Germany: the government obligates

a. The Prussians take charge

Between 1849 and 1853, 226 Prussian municipalities made it mandatory for employees to sign up with a health-insurance fund. Apparently the government was dissatisfied with the low rate of growth. In 1854 the Unterstützungskassengesetz (Relief Fund Act) was enacted, which greatly strengthened the Prussian government's hold on health insurance. Through this law, local governments were also given the right to establish a fund and to oblige labourers, journeymen and apprentices to sign up for it. The law bolstered the government's supervision of the health-insurance system. It enabled local governments to keep the voluntary health-insurance funds from using contributions and general meetings for political ends or for organising strikes. The employer could be compelled to pay half the contribution. Factory owners who responded by deducting contributions from their workers’ wages faced the threat of prosecution. By introducing the compulsory employers’ contribution, which is what happened with hospital insurance in Bavaria, the government's aim in the wake of the revolutions of 1848-1849 was to force employers to pay more attention to the working conditions and the health of their employees. At the same time, the employers’ contribution created financial stability within the healthcare funds and reduced the pressure on urban poor relief. Not only was the compulsory employers’ contribution a unique phenomenon in Europe, but the legislature also handed the leadership of the funds over to a board made up of contributors who were proportionally represented on the basis of their contributions. For the municipal funds and Ortskassen (local health-care funds) this meant the introduction of joint self-rule by representatives of workers and employers. Conversely, the factory funds were directed exclusively by the managements of the various companies and the Knappschaften by the mineworkers.

The Unterstützungskassengesetz of 1854 had an especially powerful impact on the mineworkers’ funds. A unified structure was imposed on the Knappschaftskassen, many of them centuries old. They were now officially to be known as insurance institutions, and all the mineworkers of Prussia were obliged to join.