The emergence of compulsory health insurance (CMI) is associated with the development of handicraft production in medieval Europe. Artisans were a group of the population that could not provide themselves with medical care by private payment due to the increase in the cost of medical services and could not count on state and charitable assistance, since they did not belong to the poorest segments of the population.

In the 17th century, artisans in Germany organized the first insurance (hospital) funds or mutual funds, which, in addition to medical (hospital) insurance for artisans and their families, also provided protection in other cases related to the social insurance system in our time.

Health insurance originated as voluntary public insurance, and insurance funds were public organizations. Such insurance organizations spread in the nineteenth century in most European countries.

But they received the greatest development in their historical homeland, in Germany.

With the development of capitalism, the artisans’ funds were replaced by the insurance sickness funds of hired workers, whose funds were formed from the contributions of workers and employers. The sickness funds were still public organizations.

The sickness funds were managed by general meetings of members of the sickness funds, which included representatives of workers and entrepreneurs, the meeting elected the board that organized the work of the fund.

The experience of the insurance sickness funds later, under the reign of Chancellor Otto Bismarck, became the basis for creating a system of state social insurance. This system in Germany was regulated by three main laws:

– July 15, 1883 “The law on insurance of workers on the occasion of illness”;

– July 6 , 1884 “Act on the insurance of workers against accidents”;

– June 22, 1889 “Insurance Act for Disability and Old Age.”

The main reasons for the adoption of these laws were:

a) industrialization and growth in the number of hired workers;

b) exacerbation of social problems;

c) the growth of the labor movement.

The social security laws in Germany gave rise to a health care system called “insurance medicine” or the “Bismarck System” after the German Chancellor.

The healthcare organization system began to be based on three sources of funding: the state budget

zhet, obligatory contributions of workers of hired labor and employers.

In most European countries, similar laws were passed between 1883 and 1912,

In 1911, the “State Insurance Rules” were adopted in the German Reich. They were included in the consolidated “Law on Social Insurance”, which included all types of insurance: in case of illness, accident, disability, old age.

This law was interrupted by the First World War. Social insurance was revived in Germany in the difficult post-war years in the Weimar Republic and was preserved even during the period of fascism. At this time, the stimulation of the birth rate and the social security of the participants in the war became priority areas of social insurance.

In the postwar years, the traditional social insurance system began to revive in Germany. In the mid-70s, before the unification of Germany, the level of social insurance was quite high. With the entry of the Eastern Lands into the FRG, new problems appeared in the field of social and health insurance related to certain economic difficulties and the need to extend the social insurance and health care system of the FRG to the Eastern Lands.

The stages of development of health and social insurance in Germany until the early 1950s are typical of many other European countries.

There are three stages in the development of health insurance:

ХVН-ХIХ centuries. – the emergence and development of voluntary medical insurance (VHI) as a social movement of artisans and hired workers, the formation of insurance organizations for workers – sickness funds.

– 1883-1914 (1917) — adoption of insurance laws in most European countries, formation of a system and bodies of compulsory social health insurance.

– from 1917 to the present – the development of various types and forms of organization of health insurance in accordance with the needs of health care systems in various countries.


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