HEALTH INSURANCE Voluntary.
France, 1850, 1898 (voluntary except for miners).
Belgium, 1851, 1894.
Italy, 1880.
Sweden, 1891.
Denmark, 1892.
Holland (authorized private societies and poor relief).
Compulsory.
Germany, 1883, 1911 (voluntary for others with earnings of $500).
Austria, 1888 (voluntary for some classes).
France, for miners, 1894.
Norway, 1909.
Great Britain, national system 1911 (was voluntary 1875-1911).
§ 12. Need of health insurance in America. Contrary to the usual opinion in America, the sickness insurance in Ger many is, both in amount of contributions collected and in im portance to the welfare of the workers and their families, of more importance than is either accident compensation or the system of invalidity pensions. Yet, thus far, our interest and efforts in America have been directed almost entirely toward the reform of accident compensation, and almost every thing remains to be done in the matter of social insurance against sickness. It is true that in recent years there has been a rapid development, in some of the larger cities, of medical insurance clubs conducted by private companies, with dues of ten cents weekly. They give medical care in ordinary cases, but require extra payments for surgical treatment and for medical supplies. They as yet touch only the outer fringe of the problem ; but they testify to the need and to the increasing desire of the wage workers for insurance of this kind. It is believed that at least 4 per cent of the income of wage workers now is expended for the care of sickness and for burial insurance. The losses of wages meantime re main unequalized by insurance indemnities. An Illinois commission reported in 1919 that the loss in wages and medi cal bills averaged 5% per cent or more of the family incomes.
A large proportion of the cases of temporary destitution in ordinary self-supporting families is due to sickness, at least 25 per cent, as shown by various investigations. The German ex. perience shows that 4 per cent of wages, collected in part from employers and in part from wage workers, is sufficient to give a far better medical service than can be had through private effort, to give some indemnity for loss of wages, and to carry on a very useful hygienic work for the families and for the public health.
At present, development in this field is along two lines, that of subsidized trade-union relief (the Ghent system), and that of compulsory state insurance in certain industries. By the Ghent plan the public pays a certain proportion (from one sixth to one half) of the amounts of the benefits paid by the unions or other associations. This plan, originating in Belgium, had been adopted before 1914 in many cities and by some countries in Europe, and in the war period was ex tended to other countries. Great Britain is the first country to adopt a compulsory state system, and it virtually incor porated the Ghent system by providing for grants out of state funds to associations that grant out-of-work benefits. It began operation in 1912, and applied to 2,500,000 per sons, or one sixth of all the wage-earners. The contribu tions are made as follows: % by employers, % by wage-earn 8 Ch. 23, ft 12-19.
ers, and % by the state. The application of the law was ex tended in 1916 to workmen engaged in any of the war indus tries. There are several original and interesting features of the act, such as rewarding, by the refunding of dues, those employers who provide regular employment, and older work men who have received benefits amounting to less than their contributions. Its administration in close connection with the labor exchanges is giving valuable experience in this field. The working out of the many minor problems of clas sification, assessment, and administration of unemployment insurance will require many years of experimentation.