Physical, mental or physical impairment is common. Nowadays in Switzerland, more than ten per cent of the working-age population suffers from a disability, be it due to birth defect, accident or illness. How disabilities have been defined, and addressed (or ignored), has changed significantly over time. In the history of the Swiss welfare state, those with disabilities were long overshadowed by other groups at risk. A national disability insurance scheme was only created in 1960.

Physical and mental disability was ubiquitous in pre-modern society, but medical care for it was rudimentary. Minor accidents or illnesses often had visible, lasting consequences for people’s health. People with disabilities were primarily perceived as a problem if they were poor and in need of financial support. The authorities permitted them to beg or accommodated them in hospitals or placed them in foster families. Special institutions for the blind, deaf-mutes, or those with mental disabilities were established in the 19th century. Disability thereby became a medical or educational issue. The notion of rehabilitation also gained momentum thanks to advances in medicine, such as in the treatment of goiter, as well as the emergence of new disciplines such as orthopedics and special education. Once schooling became compulsory, with revision of the federal constitution in 1874, children with disabilities also became entitled to an education. In many places, special education classes were set up to support children with learning difficulties. 

Patchy Provision

The first type of social insurance which addressed the risk of disability was accident insurance. In the 19th century, men and women increasingly engaged in work for wages and those who could no longer work found their very existence endangered. Work in factories resulted in new accident hazards, and under the pressure from middle-class social reformers and the workers’ movement, early factory laws did somewhat improve work safety. Yet the liability of factory owners remained limited. Even after passage of the Swiss Factory Act of 1877, injured workers still had to go to court to receive compensation. In many places, voluntary relief schemes were therefore established to insure workers against the consequences of accidents. The risks covered not only included the short-term consequences of accidents but disability as well. Those who were covered by accident insurance were typically also entitled to a pension or a settlement amount in the event of disability. 

A dual protection against accident consequences and disability was included in the governmental accident insurance scheme introduced in 1918. Following the Health and Accident Insurance Act (KUVG), the Swiss Institute for Accident Insurance (Suva) had to pay for both the treatment and rehabilitation costs as well as compensate for the loss of income. In the event of permanent (or partial) inability to work, policyholders were entitled to a disability pension. The insurance covered the consequences of occupational accidents as well as acknowledged occupational illnesses, such as those resulting from poisons used in the chemical industry. The pension amount depended on the loss of earnings. Soldiers were also insured against disability; after 1902, they were entitled to military insurance benefits (taxpayer-funded) in the event they became disabled. Pension plans, initially in the public and later in the private sector, also began to disburse disability pensions. 

However, the scope of these insurance schemes remained limited. Only a fraction of the workers – primarily those working in industry – were Suva-insured at all. Those employed in the service sector or in agriculture, and those who were self-employed were not subject to obligatory accident insurance. Admission to a pension plan depended on the respective employer, and taking out a life insurance policy was entirely voluntary. In 1941, less than one-sixth of the gainfully employed were insured by a pension plan that covered disability risks. In addition, all such insurance was restricted to the employed, since insurance parlance equated disability with the inability to work. Disabilities that did not result in a reduction of earnings were considered irrelevant. For that reason, those not gainfully employed, particularly housewives or many who had congenital defects, could not claim disability benefits. Before the First World War, the workers’ movement, as well as some in left-leaning liberal circles, had thus called for a disability insurance (IV) that could be expanded to cover the entire population. Only the Canton of Glarus had introduced this form of insurance by 1919. It was not until after the First World War, when demands for greater change to social welfare arrangements began to be made, that disability insurance made it on the political agenda. In this era, countries like France had introduced insurance for the many war wounded. In Switzerland, attempts were initially made to introduce disability insurance alongside old age and survivors’ insurance (AHV). The constitutional article which passed in 1925 ultimately gave priority to the AHV. When the first AHV bill was rejected in 1931, the authorities put implementing disability insurance onto the back burner. 

