Welt. 1. Herausforderung: Das Erkennen und Bewältigen neuer Risiken Was ist eigentlich ein Risiko? Bei der Antwort kommt es vor allem auf die Betrachtungsweise an. Im Chinesischen setzt sich das Wort „Risiko“ aus zwei Zeichen zusammen: aus „Chance“ und „Gefahr“. Will man das eine, muss man mit dem anderen leben können: Wer laufen lernt, stürzt; wer hoch pokert, verliert manchmal; wer nach den Sternen greift, kann dabei aus dem Fenster fallen. Wie im Leben allgemein, so kommen wir auch im Arbeitsleben nicht am Risiko vorbei. Eine risikofreie Welt gibt es nicht – und wird es niemals geben. Und deshalb ist die erste Herausforderung nicht nur das Erkennen neuer Risiken, sondern auch die Wahl des richtigen Umgangs mit ihnen. Neue Risiken werden im Zuge des technologischen Fortschritts unausweichlich produziert. Ein völliges Ausschalten jeglicher Risiken wird nicht gelingen, ja es widerspricht dem Wesen des Fortschritts. - 215 - Selbst der Versuch der völligen Eliminierung eines Risikos kann noch schwerer beherrschbare Folgen oder neue Risiken zeitigen. Denken Sie bitte an Operationssäle, die wir im Laufe der vergangenen Jahrzehnte immer keimfreier zu gestalten wussten. Was ist das Resultat? Heute sehen wir uns mit einer Zunahme resistenter Keime konfrontiert, die Infektionen nur noch folgenschwerer machen. In der Medizin denkt man bereits darüber nach, Hygienestandards dahingehend zu verändern, wieder gewisse Keimbelastungen zuzulassen. Der Fortschritt in seiner technologischen, ökonomischen, sozialen und kulturellen Dimension produziert zwar unaufhörlich neue Sicherheiten; aber genauso schnell überwindet er sie: Wir entwickeln bessere Bremsen - und fahren dichter auf. Wir erschließen neue Energiequellen - und verbrauchen mehr Strom. Wir entwickeln ein unschlagbares Dämmmaterial - um festzustellen, dass es im Umgang damit zu tödlichen Krankheiten kommen kann. Welche Risiken werden das 21. Jahrhundert prägen? Derzeit diskutierte „neue“ Gesundheitsgefahren wie psychische Fehlbelastungen? Die Nanotechnologie? Viele derzeit diskutierte Problemfelder haben zwei Gemeinsamkeiten: ihre schwierige Abgrenzbarkeit als dem Arbeitsleben zuzuordnende Risiken und die Multikausalität damit zusammenhängender Krankheitsbilder. Es ist bezeichnend für diese „neuen“ Phänomene, dass ihre Wahrnehmung geprägt wird von einem breiten gesellschaftlichen Risikodiskurs, der zu Beginn des 21. Jahrhunderts anders verläuft, als noch vor zwanzig Jahren. Zu den klassischen Experten im Bereich der Arbeitssicherheit, Politik und Wirtschaft gesellen sich, stärker als je zuvor, NGOs wie Umwelt- oder Versichertenverbände, als Anwälte der Zivilgesellschaft. Das Beispiel der Neuordnung der Europäischen Chemikalienpolitik „REACH“ zeigt, wie groß der Einfluss der NGOs geworden ist. Gerade auf europäischer Ebene wird ihre Einbindung bewusst gefördert und der Trend hin zu einer „Stakeholderdemokratie“ ist unverkennbar. Was heißt das für uns, die „angestammten“ Experten? Ich sehe uns - Verantwortliche und Sachwalter der sozialen Entschädigung von Gesundheitsgefahren am Arbeitplatz - an einer Schlüsselstelle in der Diskussion um neue Risiken. Stärker als in der Vergangenheit müssen wir in die Öffentlichkeit hineinwirken, um den ebenfalls zunehmend öffentlichen Risikodiskurs zu beeinflussen. Es wäre wünschenswert, wenn wir auf der gemeinsamen Plattform des FORUMs in diesem Bereich zu länderübergreifenden Aussagen angesichts dieser Risiken in der Lage wären. Dies würde unseren Einfluss auf die europäische Politik befördern, in