The Preventive Approaches of the
Statutory Accident Insurance System
and Their Effectiveness*
Wilfried Coenen
HVBG—Hauptverband der gewerblichen
Berufsgenossenschatften, Germany
Karlheinz Meffert
BIA—Berufsgenossenschaftliches Institut fur
Arbeitssicherheit, Germany
For decades, prevention has been an integral and im p ortan t part o f the German statutory accident insurance system . The very close link between prevention, rehabilitation, and com pensation, w h ich is so typical fo r the German system , had an extrem ely positive effect on the frequency o f no tifiable occupational accidents. W hat is more, if we com pare benefits and costs o f the system, it appears tha t prevention has also been successful in a s trictly m onetary sense.
A fte r a short ou tlin e o f the basic principles o f the German accident insurance system , the authors take stock o f the last 33 years. The period between 1960 and 1993 also covers the repercussions o f the German reunification in 1990. The trends in accident and disease frequency are presented tog ether w ith the trends in costs and benefits. To a llo w a realistic com parison, all figures are indicated in term s o f 1960. It can be shown tha t the average co n trib u tio n rate to accident insurance decreased in the period under consideration. This is particularly rem arkable if we look at the enorm ous increase in c on tribu tion rates that too k place in all other branches of social insurance. It is also noted tha t the c on tribu tion rates o f th e d iffe re nt in dustrial branches are im m e dia te ly dependent on the accident risks in those industries. The last part o f the article contains a qualitative and quan tita tive description o f the prevention measures available to the Germ an accident insurance institutions.
OCCUPATIONAL SAFETY AND ERGONOMICS 1996, VOL. 2, NO. 1, 47-59
prevention costs benefits accident frequency co st-risk relationship co ntribution rate financial incentives prevention measures
1. IN TR O D U C T IO N
The occupational accident insurance system for trad e and industry in G erm any (the Statutory A ccident Prevention and Insurance Institutions in Industry) is a special m odel of social security which attaches particular im portance to prevention as a hum anitarian and strategic elem ent o f the system. A n analysis of trends in costs and benefits in the p ast 33-year period has proven th at the success of preventive m easures has contributed significantly to the stability of this system, in spite of m ajor increases in specific benefits. A n assessm ent has shown th at if occupational accident and pension frequency w ere still as high today as it was in 1960— with
*Reprinted with permission from Die B G , 2,1996.
Revised paper presented at the European Regional Conference of ISSA (International Social Security A ssocia tion), November 30-D ecem ber 2,1994, in Helsinki, Finland, to be published in the proceedings available in German, English, and French.
Correspondence and requests for reprints should be sent to Karlheinz Meffert, B IA —Berufsgenossenschaftliches Institut fur Arbeitssicherheit, 53754 Sankt Augustin, Germany.
the cost structure being that of the present day—com panies would have to pay at least D M 8 billion m ore every year as a result of contributions tow ards accident insurance. This rep o rt exam ines the basic structure of the system and the knowledge gained with th e aim o f stim u lating new ideas for the m ore intensive exploitation of preventive potentialities in o th er social insurance systems.
The B erufsgenossenschaften (BGs, Statutory A ccident Prevention and Insurance Institu tions in Industry) in the Federal R epublic of Germ any, as carriers o f th e statutory accident insurance system for the industry, trade, and commerce, are also com m itted to the statutory duty “to prevent occupational accidents and diseases with all appropriate m eans and to reduce their consequences” (A ccident Insurance A ct of July 6,1884, under the Im perial C hancellor O tto von Bism arck). In over 100 years, this statutory duty, which reaches beyond the field of insurance, has developed into a functional netw ork of key tasks involving prevention, rehabili tation, and com pensation. The effectiveness of the prim ary preventive m easures carried out in the field of accident insurance in trad e and industry is proven by the d rop in the frequency of notifiable occupational accidents since 1960 to 40%. The success of the various m easures of m edical and occupational rehabilitation—that is, secondary prevention—is reflected in an even m ore significant decline in the frequency of accidents in which the consequences of injuries reduce an individual’s capacity to work. In spite of increased expenditure on preven tion and rehabilitation, the BGs have been able to reduce contributions— in relation to the respective wage level—in the last 30 years.
