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Ticari sigortalar ile sosyal sigortaların karşılaştırılması (özellikle sağlık sigortası açısından)

Comparasion of private insurance and social insurance (especially with respect to health insurance)

  1. Tez No: 27382
  2. Yazar: BAYRAM NECMİ ÖZER
  3. Danışmanlar: DOÇ. DR. MÜJDAT ŞAKAR
  4. Tez Türü: Yüksek Lisans
  5. Konular: Sigortacılık, Insurance
  6. Anahtar Kelimeler: Belirtilmemiş.
  7. Yıl: 1994
  8. Dil: Türkçe
  9. Üniversite: Marmara Üniversitesi
  10. Enstitü: Sosyal Bilimler Enstitüsü
  11. Ana Bilim Dalı: Sigortacılık Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 95

Özet

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Özet (Çeviri)

INTRODUCTION The base of insurance is dividing probable loss of individuals who face with risk. Insurance gives to people to protect from hazardous. This security provides to increase of insurance sector. Private and social insurance found large application places in the dependent of country economics. In spite of purposes are the same inthe private and social insurance, there are differences in the legals, applications and organizations. Today, in the near of social insurance, there are 56 private insurance company which give services to insurers. In the first section, it will be searched the operation the sources of legal and the financial sources in the social and private insurance. Then in the second section it will be explained the applications in the social and private insurance.The main cooperation in the comparation is selected Social Insurance Cooperation.T.R. MARMARA UNIVERSITY BANKING AND INSURANCE INSTITUTION INSURANCE DEPARTMENT COMPARISION OF RRIVATE INSURANCE AND SOCIAL INSURANCE ( ESPECIALLY WITH RESPECT TO HEALTH INSURANCE ) MASTER THESIS SUPERVISORY : DOÇ. DR. MÜJDAT SAKAR PREPARED BY BAYRAM NECMÎ ÖZER İSTANBUL - 1994SECOND SECTION PRIVATE AND SOCIAL INSURANCE WITH RESPECT TO HEALT INSURANCE I. HEALTH INSURANCE IN TURKEY 18 II. HEALTH INSURANCE IN THE SOCIAL INSURANCE AND THE CONDITIONS OF UTILIZE 19 III. HEALTH INSURANCE IN THE PRIVATE INSURANCE AND THE CONDITIONS OF UTILIZE 20 IV. THE SCOPE OF HEALTH INSURANCE 21 1. The Search In The Doctor Inspection Clinic And Laboratory 22 a ) In The Social Insurance 22 b ) In The Private Insurance 23 2. The Remain Treatment In The Health Cooperation.. 24 a ) In The Social Insurance 24 b ) In The Private Insurance 24 3. The Needed Medicine And The Providing Of Improving Tools 25 a ) In The Social Insurance 25 b ) In The Private Insurance 26 4. Disability And Death Benefits In The Scope Of Health Insurance 26 a ) In The Social Insurance 27 b ) In The Private Insurance 27 5. Financial State And Activities In The Health Insurance 28 a ) In The Social Insurance 28 b ) In The Private Insurance 29 CONCLUSION 30T.R. MARMARA UNIVERSITY BANKING AND INSURANCE INSTITUTION INSURANCE DEPARTMENT COMPARISION OF RRIVATE INSURANCE AND SOCIAL INSURANCE ( ESPECIALLY WITH RESPECT TO HEALTH INSURANCE ) MASTER THESIS SUPERVISORY : DOÇ. DR. MÜJDAT SAKAR PREPARED BY BAYRAM NECMÎ ÖZER İSTANBUL - 1994FIRST SECTION PRIVATE AND SOCIAL INSURANCE IN GENERAL I. THE CONCEPT OF INSURANCE Insurance is emerged because of the protect to from some conditions which give to people problems. In fact, individuals have some dangerous in their life. For example, they can be ill or their some goods can be stolen. When the culture grows, individuals could see the dangerous which threat them, they looked to remove these. To solve their problems they looked the other people possession necassarily and this necassarity appropriate the idea of insurance. Insurance concept can be described some fields in different ways. But in the any fields that components must be in the insurance concept. First it must be a group which have the same dangerous. Second it must be probability of a risk. Third, they must have the same risk. Fourth after the realization of risk which must be removed that disadvantage. Fifth Individuals are obligated to pay premium in order to get benefit and the last insured must have the rights to get protection. In insurance, some technic and science must be used to service ( Statistic, the calculation of probability and legal etc. ) According to the result of statistic and the base of science, risk can be selected. Frequent realization risks can be insured or behind this, rarely risks can be accepted so it is tried to balance.II. THE FUNCTION OF SOCIAL AND PRIVATE INSURANCE We can determine the functions of social and private insurance as indicated below; 1- Economics functions 2- Risk management and regardless enterprise In the first, the purpose is the field, the country and the economy of the world and in the second it is the field, individuals and enterprises. The functions of economics; - It is a important disposal, - It prevents from sosyo-economic debris and loses, - It elevates the level social prosperity, - It grows the relationships of the economics with outside, - It is the source of tax, - It is the sector in the economy. Like in private insurance, the basic purpose is to distribute risk in the social insurance. The function of economy in the insurance is valid either