jedem Fall aber unsere Wahrnehmbarkeit und sicherlich auch die Akzeptanz unserer Stakeholder, Versicherten und Beitragszahler auf nationaler Ebene verbessern. Diese Akzeptanz gewinnt, wer glaubwürdig kommuniziert und Transparenz schafft. Wer nicht nur Erfolge, sondern auch Probleme und Zweifel offen legt und den Mut hat, sich auch einmal gegen den Trend der öffentlichen Debatte zu stellen. Lassen Sie mich mit einigen Bemerkungen zum Thema Akzeptanz nun die zweite Herausforderung skizzieren. - 216 - 2. Herausforderung: Der Erhalt gesellschaftlicher Akzeptanz sozialer Sicherung Meine Damen und Herren, wir alle wissen, dass allein der Verweis auf sinkende Unfallzahlen uns nicht gesellschaftliche Kritik erspart und auch nicht vor Angriffen aus dem politischen Raum schützt. Was aber können wir mehr tun, als unsere „Hausaufgaben“ erfolgreich zu erledigen? Eine wichtige, unterstützende Funktion für den Erhalt gesellschaftlicher Akzeptanz kann der internationale Austausch spielen. Ich weiß als Vorsitzender des IVSS Fachausschusses für Unfallversicherung um die zahlreichen Möglichkeiten, die uns hier zur Verfügung stehen: Im Rahmen unserer im Jahr 2003 in Zypern begonnenen Seminarreihe zu Berufskrankheiten in der Welt, wird gerade die Gewinnung des öffentlichen und maßgeblichen Regierungsinteresses ein wichtiger Akzent unserer Abschlussveranstaltung im Jahr 2007 auf dem afrikanischen Kontinent sein. Jüngste Seminare in Asien und Lateinamerika haben gezeigt, dass mittels international ausgerichteter Veranstaltungen das Gehör der eigenen politischen Elite bisweilen leichter zu erreichen ist, als unter den Gegebenheiten des alltäglichen, nationalen Geschäfts. Ich möchte an dieser Stelle im Namen des Fachausschusses auch den Kolleginnen und Kollegen der neuen EU-Mitgliedsstaaten, der Kandidatenstaaten und in den außereuropäischen Nachbarländern Unterstützung zusagen, um mittels unseres Pools internationaler Experten in Ihren Ländern mehr Gehör für Ihre Belange zu finden. Dass der Prophet im eigenen Land mitunter weit weniger deutlich gehört wird, als der Experte eines fernen Landes, wissen wir auch aus Deutschland zu berichten: Ausgerechnet fand jener besondere Umstand bei unserem Bundeskanzler Gehör, dass sich die Volksrepublik China bei der Ausgestaltung ihres Unfallversicherungssystems deutlich am Vorbild der Berufsgenossenschaften ausrichtet. Derlei Fakten beeindrucken mitunter mehr, als eine erfolgreiche Jahresbilanz. Unbeschadet eines guten Rufs in der Welt, müssen wir aber unsere originären „Hausaufgaben“ erledigen und Antworten auf konkrete Herausforderungen finden: Vor eine solche konkrete Herausforderung stellt uns die immer wieder aufflackernde Privatisierungsdebatte. Diese zeichnete sich in der Vergangenheit vor allem durch ihre undifferenzierte Art und Weise aus. Auch wenn sie in unterschiedlichen Kontexten immer wieder auflebt, so können wir heute selbstbewusster denn je argumentieren und auf Belege aus der internationalen Praxis verweisen: Mehr und mehr Entwicklungsländer entscheiden sich für eine soziale Absicherung von Arbeitsunfällen und Berufskrankheiten. Viel ist derzeit von China die Rede, aber auch andere Länder Asiens - wie Laos – gehen diesen Weg. Das jüngste Beispiel dürfte der afrikanische Staat Malawi sein, der gegenwärtig seine Gesetzgebung dahingehend ändert, die individuelle (private) Absicherung der Unternehmen durch eine gesetzliche Unfallversicherung abzulösen. So erfreulich diese Beobachtungen sind, ein Beleg für die prinzipiell bessere Geeignetheit