9 years and no occupational disease insurance

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Estonian policy-makers and stakeholders can't find the opportunity to introduce work accident and occupational disease insurance (WOI). The first version of the law was drafted in 2001 already, but it was stopped six years ago. Most stakeholders have already approved the main policy ideas, but there are yet some disagreements on technical details. Also, the current difficult economic situation makes it hard to take decisions which involve new costs.

Purpose of health policy or idea

Estonia has a similar demographic situation as most European countries: the population is aging and the share of people of working-age is decreasing. In order to guarantee economic stability, it is significant to preserve the working capability of the working-age population and to avoid a loss of health through work. It is necessary to prevent work-related accidents and occupational diseases but also to deal effectively with the causes. Actuating WOI hopefully motivates employers to improve the working environment and assures legal and fair protection for the victims of work-related accidents and occupational diseases .

Main points

Main objectives

Initially, the implementation of public law-based WOI was lead by the Ministry of Social Affairs who worked out a draft act of WOI in 2001, but this was stopped in 2003. The Ministry of Social Affairs and the Ministry of Finance issued a document analyzing the expected impacts of WOI implementation on working labour politics, the working environment and labour force costs. As a proposal for compulsory WOI based on private insurance, this was presented to the government in 2006.

It is based on the following conditions:

• All employers have the obligation to offer insurance;
• The rate of insurance payment depends on the employer's risk rate, working environment and other conditions;
• No cross-subsidies;
• The interest to pay less insurance payments motivates employers to invest into improving their working environment. This helps to prevent work-related accidents and occupational diseases.

The main objectives of implementing the WOI are:  

• to decrease the incidence of work accidents and occupational diseases through effective prevention activities at work places
• to protect employees' income levels after a work accident or occupational disease has occurred
• to ensure equal rights and benefits for employees in situations of work accidents or occupational diseases
• to ensure aid to employees for rehabilitation and quick return to work after work accidents and in case of occupational diseases
• to ensure the financial sustainability of employers.

Type of incentives

WOI implementation definitely increases both employers' labour costs and state budget costs. But in a long-term perspective it is expected that the benefits outweigh the costs by bringing along improvements in population health, lessening employers' financial risks and guaranteeing monetary and social benefits in case of work-related accidents and occupational diseases to victims.

The monetary stimulus is connected with politics - saving public money. The financial risk of consequences of work-related accidents and occupational diseases is shifted to employers, which then would insure themselves against it.

The non-monetary stimulus is creating a feeling of safety in coping with work environment diseases, leading to the existence of social guarantees and the improvement of population health.

Groups affected

Employers, employees

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Politicians have been in favor of actuating WOI but so far, the different interest groups have not been convinced or motivated to implement it. Due to the current difficult economic situation, different interest groups are against any laws causing additional tax costs. The changes in government have led to the discussions starting all over again and standpoints are changing.

The current minority government (a coalition of the lliberal Reform Party and the conservative Pro Patria and Res Publica Union) has dropped the promise of its predecessing coalition, which also contained Social Democrats. The plan foresaw "creation of WOI without increasing employers taxes rate", but it is obvious that a private, insurance-based, compulsory WOI system would not have been implemented by keeping that promise.

 

 

Political and economic background

Most expenses and incomes of work-related accidents and occupational diseases are covered by health insurance (Estonian Health Insurance Fund - EHIF) and by the social insurance (Social Insurance Board - SIB) budget.

EHIF pays a sickness allowance in case of temporary incapacity to work, compensates for medical treatment and partially for medicines. The Social Insurance Board pays the incapacity to work pension, disability allowance and survivorship allowances. In case of work-related accidents and occupational diseases, EHIF's compensation rate is 100%. Until 2003, per court adjudication the Estonian Health Insurance Fund had a right to demand 20% of costs back from employers (gap between 100% rate and 80% rate in case of general illness). Later on, all work-related accidents and occupational disease benefits have been fully covered by the Estonian Health Insurance Fund without any participation by employers.

In some cases either through court adjudication or voluntarily, employers also pay some compensation for work-related accidents or occupational diseases. Until 2005 victims had a right to get benefits according to the occupational health and occupational safety laws of the Estonian government. Since 2006, victims have a right to get benefits for health impairment according to the law of obligation, which implies a court verdict. For smaller companies, the compensation of work-related accidents and occupational diseases has a financial risk because it can cause the employer to go bankrupt. In case of company bankruptcies the obligation to pay benefits goes over to the state, causing extra expenditures. Employers have the possibility to buy work-related accident and occupational disease insurance (WOI), but since it is not regulated by legislation and it is considered a special benefit, employers tend not to use this insurance product.

The current system of work-related accident and occupational disease benefits does not motivate employers to improve their working environment. Estonia does not fulfil minimum requirements of the European social insurance codex because in some cases victims have to partially finance treatment expenses themselves which is not suitable in case of work-related accidents. In Estonia such expenses are for example visitation fees, daily costs for beds, rehabilitation, care and dental care fees. There are no medical rehabilitation services evolved. The calculation and indexing of benefits is not regulated by law, and there are cases when the legal person responsible for the damage has gone into bankruptcy or has been suspended.