private or social insurance. Mean, private and social cooperation realize the same functions. It may be debated the basic economic functions as indicated below; 1 - The income of social yields mutual, 2 - Capital accumulation and the increasing of economical investment, 3 - Causing economical konjonktür to earn stabilization, 4 - Providing stability to prims and social incomes, -3-5 - Bringing reveneu 6 - Increasing of investment having a social goal. Especially, the functions that interest in the capital a accumulation of the social insurances are important for undeveloped country. We can summarize the functions from the point of risk management of enterprises; - Insurance is an organizations which has solidarity functions. - It effects the decision of enterpreneur. - Insurance quarentee create the loan it's enterpreneur. - Insurance constitute the level of prices much reality. The method of risk management is also insurance. In this case the basic of distribution risk management is natural in the insurance cooperation. III. PRIVATE AND SOCIAL INSURANCE WITH RESPECT TO LEGAL PROVISIONS 1. IN GENERAL It is called the insurance law which prepare the insurance relations and the cooperation of working with insurance. Insurance law is into two parts, they are; 1- Private insurance law 2- Social insurance law Insurance depent on person desire but social insurance put in order with law. In this law quaraty system, insurance can be done only with social security cooperations. However, in private -4-cooperation a person can make a contract with desire. There is a difference from the view of economic and technic. In social insurance there is an aid. In here, insured pays to rest of the premium. If we think about technical part, there is no risk selection like in private insurance. In the social insurance of instutiate it is determined that some situations is dependent in private laws. This brings to a questions, that social insurance is inside of public laws. Because, in here, there is no equality between insured and insurance institute. On the contrary, there is a law and up relationships. 2. THE SOURCES OF PRIVATE INSURANCE LAW In Turkey, today. It is shown below that arranging the private insurance laws; - The laws ( The fifth book of Turkish Trade Law, Debts Law Cooperative Law, Traffic Law ) - Regulations, - General Insurance Norms, - Trial legal imate And Doctrins. In the fifth book of Turkish Trade Law, the sentences of belonging to insurance is arranged in 4 section. FIST SECTION : General Sentences (matter 1263 - 1267 ) SECOND SECTION : Property Insurance ( matter 1268 - 1320 ) THIRD SECTION : Life insurance ( matter 1321 - 1338 ) FOURTH SECTION : Toward Of Seamanship Risk Insurance ( matter 1339 - 1459 ) In the first section, the tariff of insurance contract -5-and the same general sentences are stated. In the second section, the general sentences of property insurance and the kind of some property insurance are stated. In the third section, life insurance and toward to accident insurance are stated. In the fourth section, all is arranged about seamanships insurance. In the field of insurance law, the sentences of Turkish Trade Law ( outside of 5. book ) is shown below; - The sentences of trading. - The sentences of joint-stock company. Today in Turkey, the only mutual insurance company is established in apperance with cooperative company ( Unity Insurance Cooperative ). The law about supervisor of insurance companies, which is 7397 number and 21.12.1959 date, are in force at 30.12.1959. This law is called Insurance Supervisory Law and after 11.06.1987 date and 3379 number as a change stiation. Insurance and Reinsurance companies are inspected with insurance Supervisory Law by T.R. Prime Ministry Finans Secretary. The regulations are shown below that they are put from the law of insurance supervisory in number 3379. - The regulations of insurance and reinsurance in base founding and working. ( Official newspaper, 1988, number: 19849) - Insurance Scruting Committee and Tariff Regulation. ( Official newspaper, 1965, number: 12027 ) - Insurance Expert Regulation ( Official newspaper, -6-1968, number: 12943 ) - The regulation of Motor Vehicle Office in Turkey insurance and reinsurance companies unity ( Official newspaper, 19 73, number: 12943 ) Insurance General Norms, which is written back of policy and is prepared different for every insurance branch and is inspected by T.C. Prime Ministry Finans Secretary, is the conditions of insurance act. Also, as any law branch in the insurance law there are trial legalitimate and doctrin. 