einer Sozialversicherungslösung sind sie sicher nicht. Schließlich handelt es sich bei Entwicklungsländern um unreife Versicherungsmärkte, gekennzeichnet durch mangelnde Rechtssicherheit, Defizite im Schadensmanagement und in der Reservierung von Schadensereignissen – mithin für private Versicherer unattraktiv. Nein, die Privatisierungsdebatte ist anspruchs- und voraussetzungsvoll nur vor dem Hintergrund weitgehend effizienter und transparenter Märkte in den Industrienationen zu führen. - 217 - Doch auch hier offenbart sich interessantes: Eingangs wies ich auf das Phänomen so genannter „neuer“ Gesundheitsgefahren und Krankheitstypen hin, die auch in finanzieller und versicherungstechnischer Hinsicht besondere Herausforderungen darstellen. Bemerkenswert ist, dass Konzepte, die gegenwärtig im Bereich der Privatversicherungen zu diesem Thema erarbeitet werden, uns bestens vertraute Lösungen vorschlagen: So spricht sich etwa der weltgrößte Rückversicherer - die Münchener Rückversicherung - in einem Papier zur Versicherbarkeit von Berufskrankheiten dezidiert für solidarische Pool-Lösungen aus, die – gegebenenfalls staatlich verwaltet – sämtliche so genannte „long tail risks“ entschädigen sollen. Der Anteil des Staates and diesem Pool müsse anfangs sehr hoch sein und könne – so heißt es selbstbewusst – dann graduell zurückgefahren werden. Nur gut, möchte man anmerken, dass auch im Fall der Insolvenz eines am Pool teilnehmenden privaten Versicherungsunternehmens jemand dessen Lasten übernimmt: entweder ein neuer solidarischer Pool oder gleich der Staat selbst. Ohne staatlich verordnete Solidarität – so gesteht also auch die Privatversicherung ein – sind komplexe Risiken nicht zu versichern. Der gegenwärtig im US-Senat verhandelte, 140 Milliarden US Dollar schwere Fonds zur Beilegung der Asbestklagen ist hierfür ein Beleg. Der Fonds, der alle noch nicht erledigten Asbestschäden in den USA kompensieren soll, schließt weitere, zivilrechtliche Ansprüche aus. Einzahler sollen Versicherer und Unternehmen mit Entschädigungsverpflichtungen sein, die den Fonds innerhalb von 27 Jahren in Raten zu bestücken haben. Die Zahl der zu beteiligenden Unternehmen wird auf etwa 10.000 geschätzt. Dieses Verfahren, so kommentiert die „New York Times“ vom 16. Mai dieses Jahres, ähnelt dem der amerikanischen Unfallversicherung (workers compensation). Am Ende also doch die Besinnung auf – staatlich verordnete – Solidarität, analog einem öffentlichen Unfallversicherungssystem? Ist das der Schlussakkord der Privatisierungsdebatte? Zumindest würde sich so ein Kreis schließen, der zurückführt an die Ursprünge der Unfallversicherung, am Ende des 19. Jahrhunderts. Damit komme ich zur dritten und letzten Kategorie der globalen Herausforderungen. 3. Herausforderung: Ausweitung und Nachhaltigkeit des Sozialschutzes 3.a.) Ausweitung des Sozialschutzes: Meine sehr geehrten Damen und Herren, wenn wir in Europa von der „Ausweitung“ des Sozialschutzes sprechen, so ist dieser Begriff in der aktuellen politischen Diskussion oftmals negativ besetzt, jedenfalls wenn wir darunter – in Zeiten knapper Kassen – eine Ausweitung des Leistungsumfangs verstehen. Für den Großteil der Weltbevölkerung allerdings ist jede, auch die geringste Abdeckung durch eine formelle soziale Sicherung, ein noch immer unerfülltes Bedürfnis. Die Internationale Arbeitsorganisation (ILO) schätzt, dass etwa 80% der Weltbevölkerung nicht angemessen von der formellen sozialen Sicherheit abgedeckt wird. Auch in unserem Zweig der sozialen Sicherung ist, global