HEALTH SINCE 1945: INSTITUTIONALIZATION PERIOD, PART 6
SOCIAL SECURITY IN BULGARIA /1945-1989/
Basic Principles and Historical Evaluation.
Social security was first introduced in Bulgaria immediately after the Liberation from Ottoman rule in 1878. At first the social security scheme covered only civil servants as there was a strong desire to consolidate the Bulgarian State. The Turnovo Constitution of 1879, the first Bulgarian Constitution, stipulated that 'civil servants appointed by the Government are entitled to pensions the size of which will be fixed in a stated manner'. With a view to legally regulating the social security scheme, laws on pensions were voted on covering disability pensions, retirement pensions and pensions paid to dependants. Those entitled to these pensions included the military, administrative and police officials, teachers, ministers, clergymen, civil servants and those holding elective posts. The bourgeois State excluded the working-class people from social security, which was the privilege of certain classes. Retirement pensions paid to the military were extremely high. The aim was to prevent civil servants and municipal workers from waging an organized struggle for better working and living conditions and from carrying out joint actions with the workers. When setting up their first trade union organization, workers from the private sector established mutual-aid funds to cover the event of unemployment, sickness and death. This voluntary trade union security failed to provide the necessary social security against labour risks.
The Bulgarian proletariat launched an organized struggle for mandatory social security for workers, a struggle which achieved the first results, whereby the State was compelled to establish mutual-aid funds and friendly societies. An important role in the proper direction of the workers' demands was played by the Bulgarian Workers' Social Democratic Party which, in the programme adopted at its first congress in 1894, demanded social security for workers as well. A law was adopted in 1905 regulating female and child labour in industrial enterprises and a social security scheme was introduced to cover sickness and industrial injuries for workers from the public building enterprises. The raising of the revolutionary spirit of the working people as a result of the victorious Great October Socialist Revolution, and of the hard conditions on the battle front during World War I led to the introduction in 1918 of compulsory social security covering industrial and office workers in the event of sickness and industrial injuries. The sickness insurance was confined only to low-paid workers, those receiving up to 2,400 levs annually. Provisions were made for treatment of up to six months with the sick person receiving, from the third day of falling sick, compensation amounting to three quarters of his or her monthly wages when treatment was given at home. In the event of hospital treatment, the corresponding proportion was 50 per cent of the respective wages. The insurance against industrial injuries came to cover, for the first time, all workers and employees at state, public and private enterprises and establishments irrespective of their age, sex, nationality and form of pay. The principle of vocational risk was recognized. It required that the insurance contributions be paid by the respective enterprise, with full compensation being given in the event of any kind of industrial injury, and there was no need to prove who was to blame for the labour accident. Those who suffered industrial injuries were allotted pensions in a statutory way rather then through the court. In 1920 the pensioning scheme covered 62,000 people but insurance was poorly organized and inadequately financed. Under the conditions of the organized struggle of the workers, grouped in powerful trade unions led by the Bulgarian Workers' Party after the suppression of the world's first anti-fascist uprising of September 1923, the bourgeois Government was compelled to initiate a workers' social security scheme. As a result of the 1924 social insurance act, an insurance scheme was introduced covering industrial injuries, occupational diseases, sickness and maternity, disability and old age. An unemployment insurance system was initiated in 1925, while from 1941 onwards insurance came to cover private craftsmen, and from 1943 onwards it included merchants as well. The contributions for the 'labour injury" insurance were paid by the employers, while the contributions for the rest of the insurances were shared equally by those covered by the insurance scheme, the employers and the state.
Bulgaria's experience in introducing insurance for private farmers in 1941 was interesting. That insurance originally covered only men, and from 1946 on women as well. The retirement age for men was 60, for women 55. The size of pensions was not very high. Under the conditions of capitalist development social security was incomplete arid financially unstable, and the size of pensions was insufficient. Social security in those days was characterized by various financial irregularities and bureaucratic administration.
After 9 September 1944 social security became part of Bulgaria's social policy. It was aimed at promoting the working people's health and at raising their living standard. From the first years of the popular regime it was placed on solid foundations. In 1949 all social security schemes were overhauled and were administered by a unified State Social Security Institute. In 1951 free medical care was introduced throughout the whole country and a Labour Code was adopted, regulating state social provisions. Since 1957 pensioning has been regulated by a law, which is still in force, although some amendments and additions have been made to it.