3. THE SOURCES OF SOCIAL INSURANCE LAW Social insurance have some legal sources which give illustration of legal, fiscal and f inansal construction. One of them are inner law and the others are international laws which change and develop always. In the social insurance, the source of inner laws are brought by legislation, admination and adjudication. At the number 60 constitution, it is said that everybody has the rights of social security and the goverment take the necassary prevative measures and the set up organizations. In 1945, Worker "s Insurance instituation law is consructed with number 4792 which provide to carry out of social insurance and then with acceptance of social insurance law with number 506 which is called afterthis Social Insurance Instituations. With the reletion of providing laws, regulations and statutes which is general and objective, is taken out by goverment. Statutes and regulations are changeable at various -7-times. Behind, the domestic law sources in social insurance of our laws, the international laws sources is also important. These are double and very portion agreement. These laws are accepted by T.B.M.M. with signing forign countries agreements and then that laws belong to us. IV. THE SECURITY COOPERATIONS IN TURKEY It is shortly benefit to examine the three basic Social Security Inst ituat ion which we will indicate the structure and providing advantage of their insurers. 1. SOCIAL INSURANCE COOPERATION Social Insurance Instutiation provides these services which is shown in the below, to their insurers: - Workers Accidents and occupation diseases. - Disease. - Maternity. - Disability. - Old age and death. It must be an agreement with one or several employer to benefit from these services. Also insurer mate and childs and their mot her and father can use from this social service and aids. Social Insurance Instituation which provides social incomes and aids, is supported by taking premiums from workers and emp 1 oyers. Worker accident and occupation disease premiums are settet with respect to jobs which are heavy or light. The rate of premium is between %1.5 - 7. Employer pays the whole -8-premium. The rate of disability, old age and death premium is %2Q of insurer base earning in premium. %11 of premium is paid by employer and %9 is paid by insurers. At the maternity insurance whole premium is paid by employer and this rate is %1 of insurer base earning in premium. At the maternity, it is not to be said long term income. So, in this type insurance, there is no response. At the disease insurance, a part premium is paid by employer, and the other part from insurer. The rate premium of applying is 11 % of insurer base earning in premium. In this rate, 5 % is paid by insurer, the other part from employer. Insurers the people who takes disability, old age or continously job incomes and their close relative can benefit from health insurance. As maternity insurance, there is no response at the health insurance. The old are insurance gives to insurers old age salary and paid whole sale. To take this salary, the insurer must be women and age 50 or man and age 55 and at the 15 years in the insurance. they must pay 3600 days premium and pay disability, old age and death premium minimum for 5000 days. 2. T.R. PENSION CHEST The first group in the social security in tidy is the working at the public sector. T.R. Pension Chest Law with number 5434 ( Official newspaper, 17.16.1949, number: 7235 ) put insurers on salary disability, retiretment and death. Helth insurance can be -9-provided, insurers who take the monthly salary. The health aid of active insurers is provided by association with works together. The people who is civil servant with the number 657 law, are utilized from helth aid. At the law there is some conditions to utilize from pension chest. There are to finish 18 years-old, and to work certain place and works. 3. BA? - KUR The last group in the social security with legal and compulsory is the working independent workers with the number 1479 Tradesman and Craftsmanship and the other independent Workers Social Security Cooperation Law. Bag-Kur provides to insurers disability, old-age and death insurance. With number 1479 law accept two group insurance. Compulsory insurance and depend on desired insurance. At the compulsory insurance, there is three condition area of Bag-Kur. These are to go in certain profession group or to be partner certain company, not to be another social security instutiation at scope and not to be depend on a employer. At the depent on desired insurance, housewifes, the people who is not depend on any social security and the people who lost compulsory insurance can benefit from the law. The most important source of income at Bag-Kur are premiums. The financial source of instutiation are the premium which is paid by insurers, donations, the incomes of moveable-unmoveable goods of instutiation and the other incomes. -10-V. THE DIFFERENCES BETWEEN SOCIAL AND PRIVATE IN GENERAL The purpose of insurance is to distribute to group prabable damage which is happen in the future. The people, who is in this group, pays the known premium. And in this stuation, the important think is to distribute poverty to a group not to a person. The basic common element of private and social insurance is to comprise something risk, the different elements are the methods. Either private or social, the purpose of all insurance is to distribute the risk, which is happened, to a group. However there are important differences between social and private insurance. We can list in order as in the below. - The private insurance organizations are depend on desire as for social insurance organizations are setted obligotory by laws. In the private insurance, the kind of the companyis