Disability insurance (IV) was introduced in 1960 after a brief period of preparation. A sustainable administrative structure had to be set up quickly. The new social security scheme solved the problem by making use of existing schemes. Fundamental reorganization followed at the beginning of the 1990s. The autonomy and clout of IV institutions have since been consolidated.
The Federal Law on Disability Insurance (IVG) was passed in 1959 after an extraordinarily brief preparation period, resulting in the introduction of disability insurance in 1960. Within a short timespan, an administrative structure therefore had to be found to enable the collection of insurance contributions, the verification of individual benefit entitlement and the disbursement of pensions and daily allowances. In addition, the vocational re-integration measures envisaged in the IVG had to be put into practice.
Decentralized Structures: AHV Equalization Funds, IV Commissions and Regional Offices
The legislator solved this problem by making use of existing structures wherever possible. This led to a decentralized, complex form of organization that was not always easy for policyholders to grasp. In terms of its funding (wage deductions and public subsidies) and benefits system, the IV was closely based on old age and survivors’ insurance (AHV). Notably, the equalization fund was adopted. From 1960, the AHV equalization funds largely controlled by employer organisations were also responsible for collecting IV contributions (1960: 0.4 percent of wages; since 1995: 1.4 percent of wages) as well as for decisions regarding benefits and the disbursement of cash benefits. In addition, contributions and benefits were settled through the AHV Central Compensation Fund. The legal process was likewise based on the AHV act and overseen by the Federal Social Insurance Office (BSV).
Unlike the clear-cut allocation of AHV pensions, the granting IV benefits required extensive clarifications. It was necessary for a specialist doctor or social worker to assess whether an insured person suffered from incapacity to work or required retraining measures on a case-by-case basis. For this purpose, the law stipulated an IV commission for each canton that was to be composed of a doctor, a re-integration specialist, a vocational education specialist, a lawyer and a social worker. These were voluntary positions. At least one member of the commission had to be female woman. The commission secretariats were affiliated to the cantonal AHV equalization funds from an administrative standpoint. At the federal level, there were also two commissions for federal employees and Swiss citizens abroad. The main task performed by the IV commissions was to prepare decisions regarding the degree of disability, the suitability of re-integration measures or pension entitlements on behalf of the compensation funds. They held no formal decision-making authority themselves. However, the findings ascertained by the IV commissions were binding for equalization funds.
The IVG also delegated the execution of vocational measures to around six to nine regional offices. These measures sought to enforce the principle of ‘re-integration before benefits’. The regional offices performed purely executive tasks such as career counseling or the transmission of job vacancies. The federal law likewise entrusted existing, typically cantonal as well as private, counseling offices and job centres. The IV was also to make use of established re-integration facilities and training workshops.
Reorganization Measures: More Efficiency and Proximity to the Insured
The structures created in 1959 held for the time being. Both IV revisions of 1967 and 1986 streamlined a number of processes but did little to change how the system was organized. However, at the end of the 1970s, political officials began to focus on the need for reform. A working group directed by the St. Gallen economist Benno Lutz critically examined the organization of the IV against the backdrop of the deteriorating financial situation of the program and the first debates that flared up surrounding insurance fraud. Lutz proposed a number of reforms in 1978; yet only some of these were implemented. The BSV accordingly established the Offices for Medical Examination (MEDAS) and the Offices for Professional Evaluation (BEDAS) tasked with supporting the medical assessment of complex cases. Calls for a reduction in the size of the IV commissions were not put into action due to the intervention of disabled persons associations. Nevertheless, the weaknesses of the commission system based on the militia principle and involving numerous stakeholders, became increasingly evident. The administrative clout was progressively transferred to IV secretariats that had no powers of their own. Furthermore, many cantons decided to set up their own regional offices.
Fundamental reorganization was not forthcoming until the third IV revision in 1991, which continues to govern the structures of IV today. The procedure was accelerated and contact with the insured simplified. The creation of cantonal IV offices, which took over the functions of the IV commissions, and regional offices formed the main goal of the reform. According to the vision of the Federal Council, their responsibilities included ‘all actions that are necessary from the receipt of an application for benefits to their payment.’ They were also tasked with planning and monitoring re-integration measures. The Federal Council thus stated that the IV offices were required to provide a ‘comprehensive range of services’ in a legal, medical, professional, social and administrative sense. The demand for qualified specialists was accordingly high. For the insured themselves, the reorganization measures meant that they had now a single contact partner in the form of their competent IV office. This facilitated contact and increased the level of participation, for example with the extension of the consultation procedure in 1987. However, cooperation with the AHV equalization funds continued, albeit in a different manner: the IV offices were now responsible for issuing benefits themselves. The equalization funds were only left with the administrative calculation of cash benefits and their disbursement.
Stricter Controls, New Tasks and Financial Independence
The trend towards increased integration of the system continued after the turn of the millennium. At the same time, the Confederation tightened controls over the IV offices. This was particularly the case in terms of medical services, which had come under political pressure due to the growing number of new pensions and beneficiaries with psychological complaints. The fourth IV revision (2003) envisaged the establishment of regional medical services (RAD) to enable IV physicians to examine the insured themselves. These services are subject to the technical oversight of the BSV, although they are authorized to decide individual cases autonomously. At the same time, collaboration between IV and MEDAS was tightened. Acting as external assessment centres, the MEDAS offices were mostly private and worked on a for-profit basis within the scope of an agreement with the BSV. Though the Federal Court confirmed their independence in 2011, the court stipulated that the legal position of the insured against that of IV should be improved. This came to pass in 2012 with an adjustment of the IV regulation.
In light of the IV growing deficits and the refusal to increase contribution rates, the fifth IV revision (2006) emphasized the concept of re-integration and activation and made early detection and intervention the new working priorities of the IV offices. The aim was to introduce assistance and support measures before the affected insured left the workforce and became pension recipients. By using targeted integration measures, the IV offices sought to promote the individual responsibility of the insured and improve their employability on the labor market. Authorities pushed the Inter-Institutional Cooperation (IIZ) to improve coordination of IV-activities, unemployment insurance and social welfare. This is hoped to prevent the unemployed from slipping through the social security net. With respect to the IV offices, the IIZ brought about a sharp increase in collaboration across different institutions. This also meant an increase in control and dependencies for the insured. The new vocational field of labor integration specialists emerged at the same time. Since the sixth IV revision of 2011 (in effect since January 2012), the IV offices have also been in charge of directing assistance contributions aimed at helping the disabled become more independent in everyday life.
In addition, there have been recent changes from a financial perspective. A new IV compensation fund was set up in 2011 to prevent the cross financing of the loss-making IV with AHV reserves and ensure its liquidity. The new IV fund received a starting capital of 5 billion francs from the AHV Central Compensation Fund. The IV has since enjoyed financial independence in practical terms. However, the AHV equalization funds continue to be responsible for calculating entitlements and pensions, as well as for paying out IV benefits.
Literatur / Bibliographie / Bibliografia / References: Website des Bundesamts für Sozialversicherung, Bereich Invalidenversicherung: www.bsv.admin.ch; Canonica Alan (2013), Missbrauch und Reform. Dimensionen und Funktionen der Missbrauchsdebatten in der schweizerischen Invalidenversicherung aus historischer Perspektive, Schweizerische Zeitschrift für Soziale Arbeit (im Erscheinen); Botschaft über ein zweites Paket von Massnahmen zur Neuverteilung der Aufgaben zwischen Bund und Kantonen, 25. Mai 1988, Bundesblatt, 1988 II, 1333–1441, insbesondere 1379–1387.