Entrepreneurs in Serbia Pay Health Insurance Even When Not Insured
“Solidarity Pockets”
An entrepreneur from Pančevo had been paying contributions for mandatory health insurance for years. The economic crisis triggered by the coronavirus led to a decline in demand for his goods. In an attempt to save his company, he stopped paying for mandatory health insurance. He soon fell ill, and the company’s account was frozen due to debts. This is an increasingly common scenario for entrepreneurs in our country.
How are entrepreneurs in Serbia protected from business risks, and can they access medical treatment in such cases? Due to unpaid health insurance contributions, the entrepreneur in this situation does not have the right to health insurance. He lost that right the moment he stopped making contributions.
Unemployed individuals can obtain the right to health protection by registering with the National Employment Service. Can an entrepreneur whose company is not operating and who is ill close the company, register with the employment records, and obtain health insurance?
An entrepreneur is liable for his debts for ten years. This is also the longest statute of limitations recognized by our law. Therefore, until he settles his debts, the entrepreneur cannot close his company, and as long as the company exists, he is formally employed. Factually, he is not working, his account is frozen, but each month he is still assessed taxes and contributions as if he were working.
In the aforementioned situation, the entrepreneur, as well as his children who are insured through him, will not have their health insurance cards renewed. Although they cannot access mandatory health insurance during the months when the health insurance card is not validated, the insurance contributions are still regularly calculated for those months. On one hand, the entrepreneur is obligated to pay for health insurance, while on the other hand, he cannot use the health insurance services until he settles the accumulating debts, due to circumstances such as the entrepreneur being ill and unable to work.
Health insurance emerged in the second half of the nineteenth century, influenced by workers’ movements. Due to harsh working conditions, frequent injuries, and illnesses, workers and their families were financially vulnerable as they did not receive wages during their time off work and faced increased expenses if they visited doctors or bought medications. From workers’ solidarity, the idea of savings funds arose, which operated on the principle: all members contribute, and the benefit goes to those who are injured or ill. These funds operated within smaller groups. However, this system was eventually abandoned and replaced by rules where employers were responsible for supporting workers during their inability to work due to illness.
The first comprehensive solution for health care was introduced by Germany in 1883 with Bismarck’s law. This system, with minor modifications, is still in use today. After World War II, countries that adopted the socialist system introduced health insurance for the entire population by having the state assume the responsibility for organizing the health system and providing health care to the population. In England, in response to this socialist insurance system, a universal health care system was introduced in 1948, known as the National Health Service, which provides free health care. Following this system, all Western European countries gradually adopted health care systems. In England and Italy, the entire population is covered by free health care through the National Health Service, funded through taxation. In France, 95% of the population is covered by free health care; in Germany, 85%; in Switzerland, 98%; in Belgium, 95%; in Greece, 95%; and in Spain, 95%. In these countries, health care is provided through a system of mandatory insurance or a combination of mandatory and voluntary insurance.
International documents indicate that the state is obligated to provide health care for its citizens at the highest possible level, according to the state’s economic capabilities. This includes the goal of covering as large a percentage of the population as possible with the right to access basic health care without additional payment.
According to the Health Insurance Law enacted in 2019, mandatory health insurance in Serbia is organized based on the principles of: compulsory, solidarity and reciprocity, publicness, protection of insured persons’ rights and public interest, continuous improvement of the quality of mandatory health insurance, and the cost-effectiveness and efficiency of mandatory health insurance.
The principle of compulsory insurance entails mandatory health insurance, which is ensured by the obligation to pay contributions for mandatory health insurance.
The principle of solidarity and reciprocity means that the costs of mandatory health insurance are borne by insured individuals and other contributors, while the rights from mandatory health insurance are used by those insured individuals who experience illness, injury, and similar situations. In Serbia, health insurance covers nearly 100% of the population, but there are “gaps.” Health insurance in Serbia does not cover all citizens, but only those who are insured, with a health card serving as proof of insurance status. On the other hand, the obligation to pay for health insurance applies to all who earn income or should formally earn income.
This is where the difference between form and substance comes into play. Formally, an entrepreneur is an employee and earns income, but the obligation to pay taxes and contributions is determined on a flat-rate basis, meaning that taxes and contributions are calculated at rates that do not depend on the entrepreneur’s actual income. Thus, entrepreneurs pay taxes and contributions even when, like the entrepreneur from Pančevo, they do not generate income. If contributions are not paid on time, the insured status is lost, and the validity of the health card for the insured person and their family members is not extended.
According to the records of the Serbian Business Registers Agency, there are approximately 200,000 entrepreneurs in Serbia. They contribute significantly to social development through their work. However, it seems that the entire risk of transition and market liberalization has fallen on the weakest economic entities—the entrepreneurs.
Does the principle of solidarity and reciprocity, as prescribed by the Health Insurance Law, also apply to entrepreneurs?