joint-stock company. In the social insurance the insurer is the establishment which is setted by public laws. - The relation of private insurance is depend on private law as for the relation of social insurance is depend on public law. - Social insurance contains compulsory quality. Private insurance is optional. But to this rule is brought some exceptins. For example, compulsory responsibility like traffic insurance. - The risk of social insurance are, old-age, death and disability. It means these are relation to a person life. But private insurance also gives the property of a person the -11-impression of being trustworthy. - Social insurance sets up the relation with legal continosly period. However, in the agreement of private insurance the period is restricted. - In the private insurance, the responsibility of insurer starts when the all premium or the first installment premium must he paid. However, in the social insurance the premiums must be paid at the given days systematicly. Otherwise it is given up from responsibility. In the social insurance, to be paid premium, there must be earnings. When the earnings is not become, the premium is not paid. - In the social insurance, the purpose is not to be get benefit. Whereas in the private insurance works to get benefit. So they don't want to insure the people who have the high risks. - Social insurance takes the risks quarentee which is determined by laws. Whereas, there are a lot of agreement with private insurance. Private insurance removes to damages which is happened the risks. Whereas, in the social insurance inside of this they services like social. - In the social insurance the amount of the premium is not depend on the given risks. There is no relatin between the paid premium and the suplied aid. It means, the premium is taken the rate of insurers salaries. In the private insurance, the situtiations are not like this. VI. PRIVATE AND SOCIAL INSURANCE WITH RESPECT TO FINANCE Insurance companies, like the other companies, is to continous their works, they need the financial sources. -12-Insurance companies gets large funds from this sources and these funds are operated. When these funds are operated, It must be taken note yields, realibity and profitable. 1. THE FINANCE OF SOCIAL INSURANCE The financials of social insurance are examined from the point of financial source, financial methods and operation of funds. a ) The Sources Of Finance The basic two financial sources of social insurance are premium and the sources of goverment. The income of insurance can get from two or only from one. In the prat ice, at is benefit from the two sources and it is followed a mixed way. In general, the financial of social insurance is based on the three sources ( means, worker, employer premiums and the aid of goverment ) The basic characteristic of the social insurance is the compulsory of the premiums. Premiums is calculated according to altitude of salaries in general. The workers are added to the financials of insurance because of personel responsibility and personel disposal. The employers are added to the financials of insurance because of the increasing of the yields productive power, b ) The Methods Of Finance It must be balanced beween the financial sources of social institution and expenses. The supplying of this balanced, it is used from two kind financial methods. In the application, like it can be used only one, we can use all together. -13-aa ) The Method of Sharing The bases of this financial method consist of the yields of a year which cover the other period expenses usually in a period of insurance. In this method, the income and expenses always is in balance. As the rate and the sum of premiums, at is determined with the estimating of relevant period, it can be shared worker insurers and employers like, it can be shared with the one time calculated of premiums and all the periods supplying incomes to people who is met the risks in the same period. In the first situation the level of premiums changes depending on expenses and in the second situation the level of expenses changes depending on incomes. The method of sharing which gives the trust aganist the dropping of money worth, is a easy calculation and simple system. Especially it is suitable for covering of temporary risks like health and maternity insurance branches. bb) The Method Of Kapital ization The bases of kapital ization method contracts a common fund to respond to risks which get payments in the future. In the kapital ization method, it is constituted a fund to respond to risks which gets payments in the future. So taking premiums from insurers and employers responds to current year expenses. In the kapital ization method, the premium of insurers are collected in a fund. These collecting funds which are operated, are used to aid of insurers in the future. In this method because of the unknown period, the capital arises huge -14-dimensions at the time. The method of kapital izat ion are used disability, old-age and death insurance which are long terms. But the objection of this method is open to fall the value of money. Usually these funds are not directed the investment, so these funds