The right to social security is guaranteed by the Constitution. The main principles underlying social security may be summed up as follows: to protect all the working people (all people engaged in socially useful work are covered by the insurance scheme), that is, workers, employees and co-operative farmers who are employed under a labour contract, irrespective of what has necessitated such a contract, as well as part-time workers; and servicemen in the Bulgarian People's Army, re-enlisted officers and sergeants, workers and employees on the regular payroll working half a day, those vocationally rehabilitated who are on a shorter working day, Bulgarian citizens working abroad, those working in small-scale private shops and farms, members of households and private persons, foreign workers and employees based in Bulgaria, those serving in the Bulgarian Orthodox Church, masters of arts and crafts, writers, journalists, artists and sculptors; to cover all risks against temporary or permanent incapacity for work due to industrial injuries, occupational diseases, general sickness or injuries other than industrial ones, confinement and maternity, quarantine, infectious disease, attending a sick member of the family, disability, old age and death. The insurance contributions are paid by the respective enterprise or establishment (workers and employers pay no contributions, except freelances). The size of the insurance contributions should be sufficient to enable the working people to maintain their living standard even in the event of incapacity for work. The administration of social security should be handled by the workers. Under a 1960 law this administration was entrusted to the trade unions, the largest organization of working people in Bulgaria.
Social security in Bulgaria is based on the insurance contributions paid by enterprises, establishments, cooperatives and public organizations. These contributions are deducted from the wage fund and are paid out of the funds of enterprises and establishments. There has been a great increase in the size of these deductions. This is due to the extension of the population's rights to insurance, mainly through the increase in the size of child allowances, compensation and pensions, and through the extension of maternity leave. In 1973 these contributions amounted to 12.5 per cent, in 1974 the proportion was 20 per cent and in 1980-30 per cent. Social security in Bulgaria is based on the principle of the pure system of distribution. Current expenditures are met by current revenues. No reserves for meeting future payments are formed. Any surplus at the end of the year is deposited in the State Budget, thus restoring any deficit, hence the financial stability of social security in this country.
Insurance in the Event of Temporary Incapacity for Work.
This covers workers who are unable to work because of sickness, industrial injuries, occupational diseases, balneological treatment, urgent medical examinations, quarantine, suspension from work on medical advice, attendance of a sick member of the family, the accompanying of a sick man to a hospital situated in another area, or treatment abroad; and for women workers and employees - in the event of pregnancy, confinement, or maternity leave. Temporary incapacity for work must be certified by the doctor in attendance when it lasts up to twenty days, and by a medical team when its duration is over twenty days. The amount of compensation for temporary incapacity for work due to sickness, accidents other than labour ones, quarantines, for attending a sick member of the family (not including children up to the age of seven) depends on the uninterrupted length of service of the person involved and is calculated as a percentage of the nominal labour remuneration during the month preceding the onset of the incapacity for work. The percentages are differentiated and depend on the number of years worked: 70 per cent of those with ten years of service, 80 per cent for people with service of between ten and fifteen years and 90 per cent for a service of over fifteen years. When temporary incapacity for work continues for more than fifteen days, the size of the compensation after the fifteenth day is 80 per cent, 90 per cent and again 90 per cent, respectively. The compensation for attending a sick child up to the age of nine is 100 per cent of the nominal wages, and for temporary incapacity for work due to industrial injuries and occupational diseases - 90 per cent. In both these cases the size of the compensation does not depend on the number of years worked. Temporary incapacity for work due to sickness and industrial injuries is considered to have begun from the first day of its onset and runs until the day the person involved is proved to be fit for work again, unless permanent disability is certified, in which case a disability pension is granted. In cases of quarantine, compensation is paid as long as the person involved is under quarantine. When someone is suspended from work for suffering from an infectious disease, for being a germ carrier, or for having been in contact with people suffering from contagious diseases, compensation is paid for 90 days. The duration of the compensation for attending a sick member of the family is ten calendar days per calendar year for each insured person. When attending a sick child under the age of sixteen, or when accompanying him or her to another area for the purpose of undergoing treatment or medical examinations, or when accompanying him or her abroad for the same purpose, the accompanying mother or father is entitled to compensation for up to 60 calendar days per calendar year. In the event of balneological treatment the compensation paid covers the whole period of treatment, plus three days travel allowance to and from the spa.