This resulted in many with disabilities remaining dependent on poor relief. At the national level, it was predominantly the associations devoted to aiding the disabled and the proponents of special education who shaped disability policy during the interwar period. In 1920, representatives of special education schools as well as of schools for the blind and the deaf founded the Swiss Association for the Disabled. Since 1935, it has been known as Pro Infirmis. As was the case with health and unemployment insurance, public and private stakeholders worked closely together. In 1923, the Confederation began subsidizing Pro Infirmis, primarily to finance improvements in institutional homes. Until shortly after the Second World War, Pro Infirmis also advocated preventative disability policy based on eugenic measures. There was consensus among psychiatrists and special educational teachers that it was important to prevent women from passing on disabilities to descendants; this applied particularly to those with mental disabilities but also to the deaf and the blind. Contraceptive measures, such as sterilization, and bans on marriage were considered viable means in communities and cantons of curbing social expenditures. In 2005, the federal government enacted a sterilization law. Only in exceptional cases and under strict requirements was it possible after this date to sterilize a person who was permanently incapable of judgment. 

Disability Insurance: Prioritizing Re-integration over Benefits

Once the AHV was introduced in 1948, disability insurance (IV) returned to the political agenda. Implementing IV became a matter of increasing urgency, not least due to the examples set by neighboring countries. In 1950 it was estimated that about 39,000 men and women suffered from physical disabilities or severe impairment to the senses (esp. sight and hearing), and at least 18,000 were mentally disabled. Among those of working age who had physical disabilities, two-thirds were either fully or partly unable to work. Only some received a pension; many relied on welfare. Municipalities therefore campaigned for the swift introduction of disability insurance. After individual cantons had set up insurance schemes and two popular initiatives had increased the political pressure (1954/1955), the Federal Council finally sped up their work on a legislative proposal In 1959, Parliament passed the Disability Insurance Act; by the following year, the new insurance scheme began to be implemented. 

The IV disability insurance adopted the contribution and benefits system of the AHV. It was designed as insurance for the entire population, which also included those with mental disabilities and congenital defects. Universal disability insurance was a Swiss peculiarity in international comparison. Many other European countries had disability insurance that overlapped with other social insurance schemes. In Germany, for example, coverage of the risk of disability was split between pension, accident and unemployment insurance. The reason for this was that German statutory pension insurance served not only as old-age provision but also covered the risk of having a reduced earning capacity. In Italy, both pension and accident insurance, along with public social assistance, compensated for those with physical and psychic disabilities. In the Netherlands, those with disabilities were insured until the 1990s only in the context of independent occupational workers' insurance schemes.

With regard to benefits, the IV disability insurance system provided for measures connected to medical and occupational re-integration, the provision of assistive devices as well as daily allowances, pensions and contributions to institutions and special education schools. The pensions were ranked by the severity of the disability. The IV was based on the principle ‘work before benefits’: men and women with health problems were to be re-integrated into the labor market wherever possible. In addition to military insurance, the IV was the only social insurance at the time that included measures for re-integration back into the labour force. Back then, Suva limited its benefits to medical rehabilitation. Conversely, the IV worked closely with sheltered workshops for the disabled and vocational guidance centres. The authorities not only expected such forced re-integration efforts to lead to savings, but also to an increased independence and ability to work among those with disabilities. Great symbolic importance was ascribed to pursuing regular employment, particularly for men. Gainful employment meant having an orderly biography, provided access to social networks, and led to social recognition. 

In the private sector, involvement in occupational integration was voluntary. In contrast, countries like the United Kingdom or Germany, with large numbers of disabled people from the war, forced individual businesses to hire people with disabilities. Such compulsory measures were not politically feasible in Switzerland. The voluntary model was also not discussed further in the 1950s and 1960s. The shortage of workers during the economic boom meant that people with (minor) disabilities were desirable employees. 

