Existing systems of social health insurance may be divided into two groups — voluntary subsidized insurance in five countries (Den mark, Belgium, France, Sweden and Switzer land) and compulsory health insurance, which until now has been legislated in 10 European countries, chronologically arranged as. follows: Germany, 1884; Austria, 1888; Hungary, 1891; Luxemburg, 1901; Norway, 1909; Serbia, 1910; Great Britain, 1911; Russia, 1912; Rumania, 1912; Netherlands, 1913. In addition many other countries have compulsory health insur ance systems for specific industrial groups (particularly mining, railroad and navigation). Compulsory social health insurance has there fore become the predominating form of health insurance for wage-workers.
Under the subsidized form, it. is the effort of the state to stimulate the voluntary co operative efforts through offers of financial aid from the public treasury. These subsidies were very slight in Belgium and France, somewhat higher recently in Sweden and substantial in Switzerland pod Denmark; in the latter coun try represent nearly one-third of the total cost of insurance. The effect of the subsidies in stimulating insurance is roughly proportionate to the amount of subsidy; Denmark showing the greatest effect, so that nearly 30 per cent of its population is insured.
Compulsory Health Insurance.— It is ar gued in favor of the compulsory method, first introduced on a large national scale in Germany in 1884, that only through compulsion can the neediest and poorest of the wage-workers be brought under and kept under the insur ance system, and moreover that only, through compulsory system can a part of the cost of the system be placed upon the employers and industry. The rapid extension of the compul sory type of legislation, especially since 1909, seems to indicate a general conversion to this point of view in Europe. It is understood that but for the European War, several ether countries would have been ready to introduce compulsory health insurance systems, and it is generally recognized that at least as far as health insurance is concerned, the compulsory principle has won among expert students of the problem after 25 or 30 years of experimenta tion in Germanic countries.
Though the 10 compulsory health insurance acts differ considerably in the various details, they agree more or less in certain substantial features. The compulsion is usually made
applicable to wage-workers or employed persons within certain income standards. It is not con sidered necessary to include persons in com fortable circumstances; and persons without an employer are too difficult to keep under the system. For the same or other reasons cer tain wage-groups are omitted. In all the 10 systems the employer is required to contribute a part of the cost, though the exact amount differs from one-third in Germany to one-half in Hungary. The justification for such con tribution from the employer is found partly in the responsibility of industry for a certain por tion of the illness among the employees, partly in the responsibility of industry to pay a living wage to the employee, and the recognition that support during, and care of, sickness must some how come out of the wage, and finally in the consideration that the increased efficiency aris ing from proper care of the employee will more than compensate the employer for the cost.
The state contribution to compulsory, health insurance is a comparatively new principle, though it constituted the backbone of the tsub sidized voluntary insurance.) Norway made the first effort to include the state subsidy into the compulsory system, but the most important application was found in the British Act of 1911, where the state assumed two-ninths of the total cost, and in addition furnishes various numerous supplementary subsidies, which prob make the state subsidy equal to about one third of the whole cost.
Benefits.— The benefits furnished by the va rious systems vary in detail, but on the whole follow fairly well-defined standards. The es sential two benefits are a weekly allowance and medical aid. The Holland Act of 1913 is the only one which furnishes no medical aid. The weekly benefit is usually fixed on the terms of a percentage of wages (50 to 663i in various acts, 70 in Holland) but the British act deviates from this in establishing a uniform benefit rate of 10 shillings for men and 8 shillings for women. The duration of these weekly benefits is usually determined at 26 weeks, and thus a line of demarcation is drawn between sickness and chronic invalidity and disability. The British act compensates for invalidity as well, but at a different scale, and after the expiration of the ordinary sickness benefit.