Rise in sickness insurance compensation proposed for private medical and dental fees

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According to a working party set up by the Finnish Ministry of Social Affairs and Health, at least 40 per cent of private medical and dental fees and laboratory and treatment costs should be reimbursed by the sickness insurance system. The proposal was opposed by the representative of the Ministry of Finance.
      Currently, the level of sickness insurance compensation for private medical and dental fees is around 30 per cent.
      According to information gathered by Helsingin Sanomat, the committee is proposing that a certain sum of euros be confirmed as compensation for each examination, medical care, or treatment.
     
The same reimbursement would always be paid for similar examinations, regardless of the fees charged by an individual private health centre.
      The Finnish Social Insurance Institute KELA would confirm a certain amount of money as compensation for each examination and treatment.
     
According to the current system, a patient is reimbursed 60 per cent of the sickness insurance compensation fee confirmed by KELA. While the doctor’s fee is normally higher than the confirmed fee, the compensation is always calculated according to the KELA fee.
      In addition to the reform of the reimbursement system, the committee suggests that the fixed deductible for the medical care that has been ordered by a doctor should be abandoned. The current fixed deductible is EUR 13.46.
     
However, the working party suggests that also in the future cost reimbursement should apply only to cases in which a private doctor has referred a patient for further examinations. As an exception, cost reimbursement would apply also to the direction of patients by public sector doctors to special dental technicians and physiotherapy.
      The important question is, what would be the fees on which the KELA compensation would be calculated? The group suggests that the reimbursements should be paid on the basis of the fees charged by the "most efficient providers".
      For example, the National Research and Development Centre for Welfare and Health STAKES could list the most cost-effective providers of both private and public health care services.
      The ministerial working party has calculated that if the sickness insurance coverage were to be raised to 40 per cent, the additional funding needed for the reform would be EUR 65 million, based on the total of reimbursement costs in 2006.
      One reform of sickness insurance funding has already been included in the government programme: an increase of the cost reimbursement of dental fees to 40 per cent.


Links:
  Ministry of Social Affairs and Health
  National Research and Development Centre for Welfare and Health STAKES

Helsingin Sanomat