Sick Funds

SICK FUNDS, special organizations whose task is to carry out the functions of social insurance in case of illness for insured members of S. F., and in some cases also for their family members. The functions of S. F. consist in issuing cash benefits and providing medical assistance, with the amounts, duration, and conditions for issuing benefits, as well as the forms and conditions of medical care for S. F. members and their families being established by the legislation of the respective country and the charter of the S. F. In a number of countries, various other functions are also assigned to S. F.: issuing benefits to pregnant women, nursing mothers, and those who have suffered accidents and for funeral expenses. Legislation determines the circle of insured persons, the amount and distribution of insurance contributions between employers and hired workers. S. F., existing in many countries (see more details under Insurance Funds), were first established in Germany in 1884 (law on worker insurance). The organizational structure of S. F. varies—they may unite workers and employees of a single enterprise, several enterprises, or several professions, as well as insured persons of an entire city or district. In most bourgeois countries, the boards of S. F. include representatives not only of the insured but also of employers. Workers everywhere are fighting to eliminate the influence of employers on the affairs of S. F. and demand for this purpose their removal from the boards of S. F. In all countries except the USSR, the funds of S. F. consist not only of contributions from employers but also from contributions from the workers themselves. In Russia, draft laws on S. F. began to be developed in ministerial offices after the upsurge of the revolutionary wave of 1905. Then these draft laws were increasingly adapted to the interests of industry. An extremely curtailed draft law on S. F. of the Shipov Commission underwent changes by reactionary Dumas for 2½ years, from 1908 to 1911; meanwhile, the worker movement began to rise again, and S. F. were introduced by the law of June 23, 1912 (law on securing workers in case of illness), which was the result of a long and persistent struggle of the working class. The 1912 law made it possible for S. F. to cover only 1/5 of the entire mass of the Russian proletariat—workers of factory and mill, mining, and mining-metallurgical industries, tram enterprises, inland navigation, and privately operated railway enterprises—and even in these industries, the provisions of the law did not apply to factory and mill enterprises with fewer than 20 workers if they had an engine or steam boiler, and fewer than 30 if they had no engine or boiler. Thus, agricultural and construction workers, commercial employees, domestic servants, workers of maritime navigation and general-use railways, and persons engaged in home industry remained outside the scope of S. F. Moreover, the provisions of the 1912 law did not extend to Siberia and Central Asia. Before the revolution, S. F. existed in Russia in the least democratic form—as factory funds, in which the influence of the employer was most effectively exercised. The desire of workers to organize large city-wide S. F. met stubborn resistance from the government and employers, who had a majority in the supervisory bodies over the activities of S. F. (in insurance boards there were only 2 representatives from workers out of 15 members, in the insurance council—5 workers out of 26 people: see Social Insurance and Insurance Funds). Representatives of employers, who had 2/3 of the votes at the general meeting of authorized representatives of S. F. (the chairman of the meeting was by law an employer), and in the board of S. F. only one vote less than the workers—could in every way hinder the activities of S. F. The funds of S. F. consisted of contributions from workers in the amount of 1/3 of all contributions, and contributions from employers in the amount of only 2/3. Worker contributions amounted to 1-2% of wages (in small funds the maximum was 3%). By law, the functions of S. F. were limited only to issuing cash benefits; cash benefits could be issued within the limits of 4/5 of the earnings of family members of S. F. and 2/3 of the earnings of single persons. The duration of benefit payment could not exceed, in case of prolonged continuous illness, 20 weeks, and in case of illness with interruptions—30 weeks within a year. The provision of medical care, however, was not by law an obligatory regular function of S. F. The treatment of workers remained after the issuance of this law the responsibility of employers, who had to organize only outpatient care and first aid in case of sudden illnesses and accidents, which was a step backward compared to the position of 1866, issued by the Committee of Ministers (August 26), when industrialists on larger enterprises provided both inpatient care and bed assistance to workers. Employers could enter into agreements with S. F. to organize medical care for workers. In this case, S. F. assumed all the aforementioned obligations of employers to provide medical care to workers. The corresponding expenses of S. F. were to be reimbursed by employers. In view of the fact that S. F. were granted the right to organize medical care for the families of S. F. members, S. F. not only sought to make use of this right but also began to put pressure on employers, urging the latter to transfer to them on contractual terms, according to the law, the organization of medical care for both the workers themselves and the participants, and to cover all necessary expenses. Since most employers reacted sharply negatively to the proposals of S. F. to transfer to them the organization of medical care for workers, not wishing to contribute to the development of worker initiative, S. F. were unable to develop much work in this direction; only the central S. F. of printers in Odessa, the S. F. of printers in Yekaterinburg, the tramway S. F. in Yekaterinoslav, and the S. F. in Melitopol, Saratov, and Kiev had agreements with employers on transferring the organization of medical care to S. F. Other S. F. had to develop their activities, predominantly, in organizing medical care for the family members of S. F. members. A pioneer in this matter was the S. F. at the Tula Copper-Rolling and Cartridge Plants, which organized the first insurance outpatient clinic in Russia for the families of workers. Following the example of Tula, S. F. in a number of other cities organized their own outpatient clinics. By the summer of 1917 there were only 10 of them. In general, the activities of S. F. in organizing medical care developed more widely in the provinces than in the capitals, since in the provinces medical care for workers by factory medical institutions was significantly worse. Home care and hospital care were extremely underdeveloped. Some S. F. entered into agreements with zemstvo and city hospitals, sanatoriums, and private clinics, rented beds in maternity homes, sanatoriums, and in some