gesehen, noch viel zu tun: Gemäß der Datenbank “Soziale Sicherheit Weltweit” der Internationalen Vereinigung für Soziale Sicherheit (IVSS) existieren in ihren 151 Mitgliedsstaaten etwa 270 Programme (nicht notwendigerweise eigenständige Systeme) zur Versicherung von Arbeitsunfällen weltweit. - 218 - Das ist eine beeindruckende Zahl. Doch auch dort, wo es zwar formal eine Versicherung gegen Arbeitsunfälle und Berufskrankheiten gibt, sagt dies noch nichts über den Anteil der von ihr abgedeckten erwerbstätigen Bevölkerung aus. In Lateinamerika ist die Situation besonders prekär: Auf der einen Seite zeigt sich der Kontinent auf einem wirtschaftlichen Erholungskurs. Arbeitsplätze entstehen, und selbst das krisengeschüttelte Argentinien macht ökonomisch rasche Schritte vorwärts. Doch Jobwachstum bedeutet nicht unbedingt auch eine größere Abdeckung durch die Unfallversicherung: Sieben von zehn neuen Arbeitsplätzen in Lateinamerika entstehen im informellen Sektor. Und nur zwei von zehn Arbeitsplätzen im informellen Sektor bieten zumindest ein gewisses Maß an sozialer Sicherheit. Aber es gibt auch hier positives zu vermelden, wie etwa vom ehrgeizigen Expansionsprogramm der chinesischen Unfallversicherung: Derzeit sind in der Volksrepublik China 70 Millionen Menschen durch die gesetzliche Unfallversicherung versichert. Bis zum Jahr 2007 soll der Versicherungsschutz auf 100 Millionen und bis 2010 auf 120 Millionen Menschen ausgedehnt werden. Seitens der IVSS und der deutschen Unfallversicherung unterstützen wir diesen Prozess auf vielfältigen Ebenen. Im vergangenen Monat haben wir zum Beispiel in China ein Seminar zur Prävention von Verkehrsunfällen durchgeführt, im vergangenen Jahr zur medizinischen Rehabilitation. Die Ausweitung der Abdeckung des Sozialschutzes wird allerdings nur dann nachhaltig sein, wenn wir die Leistungsfähigkeit unserer Systeme generationenübergreifend sicherstellen können. Die Schaffung der Voraussetzungen für Nachhaltigkeit sehe ich daher als weitere konkrete Herausforderung. Gestellt wird uns diese Herausforderung durch den demographischen Wandel. 3.b.) Demographischer Wandel Ein Blick in die Zukunft: Die Volksrepublik China ist eines der auffallendsten Beispiele weltweit für eine schnell alternde Bevölkerung: Im Jahr 2000 waren noch 10% der Bevölkerung 60 Jahre alt oder älter. Im Jahr 2025 wird der Anteil bei 20% liegen und 2050 sogar 30% erreichen. In Europa wird die Altersgruppe der 45- bis 64-jährigen schon im Jahr 2010 rund die Hälfte der Beschäftigten stellen. Die Langfristprojektion einer jüngst veröffentlichen Studie zeigt, dass nicht nur das Durchschnittsalter des Erwerbspersonenpotenzials steigt, sondern mit der sinkenden Bevölkerung auch die Zahl der arbeitsfähigen Menschen zurückgehen wird. In Deutschland, beispielsweise, nimmt das so genannte Erwerbspersonenpotenzial, heute 44,5 Millionen Menschen - bis 2020 um rund 1,4 Millionen ab, und bis 2050 um rund 9 Millionen – selbst bei steigender Erwerbsquote der Frauen und einer jährlichen Nettozuwanderung von 200.000 Personen. Die Zahl der Erwerbstätigen jüngeren und mittleren Alters wird dramatisch sinken, der Anteil der älteren relativ zunehmen. Für die Unfallversicherung hat das Auswirkungen in mindestens dreifacher Hinsicht: Der demographische Wandel konfrontiert uns mit der Notwendigkeit gezielter Präventionsmaßnahmen für ältere Arbeitnehmer mit der erhöhten Nachfrage älterer Menschen nach medizinischer Versorgung mit einem einhergehenden Umbruch der Versorgungsstruktur und -qualität und