Millions spent on treatment abroad for Finnish patients

 

The Social Insurance Institution of Finland (Kela) reimburses treatment aborad  in EU and EEA countries, and in Switzerland if the same medical procedures are not available in Finland within the treatment guarantee period. In 2009, hospitals in other countries invoiced Finland for just over EUR 12 million worth of medical treatments for Finnish tourists and expatriates. On top of this, Finland paid half a million euros for the medical care of Finnish patients living in Finland who opted for medical treatment abroad. The leading foreign country by far to have provided medical treatment for Finnish citizens was Spain.

All permanent residents of Finland are covered under the Finnish National Health Insurance scheme and are eligible for reimbursement of medical expenses under the Health Insurance Act. Reimbursable medical expenses include the cost of covered prescription medicines, the cost of obtaining treatment from private providers of outpatient medical services, and transportation costs related to treatment. Outpatient medical services include private doctors', dentists' and dental hygienists’ services, treatment prescribed by a doctor or dentist, and examination or treatment in a private institution.

In 2008 and 2009 Finnish patients have received treatment abroad based on decisions by hospital districts. This local jurisdiction was changes from May 2010 when Kela started reimbursing centrally for the treatment. The patient is not required to pay for the treatment. In addition to the cost of the treatment itself, Kela also covers the travel and accommodation costs for the patients and an escort if this necessary, plus the cost of medicine. Kela then invoices the patient’s hospital district for the expenses.

Where Finnish patients seek out treatment abroad on their own, Kela will cover the cost of treatment in the same fashion as it does when patients see private doctors in Finland. In practice, this translates to an average reimbursement of less than 20 per cent of the total cost. The numbers going overseas are increasing, but are still counted in dozens rather than hundreds. The main driver is specialised medical treatment abroad, such as for cancer, which they have not been able to get easily in Finland. According to law, patients are allowed to seek reimbursement for treatment performed in other EU and EEA countries, as well as in Switzerland.

The change from local to national jurisdiction has meant that, according to Kela, the majority of those who have applied for treatment abroad were rejected, although there are no statistics available on the matter. So the numbers going abroad are rising very slowly, but the number that the state is prepared to pay for, is falling. Finland has one of the most wide and varied state provisions of payment for health and social care in the world, but like all EU countries has to seek ways to control costs.

Dr. Reijo of Helsinki University Central Hospital (HUCH) accepts the modern reality of an international patient market, “We are in an increasingly globalised world and the standards are getting higher. In principle every option has to be open. Hospitals in different countries can also specialise in treatments of certain rare diseases. For example in cancer surgery practices there may be differences between different countries. Sending patients abroad to receive cancer treatment is always examined carefully and on a case-by-case basis.” The number of foreign patients treated in HUCH hospitals exceeds the number of Finnish HUCH patients that are sent abroad. The annual number of foreign operative unit patients is around 50.

Jussi Merikallio at the Association of Finnish Local and Regional Authorities adopts a realistic stance on paying for treatment at foreign hospitals. “If the treatment, safety, and price are in order, why not? If there is capacity in Sweden, a patient can travel there in a short time. But if the state is not prepared to pay for a type of treatment in Finland, overseas treatment should not be covered from public funds.”

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