Implementing work accident and illness insurance

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1 Implementing work accident and illness insurance Country: Estonia Partner Institute: PRAXIS Center for Policy Studies, Tallinn Survey no: (10)2007 Author(s): Agris Koppel, Ain Aaviksoo Health Policy Issues: Funding / Pooling Current Process Stages Idea Pilot Policy Paper Legislation Implementation Evaluation Change 1. Abstract Estonia has been searching for opportunities to introduce work accident and occupational disease insurance for 13 years. Today it is the priority of government and there is high need for such an insurance. Also, most stakeholders have already approved of the policy ideas. However, main issues about coverage levels and the management of insurance premiums are still to be discussed. It is not clear yet if there will be private companies involved or if management would be given to the public body. 2. Purpose of health policy or idea The purpose of the policy is to implement work accident and occupational disease insurance (WOI) in Estonia. The insurance should cover the risks of accidents, illhealth and incapacity to work connected to the working environment and working conditions. It is highly expected that introducing a system in which the employer pays for insurance premiums would increase the efficiency of prevention of occupational diseases through continous improvement of working environment and conditions. There are issues still to be solved about insurance coverage (is it retrospective or not) and management of funds as it could be organised by (existing) public organisations or private insurance companies. Main objectives The main objectives of implementing the WOI are: decrease the incidence of work accidents and occupational diseases through effective prevention activities at work places protect employees' income levels after a work accident or occupational disease has occured ensure equal rights and benefits for employees in situations of work accidents or occupational diseases ensure aid to employees for rehabilitation and quick return to work after work accidents and in case of occuptaional diseases ensure the financial sustainability of employers

2 Type of incentives The main financial incentives for both employees and employers are a higher financial protection in cases of work accidents or occupational diseases. Employees would have a reduced risk of loosing income due to illhealth after a work accident or in case of an occupational disease. Employers would have the opportunity of financial sustainability in situations of work accidents and when facing employees claims for remuneration in case of occupational disease. The main non-financial incentives are connected to increased safety of working environments and efficient prevention of work related illhealth. Groups affected Employees, Employers 3. Characteristics of this policy Degree of Innovation traditional innovative Degree of Controversy consensual highly controversial Structural or Systemic Impact marginal fundamental Public Visibility very low very high Transferability strongly system-dependent system-neutral The concept of work accidents and occupational health insurance is rather traditional as in many developed European countries such a security system for employees already exists. As discussions about such an insurance have been going on for more than 13 years already, there is a general consensus about implementing the system even if the final choice of private or public system has not yet been made. Beside the introduction of compulsory solidarity based health insurance and compulsory second-pillar pension insurance the development of WOI will have a rather fundamental meaning in the social system of Estonia as public guarantees would increase remarkably. Although the need for the WOI is known in society, the development of the system has been discussed only between bigger stakeholder organisations and public visibility has been neutral or even low. Also, the work accidents and occupational disease insurance system is quite system-dependent as it should fit into the existing social security system and be in consistence with public financing policy. 4. Political and economic background Currently, the preotection of employees against work accidents and occupational diseases is related to quite high costs. The main burden of these costs is carried by the health and social insurance systems. There are different benefits available for affected employees as described below. The Estonian Health Insurance Fund (EHIF) has the responsibility to reimburse 100% of the employees' income in case of incapacity to work due to work accidents or occupational diseases. However, EHIF has the opportunity to demand reimbursements of 20% of the above mentioned costs from the employer. EHIF is also paying for health services and reimburses the costs of medicines in case of work accident or occupational disease. In 2004 the cost of reimbursement for incapacity to work due to work accidents was 1.3 million Euros as reported by EHIF. In case of permanent incapacity for work or loss of provider due to work accident or occupational disease there are two pensions (allowances) paid by the Board of Social Insurance from the public pension budget: - 2 -

3 incapacity pension survivor's pension In addition to the above described main allowances there are special conditions and orders to pay pensions to employees according to the Law of Obligations Act. Employers have the possibility to buy optional insurance coverage against work accidents and occupational disease. Since these premiums are handled by Income Tax Law as fringe benefits, employers are not interested in such contracts. Therefore, employees have been complaining for many years about low protection levels against health risks due to work accidents and occupational disease. Employers have had no interest to do risk management due to the high taxes following investements into health prevention for employees. Complies with EU regulations - The basis for the insurance system comes from the European Social Charter 5. Purpose and process analysis Idea Pilot Policy Paper Legislation Implementation Evaluation Change Origins of health policy idea Discussions about implementing the working accidents and occupational health insurance already started 13 years ago. The first draft of the insurance concept based on the public insurance scheme,. However, already in 1998 a common statement of employees, employers and government was achieved claiming that the new system should base on the private insurance scheme. The first law of work accidents and occupational disease insurance was prepared by the Ministry of Financial Affairs. It was proceeded by parliament from 2001 to 2003 when the Ministry of Social Affairs withdraw the further discussions of the law. The central councelling body of the work accidents and occupational disease insurance is proposed to be created and it should involve the representatives of employees, employers, government, insurers and other stakeholders. Until today there is no such body created and no common principles are discussed. Initiators of idea/main actors Government Patients, Consumers Private Sector or Industry Approach of idea The approach of the idea is described as: renewed: The WOI is well developed in European Union countries Innovation or pilot project Else - There is no relevant innovation experiences regarding to WOI - 3 -