cases entered into agreements with individual doctors. Thus, the practical results of the activities of S. F. in the field of providing medical care were extremely small, but it is necessary to take into account the significance of S. F. as legal possibilities for uniting the forces of the working class. The February revolution brought with it a new insurance law of the Provisional Government of July 25, 1917, which granted S. F. the right to take over medical care (already without the consent of employers). But since this law established for employers a maximum contribution for medical care of 2% of wages (but not less than 18 rubles per participant per year), the funds of S. F. were clearly insufficient for the proper organization of medical care. This law retained all articles of the 1912 law on the treatment of workers, left the treatment of worker families to the funds of the workers themselves, transferred the establishment of medical rules to the insurance council, where workers did not have a majority, and did not introduce the obligation for employers to make a one-time contribution for equipping medical institutions when transferring the organization of medical care to S. F. This law, which left entire categories of hired workers (commercial and industrial employees, railway workers, agricultural workers, and domestic servants) outside the circle of insured, did not free workers from the burden of contributions, and provided a number of benefits to employers, was a bright example of an agreement between the Provisional Government and the bourgeoisie at the expense of worker interests and caused a series of protests from worker organizations. Nevertheless, even this very imperfect law was widely used by sick funds, which began to intensively unite into city-wide territorial funds and unions of sick funds, which facilitated the possibility of better organization and medical care. However, only Soviet legislation freed S. F. from all fetters that hindered the broad development of their activities. One of the first decrees of Soviet power (November 16, 1917), according to which all factory and mill medical institutions, with all their movable and immovable property, passed without compensation into the ownership of S. F., dealt the final blow to factory medicine (see) and laid a solid foundation for the activities of S. F. in providing medical care.

The following decree (adopted by the All-Russian Central Executive Committee on December 22, 1917, and published on December 31, 1917) — 'Regulations on Insurance in Case of Illness,' which extended state insurance to all persons hired labor and for all types of insurance, with all expenses placed on employers — established the mandatory transfer of medical affairs to the Sick Funds and imposed on them the obligation to provide medical assistance to insured persons and members of their families. Employer contributions were set at 10% of wages paid. The Sick Funds took control of all factory-plant medical institutions, organized outpatient treatment in their own clinics, and in some places — also home assistance at special 'home help' points. To organize inpatient care, the Sick Funds requisitioned a number of hospitals belonging to private individuals, charitable societies, former public self-governments, as well as a number of pharmacies and laboratories. At many Sick Funds, special medical departments were created to manage the provision of medical assistance. The Sick Funds developed energetic work in organizing medical assistance for the insured. Vigdorovich notes this as follows: 'In the Sick Funds, leadership of the affairs passes to the communists. This sharply changes both the pace and methods of work of the Sick Funds. The construction of fund medicine acquires feverish speed and begins to be carried out by revolutionary methods. In one year, a grand organization is created, which insurance figures of the previous era could hardly have ever dreamed of.' However, due to the enormous growth in the number of insured persons, for which the construction of medical institutions by the Sick Funds could not possibly keep up, the Sick Funds could not to a sufficient degree satisfy the insured persons' need for medical care. With the development of socialist construction after the October Revolution (nationalization of all private industry, introduction of universal labor service, etc.), and mainly thanks to the state organization of public health protection, the Sick Funds lost more and more of their significance. On October 31, 1918, the 'Regulations on Social Protection of Workers' was issued, according to which leadership of all social insurance affairs was concentrated in the social protection and labor protection sub-departments of the Labor Departments of Soviets of Workers', Peasants', and Red Army Deputies. The organization of medical assistance to the participants of the Sick Funds themselves was entrusted to the social protection sub-departments; while the members of the insured families were to be cared for by public health authorities. Thus, the Sick Funds initially became an auxiliary apparatus of the social protection sub-departments, and then, as the latter strengthened, they increasingly lost the meaning of separate existence. When the public health authorities significantly strengthened, and the idea of unified Soviet medicine found its real expression in the merger of previously scattered medical institutions under one department, under unified leadership and management — the last grounds for leaving the medical care of the insured in the hands of the Sick Funds fell away. As early as August 1918, the People's Commissariat of Health issued the 'Regulations on the Department of Insurance Medicine at the People's Commissariat of Health and Medical-Sanitary Departments of Soviets of R., Kr. and Kr. D.,' according to which the said department 'monitors the correctness of the organization of medical assistance by the Sick Funds in its entirety, in accordance with the requirements of medicine and hygiene, organizes, directs, and manages the medical-sanitary activities of the Sick Funds.' Furthermore, by a decree of the Council of People's Commissars of February 18, 1919, the Sick Funds were obliged to transfer all their medical institutions to the public health authorities, which was preceded by a stubborn struggle of supporters of the principle of unified Soviet medicine with adherents of insurance medicine (see). A month after this, by a decree of March 18, 1919, the Sick Funds were liquidated. The rich experience of the Sick Funds was subsequently used in the reintroduction of social insurance under the New Economic Policy (decree of the Council of People's Commissars of November 15, 1921) during the organization of insurance funds. But the functions of providing medical assistance to insured persons and members of their families were already entrusted not to insurance funds, but remained in the hands of the authorities of the People's Commissariat of Health (see Insurance Funds, Social Insurance).