A client is a person who uses services or is otherwise the target of services or recipient of products. A client may be a natural person (private client) or an organisation (organisation client), and an individual person (individual client) or a group of people (group client). Clients may include both real clients and potential clients, who together constitute the service provider’s clientele.
Residency is determined by the legislation of each country. In Finland, residency is determined by the Local Register Office and Kela, among others; they apply different legislation to determine residency. Based on residency, the Local Register Office register’s the person’s municipality of residence in the Population Information System. When deciding the length of person’s residence, Kela evaluates the situation as a whole. The determination of residence is affected by, for instance, whether the person is a returnee, whether the person works in Finland for a long period of time or if the person has close family ties to a person who is already resident in Finland. Kela can also consider the residence permanent if the person has previously stayed in Finland for a year already. In the EU regulation on the coordination of social security systems (883/2004 Article 1 (j)), residence means the place where a person habitually resides.
Specialised medical care
Specialised medical care refers to health care services according to the specialisations of medicine and dentistry that are part of the prevention, examination and treatment of illnesses, first aid treatment, emergency care and medical rehabilitation. It is the part of public health care that is managed by specialist physicians; however, it does not include certain basic health care units that are managed by specialist physicians. Specialised medical care covers the examination and treatment of illnesses and also preventive and rehabilitative activities. With the exception of urgent cases, access to treatment in specialised medical care requires a physician’s referral from either basic health care or private healthcare. Most specialised medical care services are organised at hospitals.
The EEA countries include Iceland, Liechtenstein, Norway and all the EU member states.
EU legislation refers to the EU regulations on the coordination of social security systems (883/2004 and 987/2009) and the EU directive on patients’ rights (2011/24/EU). The EU regulations coordinate the social security legislation of the EU member states when a person moves from one country to another. Based on the EU regulations, authorities determine which country’s social security legislation to apply to the person. EU regulations are directly applicable legislation in the EU and EEA countries and Switzerland.
The EU countries are Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the United Kingdom.
European medical prescription
The European medical prescription is a separate free-of-charge medical prescription form introduced in Finland for purchasing medicines in other EU countries. The European medical prescription is based on the EU directive on patients’ rights (2011/24/EU), according to which the EU countries are obliged to recognise medical prescriptions issued in other EU countries. The European medical prescription is written under the name of the active ingredient of the medicine. It is bilingual in Finnish and English or Swedish and English. The European medical prescription cannot be used to prescribe medicines that contain pharmaceutical products included in Schedules I and II of the Convention on Psychotropic Substances (Convention 60/1976).
European Health Insurance Card
The European Health Insurance Card is a certificate of entitlement to medical care. It entitles its holder to receive medically necessary care during residence in EU/EEA countries or Switzerland. The card is issued by the institution in the country liable for the person’s treatment costs. The card is issued in the official language of each country and is free of charge. In Finland, the card is issued by Kela in Finnish or Swedish. The card is valid in local public health care in each country. It may be a separate card or combined with the health insurance card. If necessary, a person may also be issued with a certificate that acts as a substitute for the European Health Insurance Card, which is used similarly as the card.
Actual treatment costs
Actual treatment costs mean the costs incurred producing the health care services provided to a person.
Medical care refers to activities aimed at easing, treating or healing an illness or injury, or ensuring safe pregnancy and labour. Medical care includes the medication, advice and guidance provided.
Certificate of entitlement to medical care
A certificate of entitlement to medical care is a document, which a person uses to prove entitlement to medical care in Finland or abroad. The certificate of entitlement to medical care is necessary if the person is not a permanent resident or covered by health insurance in the country where the medical care is provided. The certificate is used when the person is entitled to medical care based on EU legislation or an international social security agreement. In Finland, certificates of entitlement to medical care are issued by Kela. Certificates of entitlement to medical care issued by Kela include the European Health Insurance Card, its substitute certificate and the certificate of entitlement to medical care in Finland.