Over time, the modest benefits of the IV would be repeatedly expanded. On the one hand, IV pension recipients benefited from the introduction of supplementary benefits (1966), the increase in AHV benefits and the indexing of pensions. Many workers also gained additional coverage due to the expansion of accident insurance (1984) and occupational provision (1985). Like the AHV, in these cases the IV served as basic insurance; benefits were reduced in the case of overinsurance. On the other hand, several IV revisions brought about specific expansion in the benefits granted. For instance, re-integration measures were expanded, contributions to assistive devices and special education schools (1967) were increased and quarterly pensions introduced (1986). Moreover, the allowance system for incapacitation was redesigned (2003) and an assistance budget was introduced for people with disabilities (2006/2012). 

Though the IV system weathered the recession of the 1970s relatively unscathed, it plunged into a financial crisis in the 1990s. Rising unemployment and the lack of further benefit increases caused the number of new pensions and budget deficits to skyrocket. At the political level, this sparked a debate centered on the IV abuses; the pension beneficiaries claiming mental impairment became a particular focus. The IV system was accused of facilitating abuse and setting false incentives. The Federal Council and the center-right parliamentary majority responded with various cost-cutting proposals (1999, 2003 and 2006), which were rejected, at least in part, at the ballot box. At the same time, new funding sources were found by increasing wage deductions (1995), two capital transfers from the income compensation scheme (1995 and 2003) and a temporary increase to the value added tax (2009). Aside from reducing benefits, the fifth IV revision (2006) reinforced the principle of ‘re-integration before benefits’ by adapting the notion of activation already used in unemployment insurance. Early detection and intervention measures as well as improvements in the cooperation with other institutions sought to prevent men and women with health impairments from being dropping out of the world of work and becoming pension recipients. The work activation policy also relied on a quid pro quo from the IV recipients. There was thus a duty to cooperate with the measures promoting integration into the working world. In addition to integration, the IV also hoped it would lead to having less pensioners, which is why the revision of the law was accompanied by stricter pension practices.

Social insurance schemes traditionally aimed at compensating for the economic consequences of injury or damage to a person’s health. From the start, the focus was on partially compensating for the loss in income. This is why women in particular, but also men who were unemployed or unable to work, either had a very limited or no entitlement to benefits. Many people with disabilities were therefore long ignored in social insurance schemes. The Disability Equality Act (BehiG), which entered into force in 2004, takes a different approach to disability policy. It is aimed at overcoming the societal obstacles which people with disabilities face, whether these take the form of restricted access by the disabled to buildings, economic disadvantage, or discrimination. It calls on the society to be held accountable for promoting the equality of people with disabilities. The UN Convention on the Rights of Persons with Disabilities, which Switzerland ratified in 2014, points in the same direction. It is based on the Universal Declaration of Human Rights and its goal is to guarantee people with disabilities the same rights as those without disabilities. However, the Convention does not contain any rights legally enforceable by individuals; implementation lies with the contracting states. With its accession, the Swiss Federal Council and parliament reaffirmed its desire combat discrimination and to actively promote the equality and integration of people with disabilities.

While the main orientation in the IV employment activation policy is toward the personal responsibility of people with disabilities, the Disability Equality Act and the UN Convention on the Rights of Persons with Disabilities are increasingly geared to adapting to the needs of people with disabilities. They want to move away from a deficit-oriented view of disabilities and pursue the goal of self-determined lives and the inclusion of those with disabilities in wider society.

> Disability insurance: data and figures

Literatur / Bibliographie / Bibliografia / References: Fracheboud Virginie (2015), L'introduction de l'assurance invalidité en Suisse (1944–1960): tensions au coeur de l'Etat social, Lausanne; Germann Urs (2008), „Eingliederung vor Rente“. Behindertenpolitische Weichenstellungen und die Einführung der schweizerischen Invalidenversicherung, Schweizerische Zeitschrift für Geschichte, 58, S. 178–197; Kaba Mariama (2007), Des reproches d’inutilité au spectre de l’abus: étude diachronique des conceptions du handicap au XIXe siècle à nos jours, Cahiers de bord, 13, 68–77; Wolfisberg Carlo (2002), Heilpädagogik und Eugenik. Zur Geschichte der Heilpädagogik in der deutschsprachigen Schweiz 1800–1950, Zürich.