lose the value in the inflation period. Because of the objections of the kapital izat ion method, it is not used now. In fact, the countries which grows at the last years, need these invest ible capital more than the developed countries. Since these funds are the important sources for these countries. c ) The Operation Of Social Insurance Funds In social insurance the funds, especially, the countries applying the method of kapital ization, reach huge dimensions. The purpose of the collecting capital in the social insurance is to respond to liability and expenses in the future and now. In the operating of the funds some principle is to be developed. The main of the principles are yields, realibity and profitable. The principles in the operating of the social insurance funds is also indicator of the investment fields. The investment fields are the goverment or goverment- cooperations. At the a lot of countries, the funds are invested to goverment or the banks which is built by goverment. 2. THE FINANCE OF PRIVATE INSURANCE Althought the differences between the private and social -15-insurance, the basic purpose of them are the risk distribution. In the financial matter is the same, too. The cooperation of private and social insurance use the same financial methods. But there is a difference the source of financial. The financials of social insurance are premiums and goverment sources. Whereas the source of financial in the private insurance is only premiums which is taken by insurers. a ) The Source Of Finance The function of realibity of insurance companies is validity when the insurance policy is prepared. Received premiums from insurers const i tu the yield of insurance companies. Insurance companies get the profit or loss after the activity of technic. The elements of pure-source at insurance companies are main-capital, legal and other reserve funds, not distribution profits and quaranties. Insurance companies don't use the middle and long term bank credits. The known some reserves at insurance are mathematical reserves, premium reserves and reserves for outstanding losses. Mathamatical reserves is mentioned at life insurance. The amount of disposal premiums which constitute the mathematical reserves, is appliedthe rate of technical interest in the end of the year. Mathematical reserves are invested to productive fields. So the amount of reserves will increase at the time. The income of premium which is taken in a known period, -16-is not had a right to a part which is called premiums reserves. Because of incresing the liquidity, govermentput a strain upon this reserve. Althought the damage is happened in the period of insurance validity and the damage is not paid to insurer, insurance companies separeted the funds which is called reserves for outstanding losses. b ) The Methods Of Finance Like social insurance, distribution and kapitalization methods are used. The small function of distribution method is used to short time insurance branch like accident, health, fire. However accumulation insurance is used at old-age, retired and life insurance branches. In the accumulation insurance the capital which is constituted by risk premiums is not too much. The actual capital is constituted by disposal premiums. c ) The Operation Of Private Insurance Funds Insurance sector is not only to reduce the risk function, besides itconstitutes the funds which provide the economical structure and development. Insurance and Reasurance companies give two kinds of quaranties which are called fixed and variable. Quaranties are invested to the values which is stated by 7397 number Insurance Supervisory Law. The principles in the investments are liquidite, yields and realiability. -17-SECOND SECTION PRIVATE AND SOCIAL INSURANCE WITH RESPECT TO HEALTH INSURANCE I. HEALTH INSURANCE IN TURKEY Insurance aims to recover exact or in a certain amount of cooperate loss of obvious risk. Sickness does not remain to give people physical or psychological pain, it cause to financial inconveniences that can not be suffered by patient. An illness will cause two effects, medical expenses and loss of earnings for not being able to work, these two effects may cause economim imbalances for a person or even a whole family. In according to prevent these losses the goverment has taken precautions listed below. Social Insurance Coop. T.R. Pension Chest Bag-Kur The legal health insurance has not been able to give enough service to its members which are able to afford the cost to go to private doctors and clinic. The increase in cost of private doctors and clinics has made a demand for a new health insurance. Social and private life insurance can be summurized as down below; Life Insurance Social insurance Work Accidents and job illness Illness insurance Infirmity disebility insurance Old age insurance Death insurance Private insurance - Life insurance - Accident insurance - Health insurance - Personel - Group -18-Private health insurance will provide the insured person if injured or during illness with; - Hospital fees - Operation fees - Doctor fees - With large scope and guarantee insurance - Payment of loss of earning during disability These treatment