Responsibility for the im plem entation of occupational safety and health m easures at work lies with the em ployers who also have to pay for the full costs of accident insurance through cost-covering contributions. This encourages com panies to focus on effective preventive m eas ures in order to positively influence cost developm ents and, therefore, their own contributions towards accident insurance. The system of accident insurance in G erm any works like a control circuit (Figure 1) because the decline in the num ber of accidents and occupational diseases in the com panies of one sector of industry has a direct and full effect on the contribution levels. The indicators derived from the specific accident and cost statistics of the accident insurance system m ake it possible to assess contributions according to industry and risk, and to individu ally classify com panies from one sector of industry.
The m easures im plem ented by com panies to avoid accidents and occupational diseases are supported by the BGs, which have a wide range of organisational, allocation, and service functions th at are both industry and com pany oriented. The list of preventive m easures perform ed by the accident insurance system ranges from the developm ent of work safety regulations via Technical Supervision in m em ber companies, the counselling and support of
com panies in all m atters related to occupational safety and health, inspection of technical equipm ent and collective as well as personal protective equipm ent, the training of occupa tional safety experts and industrial physicians, to the prom otion and im plem entation of re search into the im provem ent of occupational safety and health.
2. BA SIC PR IN C IPL ES O F T H E G E R M A N A C C ID E N T IN S U R A N C E SYSTEM
The statutory accident insurance system in G erm any is divided into three sections covering industry and trade, agriculture, and the public services. The insured risks are occupational accidents and occupational diseases and accidents that occur on the way to or from work. R ecognition of occupational diseases is based, on the one hand, on a list currently containing 64 occupational diseases ordered by the legislator. In individual cases and under certain circumstances, w ork-related illnesses may be com pensated in the same way as an occupational disease. In 1992, 52.5 million persons and 4.3 million m em ber com panies were insured under the G erm an accident insurance scheme (excluding school children).
The accident insurance system is based on the following principles: • R eplacem ent o f com pany’s liability through join t and several liability.
The em ployer is responsible for the safety and health of the em ployees at work. The em ployer is liable tow ards em ployees for health dam age caused by the working conditions. To ensure that the party liable for occupational accidents and diseases is not depen den t on the financial developm ent of the individual company, the em ployer’s liability under civil law was replaced 110 years ago by the accident insurance system, which is organised under public law, with the result that em ployers bear all the costs of accident insurance jointly and severally.
• Prevention, rehabilitation, and com pensation “ with all the appropriate m eans” from one source.
The accident insurance system realised at an early stage th at co rporate and econom ic factors have an im portant effect on com pany behaviour in term s of safety and protection at work: They com pel firms not only to prevent accidents and occupational diseases by applying suitable preventive measures, but also to ensure suitable rehabilitation activities in order to reduce hum an suffering and to minimise the financial burden of com pensation. It also recognised the fact that this can only be achieved if the necessary instrum ents are available. This was the main im petus behind the developm ent of an independent and com prehensive system of prevention and rehabilitation, which is controlled by both em ployers and employees.
• Independence and industrial orientation o f accident insurance.
The workplace continues to represent a significant risk to the safety and health of the people who work there. Overcom ing those risks requires com prehensive technical, medical, and legal knowledge and the developm ent of com pany- and technology-oriented m ethods of identifying and elim inating those risks effectively. This is only possible if the w ork-related causes and consequences of dam age can be seen in their causal relationship w ithout being distorted by o ther factors. Only under these conditions is it possible to develop indicators that provide exact inform ation about the occurrence of occupational accidents and diseases, th a t identify costs and ultim ately determ ine th e effectiveness of preventive and rehabilita tion m easures. This is why occupational accident insurance in G erm any is separate from the o ther fields of social insurance, and it is organised according to econom ic sector or branch of industry. The insurance carriers are public corporations subject to state supervision.
• Joint self-m anagem ent.
Those affected by safety and health risks at work are the actual workers, those who are responsible for their safety and for the protection of their health are the employers. It is, therefore, only logical that both parties share the task of controlling accident insurance and deciding on m easures of prevention, rehabilitation, and com pensation, that is, financial com pensation, in accordance with requirem ents and possibilities. The subdivision of the individual accident insurance carriers according to branch of industry also guarantees a high level of com pany orientation for both em ployers and employees, thus m aking it possible to react directly to the respective economic and technological developm ents in the various branches of industry.
