DISEASES, INSURANCE AGAINST. – Insurance against diseases is the last to be incorporated into modern systems of social insurance, and this can be explained by a complex of reasons that can be summarized as follows: the generality of the risk, which is common to all men and in a certain sense ordinary (when the risk is specific to certain occupations, one has insurance against the so-called occupational diseases, combined with that against accidents at work); the individual incidence, which is mostly of relatively short duration and not excessively heavy in economic terms (except for some so-called social diseases due to their widespread diffusion, the intensity of their effects, the long course, and the economic burden of treatment, such as, for example, tuberculosis, for which provision can be made separately); the provisions made for the poor through free healthcare provided by municipalities or other public bodies; and the particularities of technical and financial organization. Nevertheless, even for this branch of insurance (not unknown to the ancient guilds) there have been attempts and a progressive move towards a generalized legal arrangement.
First of all, mention must be made of mutual aid societies voluntarily established among workers, which, regulated by a law of 1886, have had 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, largely overtaken by the new, broader, and more powerful institutions.
Public intervention has manifested itself in various states along three lines: subsidizing voluntary bodies recognized and controlled; compulsory insurance, but limited to certain sectors; and the generalization of compulsory insurance, adopted in some large states, with Germany leading the way and England being preeminent. Nor have some international conventions been lacking (entered into force from 1928).
Limited to Italy, treatment for diseases was provided for in the Commercial Code of 1882 for seafarers (art. 537); now it is provided for seafarers by the Navigation Code (art. 336; for air navigation personnel, see art. 909), and, more generally, for all categories of workers, by the Civil Code (art. 2110; in case of disease, if the law or collective agreements do not establish equivalent forms of social security or assistance, the worker is entitled to remuneration or an allowance at the rate and for the period determined by legislative, collective, or customary norms, and in the absence of these, according to equity; similarly, for a fixed period, the right to job retention is maintained and the period of absence is counted towards seniority for the purposes of the employment termination benefits). Finally, the Constitutional Charter has proclaimed the principle of workers' right to have adequate means provided to meet their living needs in the event of disease (as well as accident, disability, old age, and involuntary unemployment), through bodies and institutions established or supplemented by the State, while private assistance remains free (art. 38).
In the Julian and Trentino regions, at the time of their annexation to Italy, Austrian (1888) and Hungarian (1891) legislation on compulsory insurance against diseases (as well as other events) was in force; this legislation was repealed, but by virtue of special provisions (1925) the insurance system was continued with some adaptations and modifications, pending national regulation of the matter.
Fascist syndical legislation (1926) then provided for the establishment of para-syndical bodies (i.e., alongside and affiliated with professional associations), and among these those for insurance against diseases assumed particular importance, being set up by virtue of collective agreements in accordance with a general principle of the Charter of Labour (of 1927, art. 28), and legally recognized. Given the large number of such bodies and the structural differences in size and systems or methods that varied according to production categories, at a certain point it was considered practically expedient to proceed with unification, creating (by law of 1943) the Institute for Workers' Disease Assistance, later renamed (1947) the National Institute for Insurance against Diseases (INAM). The main bodies merged into this organization were the National Disease Fund for those employed in commerce, the National Mutual Federation for agricultural workers, the analogous one for industrial workers, the National Assistance Institute for workers in credit, insurance, and tax services, and the District Funds of the Julian and Trentino regions. Given the serious circumstances of the war period and the immediate post-war period, the organization of the Institute has been rather slow and laborious and in some respects still in the process of refinement, apart from the general reorganization that may be achieved with the reform of the entire complex of social insurance, which has long been under study at the Ministry of Labour.
The Institute’s bodies (with representation, among others, of workers, in those collegial) are: the president, the board of directors, the executive committee, the section committees (for agriculture, commerce, industry, credit, and insurance), the board of auditors, and the provincial committees.
Contributions (originally borne by both employers and workers and from April 1946 by employers alone) vary in amount and in collection methods according to production sectors, which affects, in some variations, the benefits as well. In addition to the main workers (registered members), their dependents are also covered (a total of about 14 million as of 30 June 1949). The obligation to register can be extended to new categories by legislative provision. Benefits are varied: medical (general home and outpatient care, specialist outpatient care, pharmaceutical, obstetric, hospital, and pediatric care); financial (daily sickness allowance, various allowances and subsidies, e.g., funeral and maternity); and supplementary (convalescent care, spa treatments; prosthetic devices, therapeutic aids; stays for the children of members in seaside and mountain colonies, extraordinary subsidies). Assistance is also distinguished into direct and indirect; the former is in-kind when the worker, in requesting and receiving benefits, turns to the Institute and is assisted by it without having to advance any expenses (this is the system preferred by the Institute); the latter (reimbursement) occurs when the worker procures the necessary assistance on his own account, bearing the related expenses, and then requests reimbursement from the Institute based on established tariffs for each benefit, according to the documentation presented. The causes for exclusion and forfeiture of the right to benefits, the administrative procedure for obtaining them, etc., are determined.
The Institute has extensive medical facilities, continually expanding, which, at the beginning of 1950, amounted to 450 polyclinics and 465 clinics, including 3,093 medical offices with 4,693 general practitioners and specialists. To this equipment owned by the Institute are added 1,524 hospitals and nursing homes and 1,987 medical offices, which, through agreements made with the individual provincial offices, provide care for the insured. In addition to the curative service (carried out by approximately 19,000 physicians who have entered into a special agreement, as well as by the clinics), there is a control service (primarily performed by physicians in an employment relationship). In the 1948 fiscal year, the Institute treated over 3.5 million cases of disabling illness. It is also expanding its activities to include preventive measures against such illnesses.
Other important category-specific institutions include: the National Welfare and Assistance Institute for State Employees (ENPAS); the National Welfare Institute for Employees of Public Law Entities (ENPDEDP); the National Assistance Institute for Local Government Employees (INA-DEL); the National Welfare and Assistance Institute for Entertainment Industry Workers (ENPALS); the National Assistance Fund for Agricultural and Forestry Employees; and a separate legislative framework (since 1937) for maritime workers. V. also: INFORTUNISTICA.