WOI systems have been efficiently functioning for decenniums. Comparing average indicators of work-related accidents and occupational diseases to European Union member states, the number of registered cases are several times smaller in Estonia due to under-registration of mild work related accidents and coding work related diseases as domestic injuries or common chronic diseases, whose treatment and rehabilitation costs are paid for by the health insurance fund.

Based on European Union member experiences it is fair to believe that an insurance system of work-related accidents and occupational diseases would promote a more reliable occupational disease registration level by motivating employers and employees with economic incentives, which in turn is expected to lead to the implementation of more adequate prevention mechanisms not only preventing work accidents but also avoiding occupational diseases.

Family physicians are not educated to diagnose occupational diseases and occupational health physicians are not involved in diagnosing occupational diseases in Estonia. The law of occupational health and occupational safety does not specify who has to pay expenses for diagnosing. There are not enough occupational health physicians in Estonia and most of them are located in Tallinn. According to EU experiences (1 occupational health physician per 1400-1600 employees), Estonia obviously needs more occupational health physicians in order to make occupational health service more accessible.

Initially, the implementation of public law-based WOI was lead by the Ministry of Social Affairs who worked out a draft act of WOI in 2001, but it was stopped in 2003. The Ministry of Social Affairs and the Ministry of Finance issued a document analyzing the expected impacts of WOI implementation on working labour politics, the working environment and labour force costs, and as a proposal for compulsory WOI based on private insurance it was presented to the Government in 2006. When the decision to implement compulsory private insurance was made in 2006, the Ministry of Finance was leading the drafting process of WOI basic principles and arranging discussion between representatives of interest groups (employers, employees).

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

 

Initiators of idea/main actors

• Government

• Payers

• Patients, Consumers

• Private Sector or Industry

• Media

• Others

• Political Parties

Stakeholder positions

Employer's representatives have recently made a statement to the government to express their disagreement with compulsory private insurance under the conditions of economical recession. Based on the practice of countries were private insurance companies are involved in mandatory insurance systems of work-related accidents and occupational diseases, the employer representatives claim that a pre-financing system of insurance causes a 2-3 % increase of labour costs and in more harmful positions even a 8% increase.

The Association of Employers suggests that the government finds another means to increase the guarantee for victims of work-related accidents and occupational diseases, for example to increase the employers' motivation to improve the working environment. For example, special benefits for improving employees' health conditions including voluntary insurance payments could be free of taxes.

The government is interested in keeping its promises to the European Commission to prepare the law of work-related accidents and occupational diseases and guarantee fulfilling the minimum requirements of social insurance codex. But implementing WOI has been strongly influenced by the economic situation in Estonia as well as the standpoints of different interest groups.

Politicians have been acknowledging actuating WOI but so far different interest groups have not been convinced and motivated yet to implement it. Due to the hard economical situation, different interest groups are against any laws causing additional tax costs. With a change in government, the discussions start all over again and standpoints are changing.

Incoherent government strategies in implementing this policy have led to a situation where the decision on WOI is strongly dependent on the current economic situation. It has furthermore led to long years of arguing over the options of WOI as a public law versus as a private insurance system.

There is an interest to lessen the financial risks linked to employers compensating work-related accidents losses, but the fear of increasing labour costs by introducing a WOI system is greater.

The necessity of WOI as a mean to guarantee a fast and fair benefits system to victims and give employers concrete monetary stimulus to create a healthier and more secure working environment has been repeatedly pointed out by the Estonian Employer`s Confederation. But employers seem to prefer a public law solution. They fear that the interest of private insurance companied is earning profits, thereby causing employers larger expenses.

Actors and positions

Government
Ministry of Social Affairs	very supportive		strongly opposed
Ministry of Financial Affairs	very supportive		strongly opposed
Government	very supportive		strongly opposed
Payers
Employers	very supportive		strongly opposed
Patients, Consumers
Employees	very supportive		strongly opposed
Private Sector or Industry
Companies	very supportive		strongly opposed
Insurance companies	very supportive		strongly opposed
Media
Media	very supportive		strongly opposed
Social Partner Organisations
Confederation of Estonian Trade Unions	very supportive		strongly opposed
Estonian Employer`s Confederation	very supportive		strongly opposed
Political Parties
Reform party	very supportive		strongly opposed
Central party	very supportive		strongly opposed
Pro Patria and Res Publica Union	very supportive		strongly opposed
Social democratic party	very supportive		strongly opposed

Influences in policy making and legislation

Currently , there is only a concept of the idea. If the government decides in favour of it, a law will be written by the Ministry of Financial Affairs.

