Patient Funds and Their Legal Status Through the Prism of the Historical Experience of the Precarpathian Region (1919–1939)
The author based her research upon the archival and other historical documents, by means of which the author deduced the peculiarities of the legal status of hospital sickness funds operating in the Precarpathian Region during the period of the Second Polish Republic (II Rzeczpospolita Polska) in 1919-1939, as a prototype of medical insurance. Those days, healthcare services were considerably impacted by a frequent change of social-economic formations, a complicated social-political situation and the transition of the Precarpathian region from one state jurisdiction to another in the early 20th century. In Western-Ukrainian lands, the first medical insurance institutions were founded as early as 1889, when the Austrian-Hungarian Empire began a transition towards a system of compulsory medical insurance following the an analogous system in Germany. Historically, this system of compulsory medical insurance received the name of “Bismarck’s system of healthcare”, or insurance medicine. Subsequently, in 1919-1939, the Polish Government developed a healthcare system in the subordinated Western-Ukrainian regions (including the Precarpathian Region), which was founded upon the Austrian-Hungarian model.
Upon the Heading Sanitarian Law, which went into force on July 19, 1919, the highest authority in the sphere of sanitary hygiene and medicine was vested upon the Ministry of Public Health, which initially had to combat a considerable problem in the hypostasis of a lack of budget funds to fulfill the necessity of providing high-qualified healthcare to all the inhabitants of the region, as the state could provide funding only in case of emergency, or for combatting epidemics. In order to involve additional funding for developing the system of healthcare, it was decided to return to the practice of using hospital sickness funds, the operation of which was founded upon contributing insurance premiums to protect the workers in case of casualties, diseases, or a loss of working capacity. The first Polish normative-legal act creating and defining the functioning of the system of hospital sickness funds was the Presidential Decree “On compulsory medical insurance in case of sickness”, declared by the President Josef Pilsudski on January 11, 1919, founded upon German legislation. Subsequently, in order to involve additional funding for the development of the system of healthcare, the Polish Seim adopted the law “On social security in case of sickness” on May 19, 1920, which promulgated the order of founding and functioning of medical insurance funds in the shape of hospital sickness funds, as a prototype of insurance medicine.
The municipal or county hospital sickness funds, which were founded earlier – during the reign of the Austro-Hungarian Empire, had a right to continue their work provided they adjusted their statutes in accordance with the newly adopted law. The hospital sickness funds, according to their statutes, could acquire rights and obligations and had a right to be a plaintiff and defendant in a court, and bore legal responsibility with all of its property. Hospital sickness fund had a right to found its own subdivisions, which were subordinated to it, had a right to acquire and build hospitals, and to involve additional funding to fulfill its statutory tasks. The author deduced the legal status of the hospital sickness funds according to the analysis of its founding documents, and the statute, as the basic one.
The documents, possessed by State Archive of the Ivano-Frankivsk Oblast on the operation of the Stanislav Voivodeship in 1919-1939, also include the statutes of the county hospital sickness funds, namely the hospital sickness funds of Dolyna, Tlumach, Nadvirna, Kolomyua, Snyatyn, Kalush, and the texts of the afore-mentioned county sickness funds have become the subject of the research. The hospital sickness fund statute, as a model statute, contained 10 chapters, which contained 113 paragraphs in overall accordingly. The chapters were usually designated as follows:
- Chapter 1: the name and the location (para. 1-4);
- Chapter 2: the conditions of membership in the hospital sickness fund (para. 5-17);
- Chapter 3: hospital sickness fund members’ premiums (para. 18-25);
- Chapter 4: insurance cases (para. 26-59);
- Chapter 5: funding (para. 60-78);
- Chapter 6: financial regulation (para. 79-84);
- Chapter 7: the governing bodies (para. 85-109);
- Chapter 8: the concluding provisions (para. 110-111);
- Chapter 9: the control of the state (para. 112);
- Chapter 10: the entry into force of the statute (para. 113)
In overall, the adoption of the system of insurance in the case of illness had its positive effect: the workers had an opportunity to receive high-qualified medical care, but at the same time, it had a number of drawbacks. Foremostly, the majority of citizens who lived in the villages could not use the said system, as they had no opportunity to pay premiums to the hospital sickness funds. What is next, a bureaucratical apparatus in the sphere of healthcare with all its features (i.e. funding delays, paperwork) was created. These and other problems of hospital sickness fund operation brought to the reformation of social insurance in March 1933, which consisted in the replacement of hospital sickness funds with insurance companies and the foundation of the institute of social insurance as the regulator of the national system of insurance. The authorities of Poland adopted a law “On Social maintenance”, which promulgated insurance in the case of illness, maternity, loss of working capacity owing to a disability or the death of the insured. According to this law, the newly established insurance companies had to operate upon the foundations similar to those of the hospital sickness funds, and the principles of their self-governance, independence and organisational autonomy were formally preserved. All of the afore-mentioned measures provided a foundation for the formation of the sphere of healthcare services for the citizens. At the same time, no considerable changes in the conditions of the healthcare of Stanislav Voivodeship occurred. The Precarpathian region remained one of the most backward and medically incomplete provinces both under the reign of the Austro-Hungarian Empire and the II Rzeczpospolita Polska. The existing insurance medical system, represented by hospital sickness funds, did not encompass all the strata of the population, and high medical fees did not facilitate for the accessibility of healthcare services. The author of the paper has deduced that the contemporary domestic experience, though not a considerable one displays that the peculiarities of the legal status of the hospital sickness funds, which operated in the Precarpathian region during the reign of the II Rzeczpospolita Polska (1919-1939), as a prototype of contemporary medical insurance, have an appropriate potential for using a positive historical experience and the comprehension of the problem of state regulation of healthcare activities. The author clarified that the legal status of hospital sickness funds is reflected in the founding documents, especially in the hospital sickness fund’s statute. The analysis of the afore-mentioned documents allows to define the peculiarities of the regulation of the hospital sickness funds’ activity while interacting with the society and the state, and the surplus of the rights and obligations of both the hospital sickness fund itself and its members. The vision of the present day through a peculiar prism of the past facilitates for a better understanding of administrative processes and decisions, and helps to comprehend the internal life of a certain historical period with its features and notions. This vision also provides for a better understanding of the contemporary state policy relating to the development of an efficient system of healthcare services and medical insurance.
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