schließlich - 219 - mit der die Notwendigkeit, durch rehabilitative Maßnahmen (wie „return to work“-Programme) das insgesamt schrumpfende Potenzial erwerbsfähiger Menschen – auch im Falle einer körperlichen Einschränkung – am Arbeitsplatz zu halten. Wirtschaft und Unfallversicherung müssen sich künftig in jedem Fall stärker mit den Herausforderungen durch die zunehmende Alterung der Arbeitnehmerschaft befassen, als bisher. spezielle Maßnahmen für ältere Arbeitnehmer rechnen sich, wie internationale Erfahrungen zeigen. Beispielsweise hat ein japanischer Autohersteller, indem er an den Fließbändern unterschiedliche Arbeitsgeschwindigkeiten für unterschiedliche Altersgruppen zuließ, seine Produktivität um zehn Prozent gesteigert. Ein amerikanischer Autobauer berichtet über mehrere hundert Arbeitnehmer, die dank erfolgreichen „disability managements“ allein an einem deutschen Produktionsstandort in produktiver Arbeit gehalten werden konnten und ersatzweise Neueinstellungen überflüssig machten. Mit derlei Maßnahmen kann ein Unternehmen Geld sparen. Daran anknüpfend kommt es darauf an, ergänzende Anreize zu setzen, um gezielte Präventionsmaßnahmen zu befördern. Deren Erfolg wiederum hilft, Ausgaben auf der Rehabilitations- und Entschädigungsseite zu senken. Das ist besonders erforderlich angesichts eines rückgängigen Erwerbspersonen- und damit Versichertenpotenzials. Für die Unfallversicherung bedeutet dies eine wichtige Voraussetzung zur finanziellen Nachhaltigkeit des Systems. 4. Fazit Drei große Herausforderungen habe ich skizziert: 1. Das Erkennen und Bewältigen neuer Risiken 2. Den Erhalt gesellschaftlicher Akzeptanz sozialer Sicherung und 3. Die Ausweitung und Nachhaltigkeit des Sozialschutzes vor dem Hintergrund des demographischen Wandels Alle drei Aspekte sehe ich als Grundkonstanten unserer Arbeit. In ihrer konkreten Ausprägung wechselnd, begleiten sie die Praxis der Unfallversicherung seit ihrem Bestehen. Das wird auch in Zukunft so sein: Der technische Fortschritt wird nicht nur Risiken beseitigen, sondern auch unaufhörlich neue Risiken generieren. Als Pfeiler des sozialen Sicherungssystems wird die Unfallversicherung immer wieder – in Zeiten knapper Staatshaushalte und konjunktureller Seitwärtsbewegungen – politische Begehrlichkeiten wecken und um gesellschaftliche Akzeptanz werben müssen. Und auch die Frage der Generationen-übergreifenden Nachhaltigkeit wird von jeder Generation neu gestellt werden, abhängig von sozio-ökonomischen und demographischen Konstellationen. Die wichtigste und zentrale Herausforderung ist daher die, den jeweiligen ökonomischen und sozialen Voraussetzungen angemessene Antworten auf diese Herausforderungen zu finden. Ich bin mir sicher, dass der grenzüberschreitende Austausch über diese - von vielen Systemen geteilten - Phänomene zu nutzbaren Erkenntnissen führt. Dafür sorgen bilaterale Kooperationen ebenso wie der multilaterale Austausch in etablieren Foren wie dem unseren. - 220 - Wenn es uns gelingt, diese Synergien nicht nur für unsere eigene Arbeit zu erschließen, sondern auch nach außen, in Richtung der Meinungsbildner in Europa deutlich zu kommunizieren, stärkt dies die Stimme der europäischen Unfallversicherung. Gemeinsame Antworten auf gemeinsam getragene Herausforderungen: Das ist meine Hoffnung für die unmittelbar vor uns liegende Arbeit. Darin liegt eine große Chance, aber auch die Gefahr, zu scheitern. Mit einem Wort: ein Risiko! - 221 - - 222 - For more information about the european Forum www.europeanforum.org www.europeanforum.org
