DISEASES, INSURANCE AGAINST. — Insurance against diseases was the last to be incorporated into modern systems of social insurance, and this may be explained by a combination of factors, which can be summarized as follows: the universality of the risk, which is common to all human beings and, in a certain sense, ordinary (when the risk is specific to particular types of work, there is insurance against the so-called occupational diseases, combined with insurance against industrial accidents); the individual incidence, generally of relatively short duration and not excessively burdensome economically (apart from certain diseases known as social diseases because of their wide diffusion, the intensity of their effects, their prolonged course, and the economic burden of treatment, such as tuberculosis, for which separate provision may be made); the measures arranged for the poor through free medical assistance provided by municipalities or other public bodies; and the particular features of technical and financial organization. Nevertheless, even in this branch of insurance (not unknown to the ancient craft guilds), attempts have not been lacking, nor has there been a gradual movement toward a generalized legal system.
First of all, mention should be made of the “mutual-aid societies,” voluntarily formed among workers, which, regulated by a law of 1886, underwent considerable development in Italy. There were between six and seven thousand of them in the decade 1894–1904, but by 1948 they had been reduced to just over 700, having been largely superseded by the new, broader, and more powerful institutions.
Public intervention has manifested itself in various states along three lines: subsidies for voluntary bodies, officially recognized and supervised; compulsory insurance, but limited to particular sectors; and the generalization of compulsory insurance, adopted in certain major states, with Germany leading the way and England predominant. Nor have certain international conventions been lacking (which entered into force in 1928).
In Italy specifically, treatment for diseases was provided for seamen by the Commercial Code of 1882 (art. 537); it is now always provided for seamen by the Navigation Code (art. 336; for navigation personnel
In Venezia Giulia and Tridentina, at the time of their annexation to Italy, Austrian (1888) and Hungarian (1891) legislation on compulsory insurance against illness (as well as against other events) was in force; this legislation was repealed, but by virtue of special provisions (1925) the insurance system was continued with certain adaptations and modifications, pending regulation of the matter on a national basis.
Fascist trade-union legislation (1926) then provided for the establishment of para-trade-union bodies (that is, alongside and affiliated with professional associations), among which those for insurance against illness were particularly important. They were established by virtue of collective agreements in harmony with a general principle of the Charter of Labour (1927, art. 28), and were legally recognized. Given their large number and the structural differences in size and in systems or methods, which varied greatly according to the sectors of production, at a certain point it was considered practically expedient to proceed with unification, creating (by a law of 1943) the Institute for Workers’ Sickness Assistance, subsequently called (1947) the National Institute for Sickness Insurance (INAM). The principal bodies merged into this organization were the National Sickness Fund for employees in commerce, the National Mutual Federation for agricultural workers, the analogous federation for industrial workers, the National Assistance Institute for workers in banking, insurance, and tax services, and the district funds of Venezia Giulia and Tridentina. Given the serious circumstances of the wartime period and of the immediate postwar years, the organization of the Institute proceeded rather slowly and laboriously and in some respects is still undergoing improvement, apart from the general reorganization that may result from the reform
of the entire system of social insurance, which has long been under study at the Ministry of Labour.
The organs of the Institute (with representation, among others, of workers on the collegiate bodies) are: the president, the board of directors, the executive committee, the section committees (for agriculture, commerce, industry, banking and insurance), the board of auditors, and the provincial committees.
The contributions (originally borne by both employers and workers, and since April 1946 borne solely by the former) vary in amount and in collection methods according to the sectors of production; this also affects, with some variations, the benefits. The actual body of workers (principal members) is joined by dependants (approximately 14 million in all as of 30 June 1949). The obligation of enrolment may be extended to new categories by legislative measure. The benefits are various: medical (general medical assistance at home and on an outpatient basis, specialist outpatient care, pharmaceutical, obstetric, hospital, and pediatric assistance); financial (daily sickness allowance, various allowances and subsidies, for example, funeral and childbirth benefits); supplementary (convalescent treatment, spa treatment; prosthetic appliances, therapeutic aids; stays for the children of members in seaside and mountain colonies, extraordinary subsidies). Assistance is also distinguished as direct and indirect. The former is provided in kind when, in requesting and receiving benefits, the worker turns to the Institute and is assisted by it, without being required to advance any expenses (this is the system preferred by the Institute); the latter (by reimbursement) applies when the worker obtains the necessary assistance on his own account and bears the related expenses, subsequently requesting reimbursement, which the Institute makes on the basis of tariffs established for each benefit, according to the documentation submitted. The grounds for exclusion from and forfeiture of the right to benefits, the administrative procedure for obtaining them, and so forth, are specified.
The Institute has extensive medical facilities, continually expanding, which at the beginning of 1950 comprised 450 polyclinics and 465 outpatient clinics, containing 3,093 medical consulting rooms, with 4,693 general practitioners and specialists. To these facilities owned by the Institute are added 1,524 hospitals and nursing homes and 1,987 medical consulting rooms which, following agreements concluded with the individual provincial offices, also provide care for insured persons. The treatment service (provided by approximately 19,000 physicians who have joined a special agreement, in addition to the outpatient clinics) is supplemented by a monitoring service (provided mainly by physicians in an employment relationship). In the 1948 financial year, the Institute took under its care more than three and a half million cases of disabling illness. It is also extending its activities to the prevention of illness.
Other important category institutions are: the National Welfare and Assistance Body for State Employees (ENPAS); the National Welfare Body for Employees of Public-Law Entities (ENPDEDP); the National Assistance Institute for Employees of Local Authorities (INADEL); the National Welfare and Assistance Body for Entertainment Workers (ENPALS); the National Assistance Fund for agricultural and forestry employees; the people of the sea have had a separate legislative system (since 1937). V. also: INFORTUNISTICA.