Direct Request (CEACR) - adopted 2007, published 97th ILC session (2008)

The Committee notes the information sent by the Government in its report. It asks the Government to provide further information on the following points.

State workers’ social security scheme (ISSSTE)

Part II. Articles 7 and 8 of the Convention. The Committee notes that the purpose of the health insurance scheme is to protect, promote and restore the health of its members by providing high-quality health services in a timely manner. The components of the health insurance are preventive medical care, curative medical care, maternity care and physical and mental rehabilitation (section 27 of the ISSSTE Act). It asks the Government to indicate the measures taken to give effect to the abovementioned provisions of the Convention.

Article 10, paragraph 1. The Committee notes that, pursuant to section 31 of the ISSSTE Act, the medical services for which the Institute is responsible pursuant to the chapters on health insurance and occupational risk insurance, shall be provided directly by the Institute or through agreements between the Institute and the service providers, in accordance with the relevant regulations. The agreements shall be concluded preferably with public institutions in the health sector. In such event, the institutions subscribing to the agreements shall be required to provide the services directly and to send the Institute any medical or administrative reports and statistics it may request. The Committee asks the Government to provide information on the application of agreements for the provision of medical services, particularly with private care providers.

Part VI. Employment injury benefit. Article 34. The Committee takes note of the benefits in kind envisaged in section 61 of the ISSSTE Act. It asks the Government to indicate how, and under which provisions, the medical care to be provided to victims of employment injury includes, in accordance with Article 34 of the Convention, dental care (clause (b)), nursing care at home (clause(c)), maintenance in hospitals, convalescent homes, sanatoria or other medical institutions (clause (d)), dental supplies, eyeglasses and prosthetic appliances (clause (e)), and the care furnished by members of such other professions as may be legally recognized as allied to the medical profession (clause (f)).

General scheme (IMSS)

Article 36, paragraph 3(b). In its previous comments the Committee noted that, according to section 58 of the Social Security Act, periodical payments due in the event of employment injury, where a worker suffers partial permanent incapacity of between 20 and 50 per cent, may be converted into a lump sum. The conversion of periodical payments into a lump sum is optional where the incapacity is greater than 25 per cent and less than 50 per cent. The Committee accordingly drew the Government’s attention to the need for the competent authorities to adopt the necessary measures, in accordance with this provision of the Convention, to satisfy themselves that the beneficiaries will use the lump sum properly.

In its report the Government states that it is in compliance with Article 36 of the Convention, since a lump sum is paid only when the permanent incapacity is partial and lower than 50 per cent. In the Government’s view, if any degree of incapacity up to 50 per cent is taken to be slight, then the requirements of the Convention are met. The Committee takes note of this statement. The Committee has always considered that permanent incapacity where the degree of loss of earning capacity is higher than 25 per cent cannot be considered slight. A loss of over 25 per cent of the normal capacity to work in his usual occupation prevents the worker from performing his essential duties. To consider any degree of incapacity up to 50 per cent as slight is to devoid of all meaning the letter and spirit of Article 36, paragraph 3(a), of the Convention. The Committee therefore expresses the hope that the competent authorities will take the necessary steps, in accordance with this provision of the Convention, to satisfy themselves that beneficiaries use the capital paid to them properly.