Legislative outcome

n/a

Actors and influence

Government
Ministry of Social Affairs	very strong		none
Ministry of Financial Affairs	very strong		none
Government	very strong		none
Payers
Employers	very strong		none
Patients, Consumers
Employees	very strong		none
Private Sector or Industry
Companies	very strong		none
Insurance companies	very strong		none
Media
Media	very strong		none
Social Partner Organisations
Confederation of Estonian Trade Unions	very strong		none
Estonian Employer`s Confederation	very strong		none
Political Parties
Reform party	very strong		none
Central party	very strong		none
Pro Patria and Res Publica Union	very strong		none
Social democratic party	very strong		none

Positions and Influences at a glance

Adoption and implementation

Since it was decided in 2006 to implement compulsory private insurance, the Ministry of Finance has been leading the drafting process of WOI basic principles and arranging the discussion between representatives of interest groups of employers and employees.

The previous government was planning to implement WOI in 2010, but under the current economic situation (unemployment rate at 15% and  expected to remain very high for a few more years) this has been postponed to an unforeseeable future.

 

Monitoring and evaluation

 

Results of evaluation

 n/a

Expected outcome

WOI implementation would definitely increase both employer's labour costs and state budget expenditure. However, in a long-term perspective the benefit outweighs the costs. WOI would bring along improvements in population health, would lessen the employer's financial risks and guarantee monetary and social security for individuals in case of work-related accidents and occupational diseases.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

 

References

Sources of Information

• Malberg, K. Increase costs waiting firms. Äripäev. August 24, 2000. www.ap3.ee/Default2.aspx?PaperArticle=1&code=1747/uud_uudidx_174720
• Taliga, H. Social insurance never-ending pooling dilemmas. September 26, 2000. http://ettk.tooandjad.ee/et/kommentaarid/2000/09/item17448
• The Parliament of Estonia. Draft act of law. Work accident and occupational disease insurance. 2001. http://roller.riigikogu.ee/orb.aw/class=site_search_content_grp_fs/action =showdoc&op=roller/id=199/doc=b8915b8ba3c01a5279533e41bc181a33/ 010750004.html
• The Parliament of Estonia. Change estimates. Work accident and occupational disease insurance. 2001. http://roller.riigikogu.ee/orb.aw/class=site_search_content_grp_fs/action= showdoc&op=roller/id=219/doc=ea97dc8c09d16e551d1d7dcf945570a7/ 020290028.html
• Rank, S. Increase in social costs would hit Estonian business climate. Payment increase waiting firms. Äripäev.
• May 2, 2002. http://bbn.ee/Default2.aspx?ArticleID=5b27fff7-9a64-42a3-92b0-d4e0f3c9aa68
• Estonian Employer`s Confederation. Employer's proposals about standpoints for work accident and occupational disease insurance not find supports for social partners. Press release. May 16, 2002. http://ettk.employers.ee/et/uudised/2002/05/item19344
• The Parliament of Estonia. Shorthand report. Interpellation Europe social insurance codex. 2003. http://web.riigikogu.ee/ems/stenograms/2003/12/t03121512-04.html
• Confederation of Estonian Trade Unions. Work accident and occupational disease insurance is need. Press release. March 26, 2003. www.eakl.ee/uudised/0303261.htm
• Ministry of Social Affairs. Plan for development Estonian working environment health. 2003. http://osh.sm.ee/legislation/arengukava.htm#strateegia
• Sihver, R. In Estonia failing occupational disease insurance. The Labour Inspectorate of Estonia. September 5, 2005. www.ti.ee/index.php?article_id=686&page=56&action=article
• Ibrus, K. Occupational victims need insurance support. Eesti Päevaleht. July 19, 2007. (Also available online at www.hrm.ee/?p=1234)
• Kirch, M. and Naaber, H. Work accident and occupational disease insurance in Europe Union countries.
• Economics and Social information Department of Parliament. March 27, 2008. www.riigikogu.ee/doc.php?49669
• Pikhof, H. Why deny work accidents and occupational diseases. Tartu Postimees. May 14, 2008.(Also available online at www.ti.ee/index.php?article_id=1471&page=56&action=article)
• Estonian Employer`s Confederation. Employers Confederation standpoints about illness benefits, payment rates for unemployment insurance, work accident and occupational disease insurance. Press release. March 24, 2009. www.employers.ee/et/pressile/seisukohad/7863
• Estonian central party. Political programs. http://www.keskerakond.ee/erakond/programm/
• Estonian reform party. Government coalition program 2007-2011.
  www.reform.ee/ee/reformierakonnast/valitsemine-valitsus-parlament-riigikogupeaminister/koalitsioonileping
• Telephone interviews: Tõnu Vare - Public relations specialist of Labour Inspectorate and Mare Jõeorg - Chief specialist of Social Security Department in Ministry of Social Affairs

Reform formerly reported in

Implementing work accident and illness insurance Process Stages: Policy Paper

Author/s and/or contributors to this survey

Lii Pärg, Ain Aaviksoo

Suggested citation for this online article

Pärg, Lii, Ain Aaviksoo. "9 years and no occupational disease insurance". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/ee/a14/5