By Prof. Dr. A. Gurhan Fisek
* This article was published in Working Environment Periodical, No. 39, July-August 1998.
Neither the early retirement age, nor the incapacity of governments and the parliament-origin interventions are the major problematic of the social security system. The major problematic is that social security system gets weak in parallel to the dissolution of the social state, and that society stays insensitive towards these developments (With respect to this, the most realistic (!) diagnosis was put forth by the Ministry of Health for a long time. Since 1965, the Ministry laid a stress on the “individual”, rather than “social” dimension of health issues, as if it proposed that the word “social” should be taken out from its law. Consequently, it put its signature on many projects regarding the privatisation of health. Yesterday, it was striving for putting family medicine in the place of community medicine approach; today, it is doing the same thing to put “individual” health insurance instead of “social” health insurance).
On that ground, the basic solution should be sought here as well. It is about how the support of “social” politics for the “social” security system would be re-ensured again; and how the “society” would be encouraged to back these “social” institutions up.
The bridges between the social state practices and the social security system have always been discarded. It happened in 1976 when the SII (Social Insurance Institution) origin payments (for the inspectors of Employment Exchange Institution and the Ministry of Labour-Department of Occupational Safety) were interrupted; in 1964-67 during which it was endeavoured to establish a bridge between socialisation of health affairs and the health services of SII; and in 1946 when SII (and then Bag-Kur – Social Insurance Institution for the Self-Employed) was established as an independent social security institution.
The privatisation of the public enterprises that are for meeting the fundamental necessities of human beings such as nutrition (Meat and Fish Institution, Milk Industry, and etc.) and allocation (cement sector, Karabuk Iron-Steel Industry, Turkey Electricity Institution, and etc.) leads to increase in prices; and this causes “socially” insured persons to be in financial misery.
Considering today’s Turkey, we may say that “social” security seems to be identified with insurance institutions. It is as if the fact seems to be concealed that is the utilisation of these institutions in order to allocate resources for the private sector with the pretext that they should become privatised more. The discussions on these facts are not presented to the public opinion ever; however, different applications or ruptured administrations of three giant institutions of the premium regime (that are under the authority of public administration) may be considered as basic discussion topics. It is, at the same time, stated that these three institutions should be unified in norm.
Nowadays, “abandonment” is the crucial problem of our social security system, 81,7 % of which is composed of the premium regime. For such giant systems to remain standing, there is only one alternative, that is the beneficiaries who should back these systems up. Considering Turkish “social security” experience that has been accumulated throughout more than 50 years, we observe that premium payers tend to direct the system in accordance with their “daily self-interests”, rather than making the system more effective and developed; and that they are “insistent” only on these issues.
This fact, to a great extent, is the resultant of the lack of sensitivity and awareness regarding the “social security” issues. Individuals not only tend to give a priority for their “individual safety”, but also tend to use and deplete other alternatives for the benefit of their “daily self-interests”.
Behind the inadequacy of these three social insurance institutions, there lie such misuses, keeping governments under the thumb of various mechanisms, and the understanding of individuals defending “first me, then deluge” approach.
Such an understanding is also responsible for the encouragement that causes the term “individual health insurance” to be thrown out for consideration. Having been turned away in the second half of the 18th century, these enterprises for finding individual solution have become a current issue again in parallel to the “dissolution of the social state”, “diminishing of the social solidarity” and “domination of the global economy”.
Persisting despite all these misuses occurred until so far, social accumulations (hospitals, drug factories, laboratories, public enterprises, and etc.) are aimed to be removed from society as well.
Behind the silence of premium payers despite all these things going on, there lie mistrustfulness that people feel towards each other and their daily concerns.
ACTION NO.1: Constituting the premium regime, these three social insurance institutions should start an “awareness raising + educational” campaign for aiming to reach insured persons or their participants. These should be discussed together with the right holders: “the grounds from which the necessity of social security arises; their superiority compared with the enterprises aiming to ensure individual security.
KEY WORDS: The concept of social security.
Once again, when we examine these three institutions composing the premium regime, we notice that they are classified according to the economic activities. The Retirement Trust is a system in which both employees and “employing representatives” are regarded as “participant”. On the other hand, SII employees and Bag-Kur employers are grouped separately. For the development of Social “Assurance System”, “paying the premium fully and at the right time” plays a significant role. Although it is considered as an assurance for the system that the Retirement Trust’s participants are composed of both employees and representative employers, it is, regrettably, observed in public institutions that “unguaranteed” employment has been started by creating some gaps. For making the social security system remain standing and perform its functions, it seems as a proper way that mutual solidarity and inspection should be initiated among these three giant institutions.
ACTION NO.2: First of all, employers associated with Bag-Kur should be persuaded, for their own future, about the necessity of paying the premiums of the ones they employ regularly, on time and fully. Concerning such a program, a discussion environment should be formed; and in this environment, it should be touched upon that an assurance ensured through individual accumulations has a supplementary function only.