Insurance in the Event of Pregnancy, Confinement and Care of Young Children.
In 1944 the number of people covered by insurance was 54,000, while in 1982 the corresponding figure was 2 million. Paid leave has been extended and the size of compensation has been raised to 100 per cent of the basic labour remuneration. Insurance coverage may be summarized as follows:
1. Vocational Rehabilitation of Expectant Mothers. With a view to preserving the health of expectant mothers and to ensuring normal pregnancy, every mother-to-be working in conditions harmful or arduous to the pregnancy is transferred to another lighter job corresponding to her health condition and qualifications. A special commission made up of the respective administrative manager, the chairman of the trade union, or trade union representatives, a representative of the Inspectorate of Hygiene and Epidemiology and a doctor from the maternity health centre defines the place of work and posts expectant mothers should not occupy and those to which they can be transferred. This vocational rehabilitation begins from the day pregnancy is confirmed. When the income of expectant mothers has fallen as a result of vocational rehabilitation, the balance of the average monthly nominal wages received during the previous twelve months is restored out of the social security fund. Vocational rehabilitation is carried out on the basis of a medical certificate issued by the respective doctor. It gives the duration of that rehabilitation and the kind of job the expectant mother is capable of doing. Once back to work after the delivery, mothers are entitled to the same job they have held before their vocational rehabilitation.
2. Maternity Leave. All women covered by the insurance scheme are entitled to paid maternity leave. This applies to all those who have been employed, even only for one day, before going on maternity leave (which begins 45 days before confinement). They too are covered by the insurance scheme and are entitled to cash compensation. Seasonal and other women workers who are not permanently employed are also covered by the insurance scheme. They are required to have been employed for seven consecutive days before going on maternity leave. Mothers enjoy 120 days of paid maternity leave for the first child, 150 days for the second, 180 days for the third and 120 days for each subsequent child. Forty-five days of this leave are given before delivery. Throughout the maternity leave mothers receive cash grants equal to 100 per cent of the nominal wages they have received during the preceding month before going on leave (which is not less than the wage scale and not higher than 120 per cent of that same scale). Adoptive mothers, too, are entitled to the same maternity leave.
3. Paid Leave for Looking after Young Children. If after the paid maternity leave the child is not placed in a nursery or a child-care establishment (this is done of the parents' own free will), mothers (adoptive mothers included) enjoy an additional leave of six months for the first child, seven months for the second, eight months for the third, and six months for each subsequent child; as of 1 July 1985 this leave is extended to 24 months. During that leave mothers receive cash grants equal to their minimum wages, which are fixed throughout the country, and amount to 110 levs a month. When mothers do not wish to take such leave and prefer to return to work, as well as their wages they also receive 50 per cent of the cash grants given to mothers on leave for looking after their children. If a mother (or an adoptive mother) on maternity leave, or on leave to look after her child, is taken ill or dies, the cash grant for looking after the newborn baby is given to the father or to another relative. In addition, mothers enjoy additional unpaid leave until the child is three years old. During that leave they receive ten levs a month in the form of a cash grant. The maternity leave and the leave for looking after the child is not considered an interruption of the length of service, and their jobs are held for them until the child is three years old.
Student mothers are entitled to a 90 lev cash grant per month. This grant is given to them for ten months for the first child, 12 months for the second child, and 14 months for the third child. A decree of the Central Committee of the BCP and the Government, issued in April 1984, provides for this leave to go up to 24 months, irrespective of the number of children born, and the grants will be equal to the country's minimum wages. Only full-time students are entitled to this grant, regardless of whether they are studying in Bulgaria or abroad. Student mothers at all higher educational establishments and at special secondary schools receive a grant of up to 80 levs a month after their maternity grants have terminated. When the husband is employed, the student wife receives 50 per cent of the grant, i.e. 40 levs. Mothers who for one reason or another are not employed and do not study are likewise entitled to maternity grants, and to grants for looking after their children. The period is considered as length of service, which is twelve months for the first child, fourteen months for the second child and eighteen months for the third child.