The effects of this system of accident insurance, which is described in greater detail in Sokoll (1994), are varied:
• It relieves the burden on the state in term s of the entire extent of accident insurance and in term s of the supervisory and controlling m easures aim ed at im proving occupational safety and health.
• It has a stabilising effect on the econom y in term s of the developm ent of costs for statutory accident insurance.
• It is humanitarian in that preventive and rehabilitation m easures help em ployees avoid injuries or minimise them.
• It is socially acceptable because the equal involvem ent of both em ployers and em ployees institutionalises the balance of interests.
3. STATUTO RY A C C ID E N T P R E V E N T IO N A N D IN S U R A N C E IN ST ITU TIO N S IN IN D U ST R Y (B G s)
The accident insurance system for trade and industry is industry oriented and covers the following 14 sectors:
1. M ining
2. Q uarrying and earthm oving 3. G as and w ater
4. M etal
5. Precision mechanics and electrical engineering 6. Chemicals
7. Wood
8. P aper and printing 9. Textiles and leather 10. Food and beverages 11. C onstruction
12. C om m erce and adm inistration 13. Transport
14. H ealth services
In 1993, a total of 2.6 million com panies were members, and 38.7 million em ployees of these com panies w ere insured parties under the system of the BGs. In that year, the insured persons produced an ou tput corresponding to th at of 29.7 million full-time workers. The following statistics are correspondingly based on the num ber of “full-time em ployees.”
TABLE 1. Cost Development
1960 1993
Index 1993 (%) 1960 = 100
1. N um ber o f m em ber com panies (m illions) 1.65 2.63 159
2. N um ber o f fu ll-tim e w orkers (m illio n s)3 17.86 29.69 166
3. Payroll per fu ll-tim e w o rker (DM) 5,379 38,103 708
4. Total c on tribu tions (DM billion ) 1.45 16.24 1,119
5. C o ntrib ution per fu ll-tim e w orker (DM) 81 547 675
6. Average co n trib u tio n rate in percentage 1.51 1.44 95
7. C ontribution rate o f total social insurance 25.9 38.4 148
8. Share o f co n trib u tio n tow a rds accident insurance 5.83 3.75 64
9. Accident rateb 3.22 1.2 37
a Full-tim e w orker: Full-tim e and part-tim e w orkers are assessed in term s o f the tim e they worked. b New pensions fo r occupational accidents per 1,000 fu ll-tim e w orkers (previously, occupational acci dents com pensated fo r the firs t tim e).
3.1. Cost and B enefit Trends
The following data provide an overview of the trends in the costs of and benefits provided by the BGs for the period betw een 1960 and 1993. In order to obtain valid indicators in spite of significant changes in the num ber of m em ber com panies and full-time w orkers in the 33-year period and especially the substantial increase in the cost index, specific indexes have been created. The original data have been taken from statistical publications by H auptverband der gew erblichen Berufsgenossenschaften (HV BG , the Association of the Statutory A ccident Prevention and Insurance Institutions in Industry; HVBG, 1994).
Table 1 contains data on cost developments. A p art from d ata for the years 1960 and 1993, the index figure for 1993 is indicated, showing the relative difference to 1960 (1960 = 100). The figures for 1993 include the num ber of m em ber com panies and full-time w orkers in the BGs in reunited Germany.
Because of the sharp increase in the num ber of m em ber com panies and full-time w orkers (lines 1 and 2) and especially because of the rise in labour costs, the total contributions of the BGs increased to 1,119% (line 4) by 1993. If this contribution is related to the num ber of full-time workers, the index for 1993 is only 675% (line 5). This increase is sm aller than the 708% rise in labour costs p er full-time w orker (line 3). For the contribution rate (line 6), this m eans a drop from 1.51% in 1960 to 1.44% in 1993, which corresponds to an index of 95%. The stability of this contribution level is particularly impressive in view of the overall increase in social insurance contributions with an index of 148% (line 7), whereas contributions towards accident insurance dropped from 64% , th at is, by a third (line 8; Kranig, 1994). The positive developm ent in accident insurance is attributable mainly to a significant decline in the num ber (line 9) of new occupational accident pensions1 from 3.22 per 1,000 full-time w orkers in 1960 to 1.20 in 1993. This rate, therefore, dropped in this period to 37% of the 1960 level. This trend will be exam ined in greater depth in section 3.2.