4 Stakeholder positions There have been many discussions about work accidents and occupational health insurance for many years. There are also many stakeholder groups who have been presenting there interests in working groups as well as in the media. At last the concept of the need for work accidents and occupational health insurance system in Estonia is commonly excepted. In the government and within political parties there are differing views on whether to implement the public or private insurance system: right-side parties support more involvement of private insurers and left-wing parties support the public insurance organisation. The private insurance system is thought to be more effective and supports the development of working conditions as higher premiums are charged from employers with higher risks in working environments. The main supportive argument for the public insurance system is said to be the sustainability of the system, but there are lower motivations for employers if risk premiums do not depend on the risk levels of working environments. Employees are highly interested in a quick implementation of the insurance system, but one of the concerns is the coverage level of people who already have the illnesses due to work accidents or occupational diseases. One of the ideas in the concept is that current beneficiaries continue to get health benefits and compensations from present sources, but these funds are limited and do not satisfy the needs of patients. Employers are somewhat interested in the implementation of the work accidents and occupational disease insurance system, but they are mainly afraid about rising workforce costs due to increasing risk premiums. There is also the idea that together with the implementation of the WOI, there is a need to decrease the share of health insurance tax (currently 13%) by 1-2%, but this idea is not supported by politicians and consumer groups. It is also interesting to note that in 2003 employers started to support the insurance scheme based on public insurance (compulsory solidarity-based system) while before they had also been supporting the system based on private insurance. Actors and positions Description of actors and their positions Government Ministry of Social Affairs very supportive strongly opposed Patients, Consumers Trade unions very supportive strongly opposed Private Sector or Industry Employers association very supportive strongly opposed Influences in policy making and legislation The work accidents and occupational disease insurance will be implemented by the new law which is not ready for public discussions yet. So far, there is only the concept of the idea. If government makes a positive decision on the implementation of the insurance, the law will be written by the Ministry of Social Affairs. Legislative outcome n/a Actors and influence Description of actors and their influence Government Ministry of Social Affairs very strong none Patients, Consumers Trade unions very strong none - 4 -

5 Private Sector or Industry Employers association very strong none Positions and Influences at a glance Adoption and implementation There is no implementation plan yet regarding to the work accidents and occupational disease insurance as there has not been a government decision. The concept has been mainly prepared by the Ministry of Social Affairs and discussed with the main stakeholders. Also, the new governement has so far not even discussed the concept of insurance system. Monitoring and evaluation There are no plans for monitoring and evaluating the implementation process of WOI in Estonia. Results of evaluation n/a 6. Expected outcome In experts' opinion the work accidents and occupational disease insurance is highly needed in Estonia. There is high need for lowering health risks in working environments and for increasing the volume of rehabilitation services for patients suffering from work-related illnesses

6 However, there are issues to be solved during the oncoming preparatory work: choosing between the private or public insurance scheme and finding the best solution in the balance between the existing health insurance tax and the future burden of WOI premiums on employers. Certainly, there is involvement of stakeholders needed in the future when the law is prepared by the Ministry of Social Affairs. While patients are interested in higher security against work-related illnesses or disability, employers' concerns should also be taken into account as increasing work-force costs may affect the sustainability and development capacities of organisations. An interesting debate about private or public insurance is to be expected as Estonia has had successful experiences with both strategies - the sustainable development of the public legal body of the Estonian Health Insurance Fund or introducing compulsory traffic or second-pillar pension insurance systems on the basis of private organisations. Quality of Health Care Services marginal fundamental Level of Equity system less equitable system more equitable Cost Efficiency very low very high Today it is hard to see the impact of implementing WOI on the quality of health services and cost efficiency, but the development of a more equitable system for beneficiaries of work-related illnesses could be expected. 7. References Sources of Information The main sources of information have been clerks of the Ministry of Social Affairs, the database of legislative acts of Parliament, and the media. The importance given to the topic of work accidents and occupational disease insurance by the parliamentary parties has been recognised during interviews with parties' representatives. Author/s and/or contributors to this survey Agris Koppel, Ain Aaviksoo Suggested citation for this online article Agris Koppel, Ain Aaviksoo. "Implementing work accident and illness insurance". Health Policy Monitor, October Available at -

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