Family Allowances are paid under the 1951 Decree for Promoting the Birth-rate and Large Families. Family income supplements were first paid in Bulgaria in 1941 to state employees only. Under legislation currently in effect, able-bodied persons are entitled to a lump-sum cash grant in the event of confinement, to monthly child allowances, and monthly grants for student families and for those of post-graduate student and conscripts. Lump-sum cash grants for live-born children at the rate of 100 levs for a first, a fourth and each additional child, 250 levs for a second and 500 levs for a third child are paid to all Bulgarian women, regardless of whether they are covered by the social security scheme. Foreign nationals giving birth to a child in Bulgaria are not entitled to cash grants. As a rule it is the wife who draws the maternity grant, though in some specific contingencies it can be drawn by the husband or the guardian. During the period 1970-82 the sum total of maternity grants rose from 17.1 million levs to 24.1 million. The monthly child allowance rate is 15 levs for a first, a fourth and each additional child, 25 for a second, and 45 for a third, so that a one-child family receives monthly a 15 levs supplement, a two-child family 40 levs supplement, and a three-child family an 85 levs supplement, amounting respectively to 15, 40 and 85 per cent of the minimum monthly pay. Child allowances are given until the age of 16.
As of 1 July 1985 the monthly allowances for children are set as: for a second child to 30 levs; for a third child to 55 levs; after the birth of a second child, the monthly allowance for the first child increases from 15 levs to 30 levs. The monthly child-care grants for families of students, post-graduate students and conscripts are 30 levs per child. State allocations for child allowances come second after those for pensions, and have grown from 219.8 million levs in 1970 to 504.7 million in 1982.
As of 1 July 1985 young newlyweds are entitled to state loans for the construction or purchase of a flat, up to the sum of 15,000 levs, without having to pay a deposit, and are allowed up to 30 years to repay it. On the birth of a second child (four years after the birth of the first child) 3.000 levs of the loan are remitted, and of a third child - another 4,000 levs are remitted. Apart from the loan for construction or purchase of a flat, young newlywed couples are entitled to a loan of 5,000 levs for other purposes, to be paid off within ten years. For the birth of a second child within four years after the birth of the first child the entire remaining unpaid part of the loan should be remitted.
4. Other Benefits. An employed person falling into a rectified disability class, but not eligible for a disability pension because of incomplete length of service, and who has been re-posted to a job suitable for his health status, can qualify for financial aid starting from the date of disability, to be paid over the course of three months, if he is graded Class 3 disabled, and over the course of six months-if Class 2 or 1. In the event of the death of a member of the insured person's family, a death grant to the rate of 80 levs is payable to the person paying the funeral expenses; in the event of death through an accident at work the sum is 120 levs. Funds allocated for temporary disability indemnities, and especially those of the child allowances, are continually on the increase.
The Pension Scheme.
Bulgaria's pension scheme is one of the most democratic in the world. Especially increased provision was made for pensions following the April 1956 Plenum of the Central Committee of the BCP. The pension scheme is being systematically improved in compliance with the extensive programme for raising the population's living standards adopted in 1972. Factory and office workers and co-operative farmers come under a unified pension scheme which covers practically all Bulgarian citizens. State expenditure on it keeps growing.
Retirement Pensions. Having completed the specified length of service, the socially insured person of pensionable age is eligible for a retirement pension. The length of service is defined as the time under contract in state, public or co-operative enterprises for which labour remuneration has been paid; for freelances (workers in the arts, journalists, lawyers and others) this is the term during which they have been self-employed, provided they had been paying the necessary contributions. Just as with the length of service, required pensionable age varies with the category of labour. There are three categories in Bulgaria which classify the degrees of hard and harmful labour: Class 1 - very hard and harmful labour, Class 2 - hard and harmful, and Class 3 - labour under normal conditions. In cases where an insured person has worked in more than one of the above-mentioned categories of labour, the rate of his pension is determined according to the class in which he has served the longest. A retirement pension can be claimed under the following terms: Class 1 labour - fifteen years of service, at the age of 50 for men, 45 for women; Class 2-20 years of service, at the age of 55 and 50 respectively; Class 3-25 years of service and at the age of 60 for men, and 20 years of service and at the age of 55 for women. Mothers of five or more children aged eight and over are entitled to a retirement pension after fifteen years of service and 40 years of age in Class 1 labour, and after the same length of service and 45 years of age for classes 2 and 3. Persons of pensionable age not having completed the specified length of service may qualify for a retirement pension with reduced rates, proportional to the length of service they have completed. For those under pensionable age each year of service above the term specified in the Law on Pensions brings an addition of up to 2 per cent to the basic retirement pension; the total rate of such additions cannot, however, exceed 12 per cent. Persons having reached the required pensionable age and completed the specified length of service are entitled to a 6 per cent addition to their basic pension for each extra year of service. The rate of the retirement pension is based on the average nominal monthly pay received during three consecutive years out of the last fifteen years of service as chosen by the person himself, and is deducted as a percentage of the basic remuneration - starting from 80 per cent for the lowest, down to 55 per cent for the highest labour remuneration. Retirement pensions are regularly being up-graded in line with changing economic conditions, so that the pensioner's living standards do not suffer.
