Service choices in healthcare

  1. What does the specification of the national choices in relation to the Patient Directive mean?

According to the Patient Directive, as regards treatment in EU or EEC countries or Switzerland, the reimbursement scheme only covers treatment that would have been provided to the patient in Finnish public health care or for which Kela would have paid the imbursement for medical treatment. Therefore, the services choices in Finnish health care cover both public health care services and private services for which reimbursement for medical treatment is paid under the Health Insurance Act (Kela reimbursement for private medical treatment services).

The Directive requires Finland to define more specifically which services are included in health care arranged or reimbursed with public funds. The service choices are defined by the National Council for Choices in Health Care. Read more in question 3.

More information is available in Finnish in the publication of the Ministry of Social Affairs and Health (STM) Suomalaisen terveydenhuollon palveluvalikoima (Service choices in Finnish health care) (Reports and Memorandums of the Ministry of Social Affairs and Health 2013:5)

  1. Can the specification of the choices in health care exclude some health care services currently in use?

Yes, in time this can happen. In specifying the service choices in Finnish health care, it is important to take centralised and comprehensive measures to monitor and assess what types of care is arranged and financed with public funds in Finland. As a result of the assessment, some treatments can be excluded from the service selection on certain grounds. One of these criteria is an unreasonably high risk to the patient’s life or health. The assessment criteria also include minor benefit to health and unreasonable costs of treatment in relation to the health benefit that can be achieved and the possible value of the treatment. However, unreasonable costs are only one factor in the assessment. In other words, specifying the service choices does not automatically result in the exclusion of expensive treatments.

On a national level, Finland can only have one unified service selection applied in both domestic and cross-border health care. Treatment will continue to be provided according to needs assessed in adherence to general views in medicine and dentistry. Patients’ right as set forth in the Act on the Status and Rights of Patients will not be changed.

  1. Which parties take part in defining the service choices?

The Council for Choices in Health Care has been established in connection to the Ministry of Social Affairs and Health. It is a permanent body comprising a council, expert secretariat and network of experts.

The Council is appointed by the Government for a period of three years at a time, and includes a chairman and a maximum of 15 members. The members represent expertise in medicine, dentistry, care, law, health economics and the Finnish health care and social security system. The Ministry of Social Affairs and Health (STM), National Institute for Health and Welfare (THL), National Supervisory Authority for Welfare and Health (Valvira), Kela and the Finnish Local and Regional Authorities (Suomen Kuntaliitto) are permanently represented in the Council.

Openness is emphasised in the specification of service choices. In conjunction with preparing the recommendations, a wide range of health care bodies are heard, including patient organisations.

  1. To what extent do the costs of treatment affect what services are accepted in the choices? Will more expensive treatments be excluded from the choices?

When defining the treatments belonging to the service choices, their cost-effectiveness is only one factor to be considered. Costs alone cannot be a basis for not adopting a specific new form of treatment. Furthermore, specifying the service choices does not mean excluding expensive treatments from the selection. On the contrary, it can secure their future availability.

Currently, assessments on the effectiveness of specific treatments and their inclusion in the service choices are made by municipalities and hospital districts. With the Council for Choices in Health Care defining the service selection, patients will gain equal status throughout Finland. At the same time, the Council will strive for open and visible specification based on open and transparent principles.

  1. How will the detailed range of choices be defined? Will it include specific diagnoses and measures or is it intended to be more general in nature?

This has not yet been decided. The Council for Choices in Health Care is looking into the matter. A variety of national guidelines and recommendations is utilised in the specification of the service choices, including Current Care Guidelines, HALO recommendations, treatment recommendations issued by a variety of specialist doctor organisations, and uniform criteria for non-emergency treatment.