R elevant data for the 1960 to 1993 period on the developm ent of the average benefit expenditure of the BGs per case are given in Table 2. The 1993 factor shows the 1993 index in relation to wage level. According to these calculations, the developm ent of pension costs per pensioner (line 1) has rem ained slightly below the labour cost developm ent (line 4; factor 93% ). O n the other hand, the specific costs of com pensatory paym ents (costs of rehabilitation and financial com pensation) per notifiable accident (line 2) and the adm inistrative costs of the BGs for prevention per full-time w orker (line 3) rose significantly (factor 233%). In
TABLE 2. Trend in Benefits
Index Factor
1960 1993 1993 (%) 1993“
Expenditure DM DM 1960 = 100 <%)
1. Pension per pensioner 1,399 9,198 675 93
2. Com pensatory paym ents per notifiable
accident 379 6,265 1,653 233
3. Prevention costs per fu ll-tim e w orker 2 33 1,650 233
4. Labour costs per fu ll-tim e w orker 5,379 38,103 708 100
aFactor 1993 = Index 1993 related to wage level.
relation to the wage level trends, the costs of com pensatory paym ents and the costs of prevention have, therefore, m ore than doubled. This trend reflects the im portance the BGs attach to rehabilitation and prevention. The fact that the average pension level has developed parallel to the wage level is due to statutory provisions that have to be observed when aw arding pension benefits.
Figure 2 shows how the cost of the main types of benefit has shifted in the period from 1960 to 1993. A ccording to these statistics, the share for financial com pensation dropped from 77.0% to 61.5%, whereas the share for rehabilitation expenditure rose from 20.4% to 31.3%. E xpenditure for prevention increased from 2.6% in 1960 to 7.2% in 1993. A bsolute expendi ture for prevention totaled DM 0.99 billion in 1993.
3.2. The D evelop m en t o f Occupational A ccidents and D iseases
Table 3 provides an overview of accident trends in the 1960-1993 period. It shows the num ber of accidents for every 1,000 full-time w orkers or, in the case of com m uting accidents (occurring on the way to or from work) in 1993, p er 1,000 insured persons (insurance relationship). The relative decline in the different kinds of accidents is indicated in Figure 3. According to these statistics, the num ber of notifiable occupational accidents or com m uting accidents has dropped by 60% or 57% , that is, to 40% or 43% of the level in 1960.
1 0 0 8 0 6 0 4 0 20 0 D if f e r e n c e in % ( 1 9 6 0 = 1 0 0 )
TABLE 3. Trend in Accident Frequency
Accidents per 1,000 Full-Time Workers3 1960 1993
1. N otifiable occupational accidents 126.7 50.9
2. N otifiable co m m u ting accidents 13.9 6.0
3. New pensions fo r occupational accidents13 3.22 1.20
4. New pensions fo r com m u ting accidents15 0.87 0.29
5. Fatal occupational accidents 0.17 0.05
6. Fatal c o m m u ting accidents 0.09 0.02
aC om m uting accidents in 1993 per 1,000 insurance contracts.
P re v io u s ly , occupational accidents or com m u ting accidents occurring en route to o r fro m w ork, com pen sated fo r the firs t tim e.
New pensions2 are such cases that involve a reduction in working capacity of at least 20% and are, therefore, highly relevant in term s of both consequences for the individual person and costs. In the period under review, an even clearer drop in the num ber of such severe accidents was registered: 37% in the case of occupational accidents and 33% in com m uting accidents. A n even m ore significant decline was recorded in the num ber of fatal accidents, dropping to 29% am ong occupational accidents and 22% am ong com m uting accidents of the 1960 level.