Seeking treatment means that a person travels from his/her country of residence to another country with the purpose of using health care services in the target country. People in Finland may freely seek treatment abroad if they wish. Similarly, people from other EU countries may freely seek treatment in Finland’s public and private healthcare services. A person may also apply for advance authorisation in his/her home country for medical care that is provided in another EU/EEA country or Switzerland. In Finland, applications for advance authorisation are submitted to Kela.
Access to treatment
Access to treatment refers to the time limits for access to treatment, which in Finland are regulated by the Health Care Act (1326/2010, Section 6). The time limits for access to treatment require that patients must have access to first aid and urgent medical care immediately, regardless of their place of residence. Patients must have access to non-urgent medical care at a health centre within three months. In specialised medical care, assessment of the need for treatment must start within three weeks of the arrival of a referral, and any treatment deemed necessary must start within six months of the date on which the need for treatment was discovered. As regards mental health services for children and young people (under the age of 23 years), the need for treatment must be assessed within six weeks and treatment must be organised within three months of the date on which the need for treatment was discovered. The time limits for access to treatment also apply to patients from other EU countries seeking treatment in Finland.
A treatment plan (health and treatment plan) is a comprehensive plan drawn up by the patient and a health care professional in accord, containing information of the patient’s recognised needs, objectives set for treatment and actions to achieve and implement the objectives.
Treatment guarantee see Access to treatment.
Medicinal substances classified as drugs
Medicinal substances classified as drugs refers to medicines that are classified as drugs in the Narcotics Act (373/2008) and Narcotics Decree (543/2008).
Public health care
In Finland, public health care refers to the basic health care organised by the municipality and joint municipal authority and the specialised medical care organised by the hospital district. Public health care also includes services that the municipality or joint municipal authority obtains from other municipalities, organisations or private service producers as outsourced services or using service vouchers.
International social security agreement
An international social security agreement is a treaty between Finland and another country regarding the social security of a person moving from one country to another. Finland has signed bilateral international social security agreements with Australia, Canada, Canadian Quebec, Chile, China, India, Israel, the Nordic countries, the United States and South Korea. Each agreement is different and specifies in detail which groups of people, social security benefits and situations it covers. The social security agreements with Australia, Canadian Quebec, Chile, Israel and the Nordic countries are the only ones that contain some stipulations regarding medical care.
The services of the National Archive of Health Information (Kanta services) include the electronic prescription, Pharmaceutical Database, Patient Data Repository and the My Kanta services for the use of citizens. The Kanta services are electronic public services that will become available to the citizens, public and private healthcare and pharmacies gradually over the period 2010–2016. The Kanta services are maintained by Kela.
Urgent medical care
Urgent medical care, including urgent dental care, mental health care, substance abuse treatment and psychosocial support, must be provided to patients regardless of their place of residence. It refers to the immediate assessment and medical care necessitated by a sudden illness, injury, aggravation of a long-term illness or decreased occupational capacity, which cannot be postponed without aggravating the illness or injury. The municipality or joint municipal authority of the hospital district must organise a round-the-clock emergency department for the provision of urgent treatment. The provision of urgent treatment is regulated by the Health Care Act (1326/2010, Section 50).
Non-urgent medical care
Non-urgent clients of basic health care are treated at municipal health centres. Patients need a referral for non-urgent medical care from a health centre’s general practitioner or occupational health physician, for example.
Experimental treatment refers to treatments that are not part of the established treatment practice in Western medicine and for which there is no proof of effectiveness.
Compensability is a property of a product or service that is used as a basis for compensating necessary medical treatment costs and acceptable occupational healthcare costs according to predefined principles.
Municipality of residence
The municipality of residence is determined according to the Act on the Municipality of Residence. A person’s municipality of residence is the municipality where he/she permanently lives. If a person has several homes or no home at all, his/her municipality of residence is the municipality that can be considered his/her municipality of residence based on family relationships and livelihood, for example.
Home health care
Home health care refers to health care that is transported to an ill person’s home or provided at home. Its purpose is to make it easier to come home from the hospital and manage at home and support the family in caring for the ill person at home.