KEY WORDS: Social sensitisation, Persuasion, Rendering Active.
Except for the Retirement Trust, one of the common problems of social insurance institutions is the prevalence of “unregistered” persons despite the obligation of “being insured”. To be sure, these “unregistered” persons, when a risk occurs, penetrate into the “social insurance system” one way or another. Therefore, at that point, the utilisation from a favour comes to the ground, the actions of which have not been performed yet.
Taking preventive measures against occupational accidents and diseases is an obligation of employers as required by the labour laws, and a precondition that is stated in the Social Insurance Law. However, they are not effective enough because of the inadequacy of dissuasive provisions against employers not taking these measures, of the inadequacy of inspections, and because of the existence of “unregistered” persons.
Additionally, the existence of occupational accidents and diseases together with the insensitivity of society on these issues are the reasons behind the presence of general (not work-based) accidents and diseases.
ACTION NO.3: The inspection network should be organised as a common mechanism. This would play a significant role in order to hold the cases back regarding uninsured employment, not paying the premiums on time and not taking preventive measures against occupational accidents and diseases.
KEY WORDS: Inspection, unregistered, dissuasion.
Today, Turkey’s social insurance system is locked because of the precondition that concentrates on the “occurrence” of risks. Put it differently, as it can be clearly deduced from their names, the measures like the “obligation to pay compensation” and “after-incident responsibilities” are applied after a risk occurs or it has caused to a loss.
ACTION NO.4: Before the efforts expended for the equalisation of norms, common mechanisms should be formed in order not no turn to these norms. All of these three social insurance institutions should develop a common action plan in order to prevent accidents and diseases in general, and occupational diseases and accidents in particular.
KEY WORDS: Elimination of Risks, Prevention.
When we examine the health services provided by these three institutions composing the premium regime, we remark that these are only therapeutic and rehabilitative health services. Thus, the system does not work on “risks”, and starts to act only after a risk occurs.
This tendency overlaps with the one that was prevalent in the 19th century during which scientific developments were limited in scope. However, the contemporary approach classifies “preventive + therapeutic + rehabilitative” services and presents them in integrity. It is in such a way that accidents and diseases are prevented; if not, health losses are reduced to a minimum through first and emergency aid facilities; if they are not adequate, they are treated; and if functional losses occur despite these treatments, it is endeavoured to recover them by means of rehabilitation.
Thence, the prevention of accidents and diseases plays a key role. Because, if that is maintained so, the services that the social insurance institutions would provide are not needed. Protection, as well as assurance, is a concept that means a lot socially.
ACTION NO.5: These three insurance institutions should work together for the formation of a service network or the improvement of the existing one. This in order to ensure that participant or insured persons and the ones these people are obliged to take care would not get sick or be injured. For such an action, there are two different networks available: first, health clinics; and the second, occupational (or institutional) medicines.
KEY WORDS: First-step health services, protection, early diagnosis.
Beside these three social insurance institutions, social participation should be ensured; and by means of common investments, expenditures should be reduced, while incomes are being increased. In this way, both the acquired resources would be utilised financially, and the enterprises that are to protect the institutional interests would be realised. Consequently, this would allow to kill two birds with one stone. For instance, in the event medical equipments are broken down, many valuable vehicles and investments are not put into use because of the inadequacy of care-repair services. In Turkey, this serious problem does not only belong to SII or public hospitals, but also to many physicians or investors who work with medical equipments.
Similarly, preventing the occurrence of risks, regarding these productive facilities, should be given a special importance. Besides, by means of new job opportunities, one would be observe an increase in the number of both “socially” insured persons and of “self-employed” persons.
ACTION NO.6: These can be materialised in co-operation: vaccine and drug production; production and importation, and care-repair of medical equipments. Additionally, the production of personal protective equipments (masks, safety belts, glasses, and etc.) would be materialised together as well.
KEY WORDS: Productive facilities, investments.
Behind the social security crises that our country experiences today, there lie “unsystematicness” and “inactiveness”. Otherwise stated, social security in Turkey has not appeared as a whole (or transformed into a system); because each and every social security institution (SII, Bag-Kur, the Retirement Trust, Social Services and Child Protection Institution, Family Institution, Prime Ministry Directorate of Handicap Department) have formed a “system” and “action” in itself separately.
Although the “unity in norm” principle has been discussed for a while, these discussions have only taken the social insurance institutions into account, while disregarding their compatibility with the social “assistance” institutions. However, one should bear in mind that the harmonious co-operation of these social security institutions in a “systematic” way and their supporting each other through “collective actions” come first, before the discussions on “unity in norm”.
The concept of social security;
Elimination of Risks;
First-step health services;
Protection + early diagnosis;
Productive facilities (investments).