Table 4 shows the quantitative developm ent of occupational diseases. Som e of the figures indicated in Table 4 w ere not statistically recorded for occupational diseases in the earlier years, therefore, the long-term developm ent cannot be revealed. T here has been a decline in the num ber of new pensions for occupational diseases, that is, serious occupational diseases (line 4), since 1960 to 76% of the cases recorded then. Cases in which occupational causes are confirm ed but special insurance conditions are not fulfilled are on the sam e scale as these new pensions for occupational diseases3 (line 5). O f the num ber of cases confirm ed in 1993 (line 7), a total of 39.9% of the suspected cases of occupational diseases rep orted to the B G s were confirm ed within the fram ew ork of the BGs assessm ent procedure (line 2). In th e last 33 years, the num ber of suspected cases reported has alm ost tripled—som ething th at is attributable to a whole series of causes:
• constant extension of the list of occupational diseases;
• statistical registration of suspected cases since 1986, even when it is clear early on th at confirm ation is unlikely on the basis of the valid occupational disease law;
• systematic registration of suspected cases based on industrial medical exam inations; • greater public awareness, especially among the m edical profession, of the adverse effects
the w orkplace can have on the health of w orkers through targeted publicity work in the media.
As explained in section 3.1., com pany contributions towards accident insurance w ere not only m aintained but actually reduced in the period from 1960 to 1993 in spite of appreciable increases in costs and specific benefits. A lthough the causal relationship could not be proven in detail, it is very probable that not only the drop in the num ber of accidents (notifiable accidents) as a result of effective corporate and B G preventive m easures but also the success of targeted rehabilitation m easures played a decisive role.
3.3. C ost-R isk Relationship
The correlation betw een accident frequency and contributions tow ards statutory accident prevention can be quantified. In view of the fact th at accident risks differ significantly in the
P reviously, cases compensated for the first time.
1 O O 8 0 6 0 4 0 20
1
960
1
993
Figure 3. Share of costs for different benefits.
various branches of industry, it is logical that the different sectors pay varying am ounts for accident insurance. This assum ption is confirmed if the contributions of the BGs, which are responsible for the different sectors of industry, are seen in relation to the accident frequencies recorded.
In Table 5, accident rates (new pensions for occupational accidents4 per 1,000 full-time w orkers) and average contributions tow ards industrial accident insurance are indicated as percentages of earnings that are liable to contributions for the health services, chemicals, transport and traffic, and mining, and for the average figure for trade and industry as a whole. The table reveals that contribution rates increase in accordance with accident frequency increases. A ccident frequencies range from 0.47 to 5.85, and the contribution rates in the different branches of industry range from 0.83% to 5.63%. A n exam ination of this cost-risk relationship for all 14 sectors reveals a linear relationship betw een the frequency of new pensions for occupational accidents p er 1,000 full-time w orkers and the average contribution rate in percentage for the respective sector of industry. With a correlation coefficient of .981, this relationship is highly significant. The relationship for 1993 is
B = 0.295 + 0.923 X A U H
where B is the contribution rate and A U H is the num ber of occupational accidents com pen sated for the first tim e (per 1,000 full-time workers).
The inform ative value of the frequency of new pensions for occupational accidents as an indicator of contribution rates towards accident insurance indicates that all cost-incurring factors either correlate highly with the frequency of new pensions for occupational accidents or are largely independent of this and are therefore recorded by the constant 0.295.
This cost-risk relationship applies only to 1993 and to the cost structure valid in th at year. In Figure 4, the contribution rates of the individual branches of industry are indicated in their dependency on risk (the num ber of new pensions for occupational accidents per 1,000 full-time w orkers), and the relevant correlation line is shown. The linear correlation betw een risk and
TABLE 4. Occupational Diseases— Reports of Suspected Cases and Definite Cases
1960 1993
1. Reports o f suspected occupational disease 31,502 92,058
2. Cases o f suspected occupational disease confirm ed * 23,086
3. Including recognised occupational diseases * 17,833
4. Including new pensions fo r occupational diseases 7,445 5,668
5. Including occupational cause determ ined, special insurance
con ditions not fu lfille d * 5,923
6. Cases o f suspected occupational disease not confirm ed * 35,025
7. Total num ber o f definite cases * 58,781
*No records fo r 1960
contribution rate is obvious. The consequences of a higher accident rate on contributions towards accident insurance in 1993 could be estim ated. If the average value of the rate of new pensions for occupational accidents had been just 10% higher in 1993 at 1.2 per 1,000 full-time workers, this would have resulted in a contribution increase for the BGs of altogether some DM 1.25 billion with the 1993 cost structure.