Disability Security. Disability pensions can be claimed in the event of partial or complete, temporary or permanent disability. They are granted in cases where the disability was caused in the course of employment, or not later than two years after termination of contract (the former contingency not applying to the congenitally blind or to persons deprived of sight before entering employment, the term of the latter being longer for certain prescribed diseases). When, in spite of treatment, ailments do not improve and the chances of regaining capacity for work are slight or non-existent, the invalid must appear before a Medical Commission on Labour (MCL)-a specialized commission of medical experts and a representative of the trade unions, authorized to ascertain permanent disability: to pronounce on the degree of disability and the date of disablement; to establish, in cases of occupational diseases. the relation between employment and ailment; and to redeploy persons with partially impaired capacity for work. Three disability classes have been set out in Bulgaria according to the degree of disability: Class 1 includes persons unable to perform any work (the severely disabled); Class 2-persons unable to perform either the job they have been trained for, or any other, but who can work in specially provided conditions; Class 3 includes persons who, because of health considerations, have lowered or been induced to lower, their standard or occupation, or have changed, or been induced to change, their conditions of labour. A disability class is granted permanently when there are no indications that the disability will be cured, or temporarily - in all other cases In the first case the disabled person can claim reassignment to another disability class with more favourable pension terms, in cases when his condition has worsened. Disability pensions fall into the following categories: industrial injury or occupational disease pensions, pensions for general illness or injuries arising from accidents other than labour accidents, and civil acts military disability pensions. Industrial injuries comprise; all injuries arising out of or in the course of employment as well as those resulting from work in emergencies c: under conditions not normal for the respective occupation if it has caused the insured person's temporary disability invalidity or death. Industrial injuries are likewise suffered in performing any service in the interest of the employer, during breaks in work-time, on the way to and from work, in saving a person's life or property, or when taking part in voluntary work-days and sports competitions. An industrial injury is ascertained by the head of the enterprise through an Industrial Injury Certificate, the disability - by the MCL. Occupational diseases fall under the class of industrial injuries. The nature of the disease and the degree of disability are established by the MCL.
The rate of the pensions granted for disability through labour accident or occupational disease is fixed according to the disability class and the basic labour remuneration. The percentage determining the rate of a disability pension grows in direct proportion to the degree of disability established, and in inverse proportion to the basic labour remuneration. Thus Class 1 disability pensions vary from 70 per cent for the highest basic remuneration to 100 per cent for the lowest, for Class 2 the percentage is respectively 55 to 85 and for Class 3-35 and 65. The aim is to ensure that the disabled receive approximately the same income as before the disablement.
Disability pensions are granted in the event of general illness or injuries arising from accidents other than labour accidents to disabled persons pronounced by an expert medical commission on labour to fall into one of the three disability groups and provided that they had completed the specific length of service graded in conformity to the respective age before the pronouncement of disability (up to 20 years of age - regardless of the length of service; up to 25 years of age-with three years of service, over 25 years of age-with five years of service). Disability pensions are payable to congenitally blind persons having been deprived of sight before entering employment with five years of service regardless of their age.
