DISEASES, Insurance Against. - Insurance against i. is the last to be incorporated into modern systems of social insurance, and this is explained by a complex of reasons that may be summarized as follows: the universality of the risk, which is common to all men and in a certain sense ordinary (when the risk is specific to particular types of work there is insurance against so-called occupational i., combined with insurance against accidents at work); the individual incidence, for the most part of relatively short duration and of no excessive economic burden (except for certain so-called social i. owing to their wide diffusion, the intensity of their effects, their long course and the economic cost of treatment, such as, for example, tuberculosis, for which provision can be made separately); the measures arranged for the poor through free medical assistance provided by the municipalities or other public bodies; the particular features of technical and financial organization. Nevertheless, even for this branch of insurance (not unknown to the ancient trade guilds) there is no lack of attempts and of a progressive movement toward a generalized legal arrangement.
First of all, mention must be made of the "mutual aid societies" voluntarily constituted among workers, which, regulated by a law of 1886, had a considerable development in Italy. Between 6,000 and 7,000 of them were counted in the decade 1894-1904, but by 1948 they had been reduced to a little more than 700, for the most part superseded by the new, broader and more powerful institutions.
Public intervention has manifested itself in various States along three lines: that of subsidizing voluntary bodies, recognized and supervised; that of compulsory insurance, but limited to determined sectors; that of the generalization of compulsion, adopted in some large States, with Germany as the forerunner and England pre-eminent. Nor have certain international conventions been lacking (which came into force in 1928).
Limited to Italy, the treatment of i. was provided for by the Commercial Code of 1882 for seafarers (art. 537); now it is still so for seafarers under the Code of Navigation (art. 336; for navigation personnel air, v. the article 909), and, more generally, for all categories of workers, by the Civil Code (art. 2110; in the event of illness, if the law or collective norms do not establish equivalent forms of social security or assistance, the worker is owed remuneration or an indemnity in the measure and for the time determined by legislative, collective or customary norms, and in the absence of these according to equity; similarly, for a determined time one has the right to the preservation of one's position and the period of absence must be counted in the seniority of service, for the purposes of the treatment upon the termination of the employment relationship). Finally, the Constitutional Charter proclaimed the principle of the right of workers to have adequate means for their life needs prevented and assured in the event of illness (as well as accident, invalidity and old age, involuntary unemployment), through bodies and institutions set up or integrated by the State, private assistance nevertheless remaining free (art. 38).
In Venezia Giulia and Tridentina, at the time of their annexation to Italy, the Austrian (1888) and Hungarian (1891) legislation for compulsory insurance against illness (as well as for other contingencies) was in force; this legislation was repealed, but by virtue of particular provisions (1925) the insurance system was continued with certain adaptations and modifications, pending a regulation of the matter on a national basis.
The fascist syndical legislation (1926) then provided for the establishment of para-syndical bodies (that is, alongside and adhering to the professional associations) and among these those of insurance against illness were of salient importance, constituted by virtue of collective contracts in harmony with a general principle of the Charter of Labor (of 1927, art. 28), and legally recognized. Given the great number of them and the structural differences of dimension and of very different systems or methods according to the categories of production, at a certain point it was deemed practically convenient to proceed to unification, creating (by law of 1943) the Institute for assistance against illness for workers, subsequently named (1947) National Institute for Insurance against Illness (INAM). The main bodies merged into this organization were the National Sickness Fund for those employed in commerce, the National Mutual Federation for illness for agricultural workers, the analogous one for industrial workers, the National Institute of Assistance for workers in credit, insurance, and tax services, the District Funds of Venezia Giulia and Tridentina. Given the grave circumstances of the war period and the immediate postwar period, the organization of the Institute has been rather slow and laborious and in some respects still undergoing improvement, apart from the general reorganization that may come with the reform of the entire complex of social insurance, long under study at the Ministry of Labor.
The organs of the Institute are (with representation, among others, of the workers, in the collegial ones): the president, the board of directors, the executive committee, the section committees (for agriculture, commerce, industry, credit and insurance), the board of auditors, the provincial committees.
The contributions (originally borne by both employers and workers and from Apr. 1946 borne only by the former) vary in amount and in methods of collection according to the sectors of production, which affects, with some variation, also the benefits. To the mass of actual workers (principal members) are added the family members dependent on them (altogether ca. 14 million as of 30 June 1949). The obligation of enrollment may be extended to new categories by legislative measure. The benefits are various: health (general domiciliary and outpatient medical assistance, specialist outpatient, pharmaceutical, obstetric, hospital, pediatric); economic (daily sickness indemnity, allowances and various subsidies, e.g., funeral and maternity); supplementary (convalescent care, balneo-thermal cures; prosthetic appliances, therapeutic aids; stay of members' children in seaside and mountain colonies, extraordinary subsidies). Assistance is also distinguished into direct and indirect; the first occurs in kind when the worker, in requesting and receiving the benefits, turns to the Institute and is assisted by it, without being forced to advance expenses (it is the system preferred by the Institute); the second (on reimbursement) occurs when the worker procures for himself the necessary assistance, bearing the relative expenses, subject to subsequently requesting reimbursement, which is carried out by the Institute on the basis of tariffs established for each benefit, according to the documentation presented. The causes of exclusion and of forfeiture of the right to benefits are determined, as is the administrative procedure for obtaining them, etc.
The Institute has at its disposal an ample health apparatus, continually increasing, which, at the beginning of 1950, was summarized in 450 polyclinics and 465 outpatient clinics, comprising 3093 medical offices, with 4693 general practitioners and specialists. To this apparatus owned by the Institute are added 1524 hospitals and nursing homes and 1987 medical offices, which, following agreements stipulated with the individual provincial offices, also attend to the assistance of the insured. To the curative service (carried out by ca. 19,000 physicians who have adhered to a special agreement, as well as by the outpatient clinics) is added a control service (performed predominantly by physicians with an employment relationship). In the 1948 fiscal year the Institute took under care over three and a half million cases of disabling illness. It is extending its activity also to purposes of prevention of illness.
Other important category institutes are: the National Body of Social Security and Assistance for State Employees (ENPAS); the National Body of Social Security for Employees of Public Law Bodies (ENPDEDP); the National Institute of Assistance for Employees of Local Bodies (INADEL); the National Body of Social Security and Assistance for Entertainment Workers (ENPALS); the National Fund of Assistance for Agricultural and Forestry Employees; the people of the sea have a separate legislative system (since 1937). See also: ACCIDENT INSURANCE.
Bibliography5 works
Ferruccio Pergolesi