fees will be paid according to personel or group insurance. II. HEALTH INSURANCE IN THE SOCIAL INSURANCE AND THE CONDITIONS OF UTILIZE Classical health insurance pays fars cost taken by doctors which agree to treath patients in public hospitals for birth and health medication for the insured person and whom he/she must look after. Income losses during the time the insured is ill all is giving birth and is not able to work will be paid by insurance upon death funeral fees etc. Fees will be paid. Todays health insurance follows three steps; - A percantage of the expenses made by the insured is paid by the insurance firm. - The insured is served in the insurance firms own association. - The payments given directly to the patient himself. Private insurance firms pay a percentages of the expences but there are just a few countries with this kind of social insurance system. The second way is perfect for social insurance health -19-services are better organized. The third way the insured does not pay anything and all payments are made by the insurance company directly to the people or firms who have given the health services. Our contries health in plans are trying to he organized according to the third system. According to the law 506, the second and the sixth article work contract done by one or more employers the employee is insured and has all the benefit of the insurance with the acceptance and start of the jop. After 120 days of being insured social insurance association gives the insured a bonus which includes a full health care service for his/her family and parents. Over-seas health services excluded. The financial aid which is given during the time the insured is unable to work, when he/she is ill is given the insured or his/her family ( partner, children or parents ) including to this, the financial aid, disable aid or pension may also be given to the family. III. HEALTH INSURANCE IN THE PRIVATE INSURANCE AND THE CONDITIONS OF UTILIZE Private health insurance usually indudes death and disableness. The insurance firm is only responsible to pay compensation for disability or that during the continuity of the contract. Different insurance policy's are made for different situations and agreements between the insured and the insurance firm. The insurance firm accepts to pay compentaiton -20-for different risk. The premium which is paid by the insured to the firm is fixed according to the validity of the insurance, the occupation of the insured, age, health, history and the situation of the families health. Private insurance firms in Turkey prepare health insurance policies in two groups, personel and group policies. The responsibility of the insurance begins after a contract is signed and the the first premium is given to firm. Insurance contract made by private firms insurer health case in Turkey and in critical situations it provides accomadition if the treatment must take place out-side Turkey the firm will cover the fees according to below requirments. - Treatment fees made abroad will be paid with the cash exchange rate of the state bank ( T.C. Merkez Bankası ) as Turkish Lira according to the requirments by the policy signed and invoice handed in. In over-seas treatments the insured must hand in a document that proves that he/she was in the contry that the treament took place between the time period stated as the treatment session. Insurance firms do not pay for the fees of treatments of an illness which lasts longer than a yaer. If an insured has to continiously stay at a hospital or go from time to time for the some illness, the firm will only pay the fees up to 365 days. IV. THE SCOPE OF HEALTH INSURANCE An ilness will effect a patient in two economic ways; -21-1- It prevents a person from working so it effcts the persons income, 2- Extra expenses ( medic ine, doc tor, hospital fees etc ) Health insurance completes itself financialy and with medical aid and tries to lossen the legalies. The extents of helth care assistance. 1. Doctor consoltation, clinic and laboratory examinations. 2. Treatment in health associations. 3. Medicine and pysical equipments provided. These assistance will be examined according to social insurance and private insurance. 1. THE SEARCH IN DOCTOR INSPECTION, CLINIC AND LABORATORY a ) In The Social Insurance Health insurance supplies the medical help needed for the insured such as doctor, consultation and the help needed during the treatment. The consoltation, the doctor, if seen needed by the doctor. Clinical and laboratory tests will be taken for the diagnose and the needed treatments will be done according to the 33 article of the S.S.K. ( Social Insurance Association ) If needed the insured will be placed in a health instutiation for the diognose treatment ( S.S.K. article 33/B ). As a general principle the treatment of the insured is taken placed in its own health instutions by its doctors ( according to S.S.K. article 117 and 118). If the treatment is not taking place in a health -22-instutions the insured pays 20 % of the medicine fee ( according to S.S.K article 33/C ). b ) In The Private Insurance Health insurance of private insurance give health care on foot or in healt