Direct Request (CEACR) - adopted 1996, published 85th ILC session (1997)

Medical Care and Sickness Benefits Convention, 1969 (No. 130) - Uruguay (Ratification: 1973)

1. Part II of the Convention (Medical care). Article 10 (Protection of the members of the insured's family). In its previous comments, the Committee noted that spouses and children of insured persons do not enjoy compulsory coverage as dependants under the existing sickness insurance scheme but are protected by the State Health Services Administration (ASSE) which is responsible for organizing first-level medical care for its beneficiaries, in accordance with section 270 of Act No. 15903 of 1987. In order to ascertain whether the requirements of Articles 13, 15, 16(1) and 17 of the Convention are being fulfilled, the Committee had asked the Government to provide detailed information on the nature and scope of the medical care provided in practice by the ASSE, indicating in particular to what extent benefits are granted irrespective of the level of the beneficiaries' resources. As the Government's latest report contains no such information, the Committee cannot but once again express the hope that this information will be contained in the Government's next report, together with any regulations adopted under the above section 270.

2. Article 12 (Protection of pensioners and members of their families). In its previous comments, the Committee had noted that persons receiving social security benefits for total and permanent invalidity, old age and death of the breadwinner and, where appropriate, their wives and children, are not protected in respect of the need for medical care of a curative and a preventive nature under the existing sickness insurance scheme, but have access to medical care under the ASSE. It had asked the Government to provide information on the nature and scope of such medical care. In reply, the Government indicates that a special commission has been set up to study the possibility of instituting and financing a medical benefit of a preventive and curative nature for persons receiving social security pensions. The Committee notes this information with interest. It recalls in this respect that, according to the Government's previous reports, it has been examining since 1989 the question of establishing a sickness insurance scheme covering these categories of persons. The Committee therefore hopes that, as a result of these studies, the Government will indicate the measures taken in this respect in its next report. In the meantime, the Committee reiterates its request for information on the nature and scope of the medical care provided in practice to the above-mentioned persons by the ASSE.

3. Article 16, paragraphs 2 and 3. In its previous comments, the Committee had asked the Government to indicate the legal provisions ensuring the maintenance of the entitlement to medical care for beneficiaries who cease to belong to the categories of persons protected, including the extension of the period during which such medical care will be granted for diseases recognized as entailing prolonged care. In reply, the Government again refers only to sections 14 and 15 of Act No. 14407 of 22.07.75, and to section 9 of Decree 7/1976. The Committee has to point out in this respect, as in fact it has been doing since 1979, that the above provisions of Act No. 14407 refer exclusively to cash sickness allowances and do not concern the entitlement to medical care. As to section 9 of Decree No. 7/1976, its first paragraph reserves the right to invalidity and involuntary unemployment for those who have exhausted the right to cash sickness benefits; its second paragraph provides for continued coverage for unemployed, pre-retired and retired persons if they chose to pay the relevant contributions. Therefore, the Committee once again hopes that the Government will take the necessary measures in the near future in order to ensure that: (a) in accordance with Article 16(2) of the Convention, any beneficiary who ceases to belong to a category of persons protected shall enjoy further entitlement, which is mandatory under law, to medical care for a case of sickness which started while he belonged to the said category, for not less than 26 weeks; and (b) in accordance with Article 16(3) that such duration be extended for prescribed diseases recognized as entailing prolonged care.

4. Part III (Sickness benefit). Article 22 (Amount of sickness benefit). In reply to the Committee's previous comments, the Government indicates the minimum (U$10.73), median (U$13.43) and maximum (U$15.61) hourly wage of a turner in the steel industry, as of June 1993, representing the wage of a skilled manual male employee; the monthly family allowance which in May 1994 constituted U$34.48; and the maximum sickness benefit which in May 1994 attained the sum of U$1,293.00, which is equivalent to three times the national minimum wage. The Committee notes with interest the statistical information. It observes that the maximum sickness benefit paid to a standard beneficiary appears to attain 70 per cent of the median monthly wage of a turner in the iron and steel industry, account being taken of the family allowance paid for two children. This would meet the benefit level prescribed by the Convention, assuming that the said turner works 40 hours a week, i.e. 173 hours a month, since the statistics given in the report refer to different time bases for the wage of a turner (hourly basis) and for the maximum sickness benefit (monthly basis). The Committee therefore requests the Government to communicate with its next report all the statistics required by the report form adopted by the Governing Body under Article 22 of the Convention for the same time basis and for the same reference period, in order to be able to fully appreciate the application of the Convention on this point. The Government is also requested to supply the sources of the national statistics relating to the wage of a turner.