School health care
School health care is intended for comprehensive school pupils. Municipalities are responsible for providing school health care for the pupils of the comprehensive schools in their area.
Rehabilitation refers to activities aimed at maintaining, improving or restoring the ability to work or occupational capacity.
In non-urgent medical care, a physician’s referral is required for access to specialised medical care. The referral is presented in oral, written or electronic format and based on an examination or account of the patient by a specialist.
In legislation, posted worker refers to a person posted by an employer to another country for a fixed period of time for work purposes.
Reciprocal recognition of medical prescriptions
Reciprocal recognition of medical prescriptions means that pharmacies must supply medicine with a prescription issued in another EU country. Based on the directive on patients’ rights (2011/24/EU), EU countries must dispense medicinal products according to prescriptions issued in another country if the medicinal products are authorised for sale in the country where the person wants to buy them. In addition to medical prescriptions issued in the EU member states, medical prescriptions issued in Norway, Iceland, Liechtenstein and Switzerland are also dispensed in Finland. The recognition of medical prescriptions issues in other EU and EEA countries and Switzerland is regulated by the Medicines Act (395/1987).
Medically necessary treatment
Medically necessary treatment refers to medical care, which is considered necessary on medical grounds by a physician or other health care professional and which the patient must receive while temporarily residing in another EU country. The treatment must be provided due to a sudden illness, long-term illness, pregnancy or childbirth so that the patient can safely continue residing in the country according to his or her original plan. The treatment is usually such that its provision cannot be postponed until after the patient returns home without endangering the patient’s health. When the treatment is decided, the duration of the patient’s residence in the target country is usually taken into account. Patients demonstrate their right to medically necessary treatment with the European Health Insurance Card or a certificate that acts as a substitute for the card.
Immigration directives refer to the EU directive on a single permit (2011/98/EU) and the directive on highly qualified employment (2009/50/EC), which apply to third-country nationals from outside the EU who come to work in EU member states. The directive on seasonal workers (2014/36/EU) and the intra-corporate transfer directive (2014/66/EU) are also in the implementation phase; their application will start in 2016. The employees referred to by the immigration directives have the right to equal treatment with EU citizens regarding social security, for example.
Travel allowance covers the necessary travel expenses. Kela pays travel allowance for journeys made due to illness, pregnancy, childbirth or rehabilitation granted by Kela.
Student health care
Student health care services are for students of upper secondary schools, schools that provide vocational basic education, universities and other institutes of higher education. Municipal basic health care must organise student health care services for the students of upper secondary schools, schools that provide vocational basic education, universities and other institutes of higher education located in the area, regardless of their place of residence.
A service is an immaterial commodity produced as the result of organised activities in order to meet the needs of a client, patient, client group or another service provider. The production and provision of a service often also involves the supply and utilisation of material commodities or products.
A service voucher is a commitment granted by the municipality to a recipient of social and health services for the reimbursement of the costs of a service provided by a service producer up to a value predefined by the municipality. The service voucher is one way to organise social and health care services that are the municipality’s responsibility. If treatment queues are shortened with service vouchers, the buyer of the service is responsible for ensuring that patients have access to treatment within the time limit required by legislation.
Family member usually refers to married spouses and partners who are cohabiting or in a registered partnership. Also regarded as family members are biological or adopted children or children of one’s spouse or partner if living in the same household, who are under the age of 18 years.
Basic health care
Basic health care refers to health monitoring and health promotion of the population organised by the municipality and the associated health advice and health examinations, oral health care (dental care), medical rehabilitation, occupational healthcare, environmental health care, emergency care, outpatient care, home care and hospital treatment, mental health work and substance abuse work wherein they are not organised in social care or specialised medical care. Basic health care may also be referred to as public health work. Basic health care services are usually provided at municipal health centres and the associated health stations.
The Nordic countries are Finland, Sweden, Norway, Denmark and Iceland. The self-governing regions of Denmark, the Faroe Islands and Greenland, and of Norway, Svalbard and Jan Mayen, and the autonomous region of Finland, the Åland Islands, are also part of the Nordic countries.