institutions of health institutions assigned by the health ministiry for domestic treatments for over- seas, treatments are done by official institutions which are outorized to accept and treat patients. The insurance firm will pay the confirmed official farms invoices and receipts of doctors and hospitals fees for the treatment. If the invoices and receipts total of the treatment is loss than the insurance warrantly some total, the guaranteed some will be paid without any reduction. Non-guaranteed circumtances of a few insurances firms policies are listed below; - Situations of surcide or commitment to suicide, physical damage done to oneself concious or unconcios. -Warm and warm movements, invasion, foreigene enemy attacks strikes- lockout lobour movements and terroristic movements. -Ilnesses or disablenesses which are caused from nuclear fission or radioactive material. -Disablenesses which was present before the contract and also expenses caused because of this disableness. -Transportation fees except for licenced ambulances. -Organ transport. - An injuriy caused during a voyaj on a unlicened -23-transport or travel company ( Except for licenced travel companies which give tickets ). 2. THE REMAIN TREATMENT IN THE HEALTH COOPERATION Patients which can't be treated on-foot or at home are treated at health institutiaions. On an emmediate illness or if there is not enough time to appeal to an official health institute because of life and death the insured may go to an unofficial health institute. On upon this the firmwill only pay the fees for the first treatment. a ) In The Social Insurance The insurance is controled by a doctor and if the doctor saya there is need for diognose the clinical and laboratory test are taken if needed. The insured will be put into a health institution for the required diognose and treatment. b ) In The Private Insurance Onfoot and needed treatments have been examined carefully by private insurance will be best to examine the subject under to headings. - The policy will pay the written limits of hospitals clinics and private consultation officies which have licenced doctors for the consultation. - The analysis done to diagnose and the help the treatment will be paid according to the limits on the policy. The payment of fees of heelded treatments are follows; - If the insured is heelded at an health institution he/she stay at the institution ( whole daybases ) and similar expenses will be paid with the room fee. The meals are also in warranty but a patient keeper is not in the warranty -24-quarantee. If a surgical operation is needed the operation and anaesthesis fees will be paid according to the maximum limits of the policy. 3. THE NEEDED MEDICINE AND THE PROVIDING OF IMPROVING TOOLS Health aids; - Tooth infection treatments, - Eye treatment and the supply of the required instruments, - Prosthesis, the supply of the required instruments, - The supply of the needed medicine for the treatment can be grouped in this form. The grouped heath aids have been explaned as social insurance and private insurance down below, a ) In The Social Insurance Mouth prosthesis aids are prepared according to the regulations. According to the official paper of 18.8.1978 of its second article; mouth prosthesis are supplied by the firm and if brought from abroud a payment of the minumum fee will be paid. Eye treatments; exceptions like colourmatic glasses and high quality frame. Every six months the glass and every two years there is a right to change the frame. Everybody that the insured has to take care of can use these benefits except for the wife/husband. And all kinds of eye operations are done by the associations hospitals. Social Insurance Association ( S.S.K. ) supplies its medicine from its own pharmacies or from pharmacia which are -25-based on contract ( S.S.K. article 123 ). b ) In The Private Insurance Private insurance firms have differences in the warranties concerning tooth treatments. Some insurance firms accept hospital, clinics and private doctors who are licenced as dentist and pay the fee according to the quarenteed policy. But to the contrary to this same insurance firms have lefterout tooth consoltations, x-rays, tooth infections and tooth prosthesis from the health insurance warranty. Private insurance firms accept to pay the feesof treatments consultations and if necassary bedded treatments for eye infection treatments at licenced doctors. Prothesis instruments and the other devices ( hearing, speaking devices etc. ) have been left out of the warranty quarantee by private insurance firms. 