Disability pensions granted in the event of general illness or injuries from accidents other than labour accidents are rated in a percentage based on the basic labour remuneration. The percentage is graded according to the size of labour remuneration and the disability group as follows - for group I - rating from 73 per cent for the lowest to 55 per cent for the highest labour remuneration, for group II-from 65 per cent to 40 per cent and for group III - from 50 per cent to 25 per cent. Persons who fall into disability groups I and II due to general illness are entitled to an addition to the basic pension, the size of which depends on the length of services prior to the date of pronouncement on disability and is fixed according to the basic pension as follows: 5 per cent after ten to fifteen years of service, 10 per cent after fifteen to twenty years of service, 15 per cent after twenty years of service and over. Pensions with 25 years of service, at the age of 55 for men, and 20 years of service and at the age of 50 for women, are granted a 25 per cent addition to the basic pension.
Civil disability pensions are granted to persons injured in the performance of civil or public duties, to members of the auxiliary defense organizations, to members of sports teams injured during training sessions or competitions, to students injured during practical training or studies and to convicts injured in labour accidents. The monthly size of pensions is 65 levs for disability group I, 60 levs for disability group II and 50 levs for disability group III.
Military disability pensions are granted to persons injured while serving in the army, depending on the respective disability group, to regular privates and NCOs in the armed forces, to called-up reservists, to regular servicemen in the engineering corps or to reservists summoned to training, inspection or practical muster roll, regardless of their rank and to persons injured in rendering assistance to troops. The dead and missing also come into this category. If the injured have been socially insured before enlisting in the army, the size of their pensions is fixed on a similar scale to the rating of disability pensions that would have been granted in the event of industrial injuries and occupational diseases, if this is to their benefit.
Dependant Pensions (Death Insurance). Dependant pensions secure an income for the heirs to the deceased if he was insured. The major requirement in Bulgaria is for the dependant to have been supported by the deceased prior to his death. The beneficiaries entitled to dependant pensions are the children, brothers, sisters and grandchildren under eighteen, and those studying at educational establishments up to 25 years of age and over if they have lost their capacity for work before reaching 18 or 25 respectively. Students are entitled to dependant pensions after 25 years of age if they have served their regular terms in the army or in the labour corps. This term is extended by as many years as served in the army or in the labour corps. The parents are also entitled to dependant pensions, the husband or wife on reaching the age of 60 for men, 50 for women, or before if disabled; one of the parents or the wife, regardless of their capacity for work or age, if they are unemployed and look after children, or the brothers and sisters of the late head of family, on reaching sixteen; the grandfather and grandmother if they have no other income or if there are no persons bound by law to support them. The size of dependant pensions is fixed on the basis of the personal pension that had been paid to the deceased: 50 per cent if there is one dependant, 75 per cent if there are two dependants and 100 per cent if there are three dependants. The size of pensions payable to the heirs of a person who has died from industrial injuries is fixed on the basis of group I disability pensions if disability was caused by an accident. Heirs of a person whose death was caused by general disease are entitled to a pension fixed on the basis of the disability pension of group II that had been granted to the deceased. If the deceased had the required length of service entitling him or her to a personal retirement pension, the dependants' pension is fixed on the basis of the former, should this be of benefit to the dependants.
Social pensions were introduced in 1973. They are insignificant in number and are granted to persons who have not been insured or do not have at least half the length of service required for retirement or disability pensions. Such pensions are granted to invalids falling into disability groups I and II (aged over sixteen), and to old people having reached 70 whose annual income is lower than the specified minimum income. These pensions are small and the same for all entitled to them. Social security has been entrusted to the Bulgarian Trade Unions. They draft bills on social security issues and, jointly with other departments concerned, submit them to the National Assembly. Jointly with the Council of Ministers the Trade Unions issue regulations, decrees and instructions.
The Trade Unions are in charge of the social security budget. The remainder of contributions deducted (after the payment of indemnities, monthly child allowances, and maternity lump-sum cash grants) is transferred by enterprises and departments to the bank account of the social security with the Trade Union's Central Council.
Sums for the payment of pensions are drawn from this bank account. The control over the correct deduction and payment of security contributions and over the lawful spending of the social security fund is exercised by the Trade Unions. At enterprises and departments, indemnities cannot be paid without the signature of the Trade Union Chairman or of the person authorized by the former. The planning of social security funds, receipts and expenditures is carried out by the Trade Unions. Pension commissions and expert medical commissions on labour must include representatives of the respective Trade Union bodies. The Trade Unions fulfill their rights and obligations through their specialized bodies: the Social Security Board with the Central Council, the social security departments with the district and city councils, the Trade Unions and the social security commissions set up with them at every enterprise, department and organization.