It would be interesting to know how much higher the contributions of the BGs m em ber com panies would have been every year if the positive trend in insurance cases and costs described in sections 3.1. and 3.2. had developed less favourably. The A ssociation has estim ated current annual additional costs if accident and pension frequencies were still on the high level of 1960. A ccording to these estimations, there would have been around 45% m ore ongoing pensions in 1990— the last year before inclusion of the east G erm an states— than was actually the case: This m eans an additional am ount of around D M 3 billion would have been spent on pensions (G reiner, 1994). A nnual savings on pensions for 1993 can be expected on a similar scale com pared to 1960.
If another im portant cost factor is considered in addition to pensions, namely, therapeutic treatm ent, total savings for the BGs are even m ore apparent: at least 8 billion for 1993 alone. The reason for this significantly higher but realistically evaluated savings effect in the case of therapeutic treatm ent is that the costs of such treatm en t have risen far m ore significantly than the costs of pensions in the past few years (see Table 2).
A lthough the positive effects of a low accident rate are im m ediately reflected in the costs of therapeutic treatm ent, the financial benefits brought about by the decline in pensions may only be reaped in full after several decades because many pensions are ongoing for many years. W ith the accum ulation of annual pension cases, the num ber of pensions decreases only very gradually over the years in spite of a decline in the num ber of accidents. The financial
TABLE 5. Cost-Risk Relationship (for 1993)
Branch of Industry
New Pensions for Occupational Accidents3 per 1,000 Full-Time Workers (AUH)
Contribution Rate in % (B)
1. Health services 0.47 0.83
2. Chemicals 1.15 1.27
3. Mean value fo r trade and industry 1.20 1.44
4. Transport and traffic 1.92 1.94
5. M ining 5.85 5.63
0 ■*-*
CO
k_ c o *+-» JQc
o
ORisk
New pensions for occupational accidents per 1,000 full-time workers
(previously, occupational accidents compensated for the first time)
Figure 4. Contribution-risk relationship.
advantage of successful prevention and efficient rehabilitation, therefore, only brings full dividends after several years. However, when this occurs, the results are impressive: If m ini mum savings of D M 8 billion in yields from contributions are recorded for insured m em ber com panies in 1993 alone, savings in the 33 years under review are likely to be significantly above the 10 billion mark.
3.4. Preventive M easures
The B G s have developed a com prehensive set of instrum ents with which preventive m easures in com panies are effectively regulated and supported. These instrum ents are regularly adapted to technological developm ents, the latest scientific discoveries, and the practical requirem ents of w ork safety. B r a n c h * * o f In d u s try 1 Health 2 Qaa k water 3 Ittd e k sdrelnlstrstlon 4 Precisian mechanics k electrical snglnssrlng ( Paper k printing • TkitMss * leather 7 Chemicals • Mstal 9 Feed ft beverages 10 l i n t p o r t Weed 12 Qaerrrlag k esrthnsvlng 13 Construction 14 Mining
3.4.1. Occupational Safety and Health Regulations
A ccident insurance carriers have the right and the duty to im pose regulations to prevent occupational accidents and diseases. These regulations are legally binding for their m em bers (companies) and insured persons. The occupational safety and health regulations of the acci dent insurance carriers take into account the interests of the sector o f industry in question, and they are specifically supplem ented by a com prehensive set of safety technical and industrial medical rules which m ake it possible to react flexibly to recent developm ents in occupational safety and health.
3.4.2. Monitoring o f Occupational Safety and Health
The accident insurance carriers m onitor activities im plem ented in com panies to prevent accidents and protect the health of w orkers with 2,300 technical supervisory staff and o ther qualified personnel. In 1993 alone, around 630,000 com pany inspections were carried out. This supervisory function is m ore com prehensive than th at of state work inspection services and, therefore, greatly relieves state work safety authorities.
3.4.3. Occupational Safety and Health Consultancy
O ne of the B G s’ m ain tasks involves counselling com panies on m atters of prevention. To determ ine and quantify risks, m easurem ents are taken at workplaces, especially in term s of harm ful substances, noise, and vibrations, and appropriate m easures for safety and health protection are recom m ended.