A patient is a person who uses or is otherwise the target of health care or medical care services. A patient is always also a health care client. Because a patient is an individual person and a client may also be a group of people or an organisation, the terms ‘patient’ and ‘health care client’ cannot be considered synonymous.
A patient document is a document or electronic record that is used, created or received during the organisation and execution of a patient’s medical care and which contains information about the patient’s health or other personal information.
Directive on patients’ rights
The directive on patients’ rights is a directive of the European Parliament and of the Council (2011/24/EU) on the application of patients’ rights in cross-border healthcare. The starting point of the directive is that patients may freely seek to use health care services in another EU country and are entitled to reimbursement for received medical care on the same grounds as if they had received that medical care in their country of residence. The directive has been enforced in Finland with the Act on Cross-Border Health Care (1201/2013).
Patient instructions are printed forms handed out to patients who receive an electronic prescription, giving information about the prescribed medication and dosage.
Psychotropic drug refers to a medicinal substance that affects mental functions. There are many psychotropic medicinal substances and they are specified in the Convention on Psychotropic Substances (Convention 60/1976) (Schedules I–IV) and the Government Decree on narcotic substances, preparations and plants (543/2008). Lists of central nervous system (CNS) stimulants and pharmaceutical products that contain psychotropic substances and narcotics are available on the Fimea website.
In emergency departments, patients are given urgent treatment regardless of their place of residence. Urgent medical care refers to the immediate assessment and medical care necessitated by a sudden illness, injury, aggravation of a long-term illness or decreased occupational capacity, which cannot be postponed without aggravating the illness or injury. Round-the-clock emergency departments are organised at large health centres and hospitals.
In the EU directives on the coordination of social security systems (883/2004 and 987/2009), a frontier worker means any person who pursues an activity as an employed or self-employed person in an EU/EEA country or Switzerland but resides in another country. A frontier worker returns to his/her country of residence daily or at least once a week.
Specialised medical care services are provided at hospitals, where specialists perform examinations and treatment procedures, such as surgical operations Most of the hospitals in Finland are public and owned by municipalities or joint municipal authorities. University hospitals or central hospitals of hospital districts are responsible of the most demanding treatments.
Reimbursement for medical care
Reimbursement for medical care refers to the reimbursements paid on the basis of the Health Insurance Act for the fees of physicians and dentists working in private healthcare, the costs of examinations and treatment prescribed by such physicians and dentists, medication and illness-related travel to health care. The reimbursement is paid by Kela and also referred to as Kela reimbursement. Reimbursement for medical care is not paid for Finnish public health care costs.
Hospital districts consist of municipalities and are responsible for organising specialised medical care in their areas. There are 21 hospital districts, including the Åland Islands. Every municipality must belong to a hospital district.
Medical care agreement see International social security agreement.
Health insurance is part of Finland’s statutory social security system and regulated by the Health Insurance Act (1224/2004). Permanent residents in Finland are usually covered by Finnish health insurance. The health insurance comprises an earned income insurance component, which reimburses lost income, and a medical care insurance component, which reimburses the costs of sickness and rehabilitation. The health insurance is funded by health insurance contributions from employees and employers as well as state tax funding. The health insurance system is administered by Kela.
Schengen refers to the European countries that have signed an agreement to abolish travel limitations and border control at their common borders for their citizens. The Schengen Area member states are Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden and Switzerland. These countries comprise the Schengen Area in which free movement of people is guaranteed.
The Schengen certificate is a document with which a person must demonstrate the necessity of any narcotic drugs or psychotropic substances they carry when travelling in the Schengen Area. In Finland, the certificate is issued by pharmacies as needed.
Social and health care
The purpose of social and health care is to organise health and medical care services or social services and the associated financial support for a specific population or population group. The different parties or actors in social and health care may be referred to as service providers, which may be further divided into service organisers, service producers and service performers according to their roles. Social and health care actors may be public, private or third sector operators.
