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In June 2000, the Spanish government decided to authorise the semi-public mutual insurance societies to take the decision on whether to grant employees sick leave for common illnesses, which was up to now the exclusive responsibility of the public health system. The trade unions have expressed their total rejection of the measure, which they consider to be an attack on the social protection system and a step toward the privatisation of the health service. Due to the controversy that this has raised, the government seems willing to reconsider its decision.
On 23 June 2000, as part of a large package of liberalising measures, the government approved a royal decree that authorises mutual insurance societies to take the decision on whether to grant sick leave to employees for temporary incapacity in the event of common illnesses. The government took this decision unilaterally at the initiative of the Ministry of Economy, without consulting the social partners in any way. The initiative has been severely criticised by the main trade union confederations - the Trade Union Confederation of Workers' Commissions (Comisiones Obreras, CC.OO) and the General Workers' Confederation (Unión General de Trabajadores, UGT) - which consider that this measure leaves workers less protected, and that it is a threat to the public health system and a direct attack on the social dialogue. The decree is pending regulatory processing, and it is possible that at this stage its content will be modified: after the harsh criticism from the trade unions, representatives of the Ministry of Labour have agreed with the trade unions to reach a consensus on the matter.
Temporary incapacity for work and the role of mutual insurance societies
The "temporary incapacity" (incapacidad transitoria) sickness absence scheme is a basic part of the Spanish social security system. Its function is to protect workers suffering temporary incapacity for work (rather than permanent disability) for reasons of health by giving them a monetary benefit that depends, among other factors, on their wages. The first 15 days of incapacity are paid by the company and the rest by the social security system, which funds this benefit through the contributions of employers and workers. The regulations on temporary incapacity clearly differentiate "common illnesses" from industrial accidents or occupational illnesses. The contributions that fund this benefit are separate, and the amount of benefit and the requirements to qualify for it differ from the schemes for other types of illnesses. There are also substantial differences in the procedure for granting sick leave, the type of healthcare and the administration of the payment of benefit.
The main function of the mutual insurance societies is the administration of the system of temporary incapacity due to industrial accidents or occupational illness. The "mutual societies for industrial accidents and occupational illnesses" (Mutuas de Accidentes Laborales y Enfermedades Profesionales) emerged at the beginning of the 20th century as employers' bodies to insure companies against industrial accidents. From their birth as private organisations they have evolved until they now have a semi-public status: at present they are collaborating organisations of the social security system under the control of the Ministry of Labour, which negotiates public contributions to them. Their boards are composed exclusively of employers, with no trade union presence. Mutual insurance societies are authorised to take the decision on whether to grant sick leave, to provide healthcare and to negotiate the payment of monetary benefits in the event of industrial accidents or occupational illnesses. The companies are not forced to insure against this contingency with a mutual insurance society - they can do so with the National Institute of Social Security (Instituto Nacional de Seguridad Social, INSS), or in certain cases they can insure themselves. However, almost all companies choose mutual insurance societies, which cover 10.5 million of a total of 11 million workers and receive around ESP 600 billion per year through public contributions.
Until the mid-1990s, mutual insurance societies played no part in the administration of the system of temporary incapacity due to common illnesses. The ability to grant sick leave, benefits and healthcare was the responsibility of the public health system; the payment of benefit was managed directly by the INSS. However, since then, at the government's initiative, several measures have been introduced to reinforce the role of mutual insurance societies in this field. At present, the societies can administer the payment of monetary benefits, carry out health checks as of the 16th day off work, and provide healthcare in certain cases with the worker's consent. These measures have been introduced against the opinion of the trade unions, which consider that the mutual insurance societies should give priority to preventing occupational risks and incorporate trade union representatives on their boards of directors.
Government decision and subsequent controversy
The government's recent decision to authorise mutual insurance societies to take the decision on whether to grant sick leave for temporary incapacity due to common illnesses is a decisive step towards reinforcing the role of these societies. The government's objective with this measure is to limit what it considers a high level of fraud in benefit paid for temporary incapacity and to contain the expenditure that it generates. In its opinion, the public health system is too permissive in this area: some of the sick leave is not sufficiently justified or its duration is too long. In fact, this is not the first time that this proposal has been considered: in 1997 there were attempts to introduce a similar initiative, but in response to union pressure the government merely allowed the mutual insurance societies to formulate proposals for the return to work of absent workers that had to be approved by the doctors of the public health system.
The new decision has again met with severe criticism from CC.OO and UGT. The trade unions point out that expenditure on temporary incapacity is decreasing and that in the past few years the controls on this benefit have been reinforced. In their opinion, the measure is an unacceptable means of action in this field, because it will make it harder, for economic rather than health reasons, for a great number of workers to obtain sick leave. The workers will be assessed by health workers who have an employment relationship with the mutual insurance societies, and who therefore have a vested interest that, it is claimed, prevents them from being as objective as employees of the public health system: the application of more restrictive criteria in granting sick leave or limiting its duration may reap major benefits for the companies affiliated to the mutual insurance societies, because the first 15 days of sick leave are paid by the company. The trade unions, however, feel that the measure is an attack on the social protection system, reflects a lack of confidence in the public health system and marks the beginning of a road that could lead to the privatisation of certain parts of healthcare. They also criticise the way in which the decision has been taken: the unions consider that the government has infringed the current national agreement on pensions (ES9710220F) with a unilateral modification and without the mandatory consultation laid down in the General Social Security Law, and that this represents a serious attack on the social dialogue. In a letter sent by the general secretaries of CC.OO and UGT to the Prime Minister, they have formally demanded the withdrawal of the measure and the re-establishment of negotiations.
The government finally seems willing to reconsider its position, although it is clear that this will not lead to a more serious debate on the role of mutual insurance societies in preventing industrial accidents, one of the most serious labour problems in Spain (ES9904215F). A few days after the decree was passed, the social dialogue on pensions between the government, the trade unions and the employers' associations was resumed (ES0006194F). At this meeting, representatives of the Ministry of Labour agreed to re-establish the consensus on the regulatory development of the decree on sick leave, guaranteeing that the last word in terminating sick leave will remain with the public health system. In the background of this controversy, there is still a great difference in the criteria used by the Ministry of Economy and by the Ministry of Labour, as has been seen on other occasions: the outcome may still bring surprises. However, it is highly unusual that in a question of this importance the formal procedures of consultation with the social partners were not respected: the government's action may be the prelude to a hardening of its position in other areas of the social dialogue (María Caprile, CIREM Foundation).