3.4.4. Training and Further Training in Occupational Safety and Health
A n o th er key task is to offer work safety experts in com panies training and furth er training. A ccident insurance carriers offer work safety experts, em ployers, o th er responsible m em bers of staff, and work councils free courses, in which the necessary technical knowledge is taught. In 1993, around 360,000 people w ere trained within the fram ew ork of these schemes, in som e cases in the B G s’ own training centres.
3.4.5. Industrial M edical Prevention
A p art from technical occupational health and safety, increasing im portance is being attached to industrial m edical prevention and care by com pany physicians. A distinction should be m ade here betw een the general industrial m edical care of all em ployees and specific m edical preven tive m easures for w orkers who m ay be exposed to certain chemical, physical, and biological influences or special stress. In this context, the accident insurance carriers are bound to define and organise the m edical checkups the em ployer has to provide for th e employees. The num ber of medical exam inations has trebled in the last 10 years, reaching alm ost 3.9 million in 1993. These w ere carried out in accordance with 43 specific B G principles.
3.4.6. Industrial Medical Supervision o f Companies
In addition to the general medical care required under w ork safety legislation, the B G s have set up facilities which are currently available against paym ent to around 280,000 com panies and which serve som e 6.5 million employees. The industrial m edical facilities of the B G s are in com petition with other industrial medical services in the Federal R epublic of Germany.
3.4.7. Inspection and Certification
C om m ittees of experts and the institutes of accident insurance carriers carry ou t tests on machines, equipm ent, and working m aterials as well as on collective and personal protective equipm ent. This ensures th at the necessary technical safety requirem ents are taken into account when products are being developed, and th at safety standards are observed during production. Knowledge gained in this context is used both for the developm ent of internal regulations and for the creation of national and E uropean standards.
3.4.8. Research Into Occupational Safety and Health
O ccupational accidents and diseases are exam ined individually in o rd er to discover the causes and to obtain inform ation for effective occupational safety and health m easures and new
provisions and regulations. To understand the causes and effects, the BGs carry out a great deal of research them selves and support external research assignments to gain new inform ation.
3.5. Financial Incentives for Preventive M easures
We have already seen, in Table 5, the high correlation betw een the different accident risks in the various branches of industry and contribution rates paid towards accident insurance. To give individual com panies an additional incentive to distinguish them selves in term s of o u t standing preventive m easures and a correspondingly low accident risk com pared to branch levels, accident insurance carriers have come up with a bonus or extra prem ium system, which m akes it possible for individual contribution rates to be assessed on the basis of accident rates in the com pany itself and is, therefore, related to the success or failure of the com pany’s preventive m easures com pared to the industry’s average. In certain cases, the supplem ent or reduction can be as high as 50% of the contribution. Taking one B G as an example, it was statistically proven that the introduction and intensification of a contribution supplem ent and reduction procedure can have a definite and positive effect on accident rates (Kotz & Schafer, 1989). In this context, m ention should also be m ade of an international conference aim ed at the exchange of experiences organised by the ISSA (International Social Security Association) section for the prevention of occupational accidents and diseases in the construction industry on May 14-15,1992, in Frankfurt/M ain, Germany. This event concentrated prim arily on the subject of “contribution rates in insurance against occupational accidents including the bo nus/prem ium systems and their effects on safety and health at the workplace.”
4. SU M M A RY AND O U T LO O K
In the industrial accident insurance system in the Federal R epublic of Germ any, contribution rates have been reduced during a period of over 30 years in spite of significant increases in specific benefits— unlike in other social insurance systems. This is undoubtedly due to a large extent to the fact that it has been possible to m ore than com pensate for general cost trends because of increased efforts to develop effective preventive and rehabilitation m easures and the related drop in accident frequency and severity. The preventive activities of companies, the state, and accident insurance carriers have clearly proven to be an effective factor in containing costs and, therefore, have a positive influence both on the economy and on companies.
Encouraged by these experiences, the BGs have passed future-oriented resolutions to continue and to intensify their successful preventive m easures on the basis of their experience and new approaches. In this context, priority will be given to the intensification of m easures for safety and health protection at workplaces in small and medium-sized com panies and to risk assessm ent in individual cases.
A similar stimulus is in evidence in the International Social Security Association. This is being provided by the P erm anent C om m ittee on Prevention of O ccupational Risks which is trying to persuade all fields of social security with a trend-setting concept th at prevention is the best approach.
R E F E R E N C E S
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