Costs of treatment and reimbursements in Finland

A customer fee is usually charged for the use of healthcare services in Finland. The fee is determined in several different ways based on whether you use public or private healthcare services.

Treatment costs in public healthcare

You can receive information concerning the prices of public healthcare services from the health centres and hospital districts. Usually, you will pay the same fee for the use of public healthcare services as the residents of that municipality. Your place of domicile will cover the actual costs of treatment. If you do not have a place of domicile in Finland, Kela will offer state reimbursement for your treatment costs or you are responsible for them yourself.

If you use public healthcare services outside of your place of domicile, the public healthcare unit that provided the treatment will invoice the costs of your treatment from your place of domicile. If you have a place of domicile in Finland, you will pay the customer fee collected by the municipality for the treatment.

The actual costs of providing the service are substantially higher than the customer fee you pay. Treatment will incur real costs also when the services are free to the customer on the basis of the customer fee legislation, such as when a person under the age of 18 visits a doctor at a health centre. Treatment provided by healthcare professionals other than doctors will also incur costs that public healthcare can invoice for.

At a maximum, the municipality or hospital district may invoice the customer for the real costs incurred from the provision of the services. The costs incurred from the provision of the services refer to the costs that your place of domicile would pay in accordance with the Health Care Act if it were responsible for the costs. These costs include the costs of services provided in both basic healthcare and specialised medical care and contain both outpatient care and hospital care costs.

In Finland, public healthcare costs include all of the costs incurred by the treatment as well as other costs generated incurred at the place of treatment. Therefore, the cost for the provision of the service includes the labour and other human resource services of the care personnel as well as the costs for facilities, meals, housekeeping, hospital clothing and linen, for example. The maximum price to be invoiced is the actual cost incurred by the provision of the service.

A healthcare professional must ensure that you understand the information concerning your treatment. If a healthcare professional considers that providing treatment requires arranging interpretation, this will usually be arranged by the treatment provider. The costs of interpretation are also a part of the costs of treatment and they may be invoiced from you place of domicile or another part responsible for your costs of treatment as part of the service provision costs.

Public healthcare prices must be based on productisation

The invoicing of costs of treatment provided within public healthcare must be based on service productisation or product prices that the public healthcare unit uses to follow its own operations or that the joint municipal authority uses to invoice its member municipalities. There is no single unified practice for the invoicing and the legislation does not define how the productisation should be implemented.

Healthcare activities can be productised in several different ways, of which DRG (Diagnosis Related Groups) is the most popular one internationally. In addition to DRG-based invoicing, public healthcare costs are invoiced based on performances, visits, treatment days and procedures, per capita and on a budget basis.

Basic healthcare services have not been comprehensively productised in Finland. Municipalities have several ways of productising their services, such as pDRG and APR within basic healthcare. Specialised medical care services have been productised more commonly, and the NordDRG pricing is commonly used for invoicing. The National Institute for Health and Welfare (THL) has published the unit costs for healthcare and social care for the year 2011.

Private healthcare providers can set their prices freely

Private healthcare services are usually productised and a clear product price has been determined. The price is individually set by each service provider and the price charged for the use of the services is usually based on market price. Private healthcare providers must inform their customers on the prices of using their services.

In private healthcare, doctors’ fees are usually based on the average time that a doctor takes to treat a patient at their clinic and the related work performed before and after meeting with the customer, such as reviewing the patient documents, writing the epicrisis and reviewing the examination results.

Doctors in private healthcare commonly work as private practitioners and decide on their prices individually. General practitioners commonly charge lower fees than specialists.

A separate fee is usually charged for any statements and certificates, laboratory and X-ray examinations and procedures as well as the medicines, vaccines and supplies that are used. The prices for examinations and procedures vary according to the scope of the examination or procedure and the doctor receiving the patient.

Any supplies used during treatment and assistive devices that are loaned to the patient are usually invoiced separately. These include bandages, crutches and limb supports, for example.

A private healthcare service provider can usually provide a precise cost estimate in advance for surgeries and demanding treatment procedures.

A fee is usually charged for separate telephone consultations. The price of a phone call related to a visit may also be included in the fee that is charged for the visit.

When using private healthcare services, you will be responsible for the price invoiced by the service provider. The price charged for the use of the services is usually based on market price. You can receive Kela’s reimbursements for private medical care directly from the service provider when using a Kela Card.

You can compare the average fees for private medical care services by healthcare providers in different municipalities. The data are based on Kela’s register of compensations for medical expenses.

Finland’s healthcare costs amount to approx. EUR 19 billion

In 2013, Finland’s healthcare costs amounted to EUR 18.5 billion. Specialised medical care costs (EUR 6.8 billion) and basic healthcare costs (EUR 3.8 billion) amounted to slightly more than half of the healthcare costs in 2013. The cost per capita was EUR 3,395.

The municipality or joint municipal authority maintaining the healthcare unit is responsible for the costs of public healthcare. The municipalities cover the costs with the taxes they collect and they also receive a central government transfer to local government that is calculated on the basis of the service needs of the residents and circumstantial factors. Therefore, the municipality’s central government transfer to local government is not affected by the manner in which the services are organised or the spending on the services.