Solicitud directa (CEACR) - Adopción: 2008, Publicación: 98ª reunión CIT (2009)

Convenio sobre asistencia médica y prestaciones monetarias de enfermedad, 1969 (núm. 130) - Uruguay (Ratificación : 1973)

With reference to its previous comments, the Committee notes the statistical information supplied by the Government on the number of employees protected by the current health insurance system, in relation to the total number of employees (Part II (Medical care, Article 10(a) in conjunction with Article 19 of the Convention (Persons protected)). It also notes that the scope of assistance to public servants has continued to increase, through the medical services provided by the public bodies themselves, or through the payment of mutual insurance contributions by the state institution, coverage which in some cases extends to the official’s dependants, as in the case of the legislative authority. Officials’ salaries continue to be paid in full during sick leave. However, the health system is in the process of being reformed, further to the adoption of Act No. 17930 of 19 December 2005 on the national budget, with a view to establishing an integrated national health system, the goal of which will be to cater fully for all residents of the country by providing equitable and universal coverage. It will be financed by a national health insurance, to be established through legislation, and to this end a draft bill was submitted to Parliament on 19 July 2006 for the decentralization of the association of health services, regarded by the authorities as a fundamental component of implementation of the integrated health system. The Committee notes the above information. It requests the Government to supply information on the progress made on the announced reform of the health system, particularly: (a) whether the integrated national health system has been made operational and, if so, the measures taken to this end;
(b) whether the abovementioned draft bill has been adopted and, if so, to send a copy thereof.

Article 10(b) of the Convention. Protection of the members of the insured person’s family. In its previous comments, the Committee noted that spouses and children of insured persons did not enjoy compulsory coverage as dependants under the existing 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. It has also requested information which showed, on the basis of the relevant regulatory or administrative provisions, that the medical care referred to by section 270 of Act No. 15903 of 1987 indeed meets the requirements of the abovementioned Articles of the Convention. Finally, the Committee requested the Government to indicate whether the right to medical care depends on whether or not the beneficiary’s resources exceed a certain limit. In view of the fact that the Government’s report does not contain any reference to the points raised, the Committee hopes that the Government will supply information on them and also on the impact of the planned reform of the health system on the provisions of the Convention.

Article 12. Protection of pensioners and members of their families. The Committee notes that section 25 of Legislative Decree No. 14407 of 22 July 1975 was amended by Act No. 17786 of 23 June 2004. The new text allows its harmonization with section 18 of Legislative Decree No. 14407, which established that, in the event of an industrial accident or occupational disease, the Social Security Bank would take care of the difference between the contribution from the State Security Bank and the benefit laid down in section 13(2) of that Act. Although common sickness benefit may not be combined with unemployment benefit, salaries, pre-retirement advance payments or industrial accident compensation, medical care benefits are maintained in full. The financial benefits provided for in section 25 may not be accumulated. The Committee requests the Government once again to provide additional information on the application in practice of the mechanism provided for in section 186 of Act No. 16713 of 3 September 1995, pursuant to which the payment of mutual contributions, which is covered by the Social Security Bank, was extended to passive affiliates who receive a pension, provided that their income does not exceed 1,300 pesos (as from 1 January 1998). It also requests the Government to indicate by means of specific examples the amount of the mutual contribution to be paid by the standard beneficiary who has become a recipient of the social security pension in order to continue to be entitled to medical care for himself and also for his spouse and two children, and to state the nature and scope of medical care provided for those persons.

Article 16, paragraphs 2 and 3. In its previous comments, the Committee asked the Government to indicate the legal provisions which ensured the maintenance of entitlement of medical care for beneficiaries who cease to belong to the category of protected persons, including the extension of the period during which such medical care will be granted for diseases recognized as entailing prolonged care. In view of the fact that the Government’s report does not contain information in this regard, the Committee requests the Government once again to indicate the legislative provisions which guarantee, in the cases covered by Article 16, paragraphs 2 and 3, of the Convention, that medical care will automatically be provided by the ASSE to the beneficiaries concerned (the insured person himself and his wife and children) who have ceased to belong to one of the categories of protected persons.

Part III (Sickness benefit) and Article 22 (Amount of sickness benefit). With reference to its previous comments, the Committee notes the statistics provided by the Government in its report relating to the minimum wage (1,397 pesos). Given the level of the national minimum wage during the reference period, the ceiling established for the maximum amount of sickness benefit would appear too low to satisfy this requirement of the Convention in all cases. The Committee therefore requests the Government to supply updated information as requested in the report form under Article 22 of the Convention, indicating, in particular, the wage of a skilled manual male employee, and also data on the amount of the national minimum wage for the same reference period.