4. DISABILITY AND DEATH BENEFITS IN THE SCOPE OF HEALTH INSURANCE Disableness is a persons ability to work partically or completely in insurance terms. This is in the warranty agreement. Disableness is a grouped into 3, disableness, complete and continous disableness and temporary disableness. A patient is put into one of those catagories by a doctor. Complete and continous disableness or temporary disableness give two outputs. The disabled person heal and reenter a job which may not be as satisfiying as the job before or he may die. Death may be bring various expenses ( fureral, attandence, taxes ect. ) -26-which may bring cause the debts this is why disableness and death states have been included to insurance to protect to people that the insured must take care of. a ) In The Social Insurance The disableness and death warranty premiums is of 20 % of the income of the insured, 9 % is paid by the insurade and 11 % is paid by the employer. For an insured person to be able to benefit from the disable salary he/she must have paid 1800 days of premium or at least have been insured for 5 years and have deposited 180 days of premium every year. The 1800 days doesn't have to be deposited to S.S.K. the beginning of the premiums may have been paid to another insurance. If person has a death insurance and dies his/her wife/husband, children, mother and father may benefit from it. b ) In The Private Insurance In general, some insurance firm take disableness death warraties in personel health insurance were as some insurance firms quarantee them in life insurance. The insurance paid for partial or complete disableness is measured by the degree of disableness and by a disableness table which shows what percantage is going to be paid according to the warranty. A death warranty is given to people who are in the age category of the insurance and in the death of teh insurade ( notwale death or by the accident ) the amount quaranteed by the policy or if there is none to the heirs of the heritage. -27-5. FINANCIAL STATE AND ACTIVITIES IN THE HELTH INSURANCE To be explicit we will now see the incomes and expenditures of social and private insurance firms during the period of 1991-1992. a ) In The Social Insurance According to law 506, the insurade are insured by- permanent unability to work fee, disableness and old-age pension and their spouse, children, mother, father, widow and arfons receive health care. According to the law 506 treatment cares are done by he lth foundation managaments which give help to 1/3 of the population. There are no limits on the health care expenditures of social insurance. However in the private insurance there are limits on the health care fees during a year. The income expenditure tanle of the social insurance firm during 1992 Expenditures ( Million TL ) Social Ins. Expenditures 21.460.859,7 Health Foundation Expend. 5.596.837,1 Other Expenditures 2.163.312,1 Total 29.221.008,9 What was founded for these 12.437.561,8 ( - ) 16.783.447,1 Incomes Premium Incomes 31.853.659,9 Other Incomes 3.685.867,3 Total 35.539.527,2 -28-b ) In The Private Insurance The warranties of private health insurance change according to different firms. There is use in looking at a couple of different firms health insurances to give an idea of the subject. Everybody who is between the age of 0 - 60 have the right to insure themselves in any private insurance company. -29-CONCLUSION The health of its citiens is very important for a country today, we understant that the people are not satisfied of the goverments health operation by the increasing demand of people which are insuring themselves. In private health insurance as personaly in groups and as instutition. This is why we should give a large space for private health insurance which complete each other. The social security system is organized by the govermentin every country. It is almost impossible to have a Social Security System without the goverment. We must form a new model were Private and Social Insurance Firms are integrated within each other for our country. For example the social instutition could have a service upto a standart degree were after this degree Private Health Insurance comes into action. In the near future the goverment organizations have made plans to increase the percantage of private insurance for health insurance. But of course not coumpletely shifting all health care services to the private sector. A health reform is wanted to be made in Turkey by improving the present state or forming a general health insurance model by integrating goverment private sector together. This will increase the potential of insurance firm which give health services and lead them to give better service. But just transfering health insurance to private insurance will not solve the problem with case. Instutitions hospitals must be formed to give health services. Today the -30-social insurance instutition as approximately 4 million people paying premiums and has 24 million people benefiting from its service. It is obvious that if everybody switched to private health insurance and went to private insurance firms will not able to supply the services demanded. But if Private and Social Insurance firms combine & complete each other it will set private hospitals to be able to give the needed service and let them complete with the prices. As a conclusion if private insurance firms anals there health premium statistic properly they will be be able to enlarger their percantage in health insurance will decrease the dencity of problems which the goverment must take care of. And they will also complete the health services which the social insurance institute must take care which will bring productive and positive results. -31-

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