Social security agreement see International social security agreement.
Person covered by Finnish national health insurance
National health insurance means that a person is covered by the national health insurance against illness and rehabilitation and the loss of income due to illness based on the statutory Health Insurance Act. Persons covered by the Finnish national health insurance are entitled to the benefits specified in the Health Insurance Act, including reimbursement for medical care and sickness allowance. The reimbursements can be applied to from Kela. Persons covered by the Finnish national health insurance are issued with a personal health insurance card, the Kela card.
Health care professional
A health care professional is a person who has been granted the legal right to practise a profession (licensed professional) or the authorisation to practise a profession (authorised professional) or a person who is entitled to use an occupational title (professional with a protected occupational title) in a health care profession. In addition to a physician or dentist, such a professional may be a head dispenser, psychologist, speech therapist, dietician, pharmacist, nurse, midwife, public health nurse, practical nurse, physiotherapist, laboratory technologist, radiographer, dental/oral hygienist, occupational therapist, optician or dental technician.
Service choices in healthcare
Service choices in healthcare refer to medically and dentally justified prevention of illnesses, examinations performed to discover illnesses and diagnosis, treatment and rehabilitation. In practice, the service choices may be considered to consist of public health care services and those private healthcare services covered by the health insurance reimbursements for medical care. The service choices are regulated by the Health Care Act (1326/2010, Section 7 a).
Health care and medical care
Health care and medical care refer to actions performed by health care professionals or at health care units to determine a patient’s condition or restore or maintain his/her health. Health care and medical care comprise medical care, preventive care, guided self-care and health promotion, which also refers to the well-being of population groups and the living environment.
A health centre is a unit maintained by a municipality or joint municipal authority, which is responsible for basic health care. Non-urgent clients of basic health care are treated at municipal health centres. On weekdays during the health centre’s operating hours, it must be possible to be able to reach the health centre by telephone without delay or visit the health centre. Health centres may also be referred to as health stations or wellness centres.
Health services refer to health services, which are produced in each country with public or private funding, directed by legislation and have valid licences issued by the authorities to execute those services. In Finland, health services are provided as public and private healthcare services.
According to Finnish law, temporary residence refers to a residence abroad lasting less than six months. Temporary residence abroad may involve a week-long holiday as a tourist, several months’ residence during the winter season or an academic year as an exchange student, for example. During a temporary residence abroad, a person’s home and the municipality of residence recorded in the Population Information System usually remain in Finland.
Certificate of entitlement to medical care in Finland
The certificate of entitlement to medical care in Finland is a paper certificate issued by Kela, which a person may use to prove his/her right to use public health care services in Finland. Kela issues certificates at the request of a person or public health care or on its own initiative. The certificate also contains information on whether the person is entitled to reimbursement for medical care and whether public health care is entitled to state reimbursement for the costs of the medical care provided to the person.
Occupational healthcare refers to activities that the law requires employers to organise or which entrepreneurs organise for themselves to promote the prevention of occupational illnesses and accidents, the health and safety of work and work environments, operations of work communities and the health and occupational capacity of employees. In addition to occupational healthcare, employers may also organise general practitioner-level medical care and other health care for their employees, and entrepreneurs may organise it for themselves.
State reimbursement is paid to the municipality or joint municipal authority maintaining public health care when medical care has been provided, based on national legislation in accordance with the EU directives on social security systems (883/2004 and 987/2009), international social security agreements or immigration directives, to a person who does not have a municipality of residence or whose treatment costs are the responsibility of another country. State reimbursement is also paid for costs when urgent treatment has been provided to a person who does not have a municipality of residence or when the costs could not be recovered from the person or another party. Kela implements state reimbursements.
A contact is a communication (telephone call, letter) that occurs at a specific time between parties. The sender of the message and initiator of the communication may be either party, which may be a person or organisation.
Private healthcare services are produced by medical centres or clinics, health care companies and private independent practitioners, for example. A private healthcare service producer must have a licence under Finnish law issued by the licence authorities for the provision of health care services.