Frequently asked questions about freedom of choice
It means clients’ right to choose a suitable service provider, service unit and professional to provide them with health and social services. These rights to choose are to be expanded as from 1 January 2020. The draft bill for the Act on Clients’ Freedom of Choice in Healthcare and Social Welfare (so-called Freedom of Choice Act) proposes that publicly funded health and social services could in future be provided by public, private and third-sector operators, such as organisations and foundations. Client fees would be the same across service providers. Clients would have more freedom to choose the service providers that best suit them.
- In practice clients could sign up with the health and social services centre and dental clinic of their choice. The client fee will be the same everywhere. The service provider would have to be approved by the county and the national licensing and supervisory authority.
- Clients can get health and social services vouchers or a personal budget to buy necessary health and social services defined in their client care plan.
- When using services provided by the county, clients can also choose which unincorporated county enterprise and which of its service units they will use. They can choose for example a social services clinic or hospital. Services provided by counties include social services and specialised medical care and some other health services.
- Clients can choose the professional they wish to see if it is possible and appropriate with regard to the activities.
- Clients can seek medical care in another EU or EEA country already under existing provisions.
A service provider offers health and social services to people. The service provider can be public or private operator or entrepreneur. The service provider operating a health and social services centre, for example, can be an unincorporated county enterprise or county-owned company, private company, a cooperative, a third-sector operator.
Clients may choose between the unincorporated county enterprises and their service entities. Unincorporated county enterprise means an administrative entity comprised of health and social services provided by the county itself. Unincorporated county enterprises will offer, for example, specialised medical care, social services, maternity and child health clinic services, rehabilitation, as well as school and student healthcare services. Unincorporated county enterprises are also economic entities. Unincorporated county enterprises’ bookkeeping shall be separated from other activities of the counties.
A service entity of an unincorporated county enterprise means services organised by the county into the same administrative entity. Unincorporated county enterprises’ service entities can be different in different counties. Service entities can offer several services or just one service. A social services clinic or a hospital, for example, can be service entities of an unincorporated county enterprise.
Unincorporated county enterprises’ service entities can have several service units. This means, for example, that a social services clinic (service entity) has one unit that offers child welfare services and another unit offering services for people with disabilities. Services may also be arranged in such a way that all units of the service entity offer all services available at the service entity.
The services of public health and social services centres and dental clinics also form part of the unincorporated county enterprises. Public health and social services centres and dental clinics can establish their own unincorporated county enterprise, or they can be part of one of the unincorporated county enterprises providing services in the county. Health and social welfare centres and dental clinics are service entities that can have several service units.
Health and social services centres and oral health services units (dental clinics) will be offering direct-choice services. The term direct-choice services is used because clients can directly sign up with the health and social services centre and dental clinic they choose. The Freedom of Choice Act will lay down provisions on the centres’ and clinics’ services.
Direct-choice services mainly include primary healthcare services and certain types of consultations with medical specialists as well as guidance and advice on social services. Services given by dental clinics are also direct-choice services.
The aim is to improve the availability and quality of services and to encourage counties and service providers to work in the most efficient and effective way. This ensures that clients will get help for their matter or problem faster than today. Clients will have faster access to a nurse, physician, social worker or to other services. Clients will also have more freedom to choose where to get services and which services to use. The goal is to increase clients’ self-determination and participation in decision-making on their own care. Service providers’ competition for clients should improve the quality and economic effectiveness of services.
Yes, they can. Patients can, for example, choose their health centre. They can also use private health services and receive reimbursement for the costs from Kela, the Social Insurance Institution of Finland. Patients can also choose a specialised medical care unit located in Finland. They can even seek medical care abroad. In social services, however, the clients do not yet have the same freedom of choice based on legislation.
More information on choosing a care facility at present:
The act is due to come into force at the beginning of 2020. From that date on the counties will be organising the health and social services. Clients can receive services from public or private health and social services centres as from the beginning of 2021. As of 2022, clients can receive dental care services from public or private dental clinics (oral health services units). Personal budgets would be available as of 1 January 2020. Health and social services vouchers will be taken into use on 1 July 2020, if not earlier. The draft bill contains several transition periods.
Today’s freedom of choice will be extended further: clients will have more freedom to choose a health and social services centre where they can visit nurses and GPs and get advice and guidance on social services. In addition, clients can choose a dental clinic. Clients can even see a specialist in their health and social services centre.
Clients will also be able to choose an unincorporated county enterprise and its service unit. Unincorporated county enterprises will offer services at health and social services centres and dental clinics but they will also provide all those services that are not available in centres and clinics. Such other services provided by the unincorporated state enterprises include, for example, maternity and child health clinics, hospitals, child protection services, home care, and services for people with disabilities.
Clients can also choose their service provider when they get a health and social services voucher from the unincorporated county enterprise. Similarly, clients who have various service needs can choose their service providers using a personal budget. Clients can choose a service provider from anywhere in the country. Client charges will be the same for the same service, irrespective of service provider. They will be collected by the county, not the service provider.
If the unincorporated county enterprise offers a services voucher, the client can still choose to receive the service from the unincorporated county enterprise.
Clients can also wish to see a certain professional from the unit they have chosen.
Some clients need more health and social services than others. In such cases, a unit of the unincorporated county enterprise (for example social services clinic, hospital or unit offering services for persons with disabilities) will assess the client’s need for services and draw up a client care plan. The client can then get the services defined in his or her care plan directly from a service unit of the unincorporated county enterprise. Alternatively, the client can be granted a health and social services voucher or a personal budget to buy the services elsewhere. Then the client can get the services from private companies or third-sector operators.
No, they don’t. A referral from a GP working at a health and social services centre can be processed electronically at the unincorporated county enterprise, and the need for specialised-level services can be confirmed in the same connection. The client will then be referred to the kind of treatment his or her needs require.
Unincorporated county enterprises must also offer social welfare services at health and social services centres. This makes it possible to plan a whole service package for the client in the same place, if necessary. Then the client will be referred to the kind of social services he or she needs.
Health and social services centres offer guidance and advice on social services. Some staff from the county’s social services will also be working at health and social services centres. Counties must have one or several groups working at health and social services centres, including a social worker, other social welfare professionals and even healthcare professionals, when necessary. This way the personnel of the county could offer social services and make needs assessments at health and social services centres. Clients would not need to separately visit the unincorporated county enterprise’s service unit to get the social services they need.
Clients will be referred to the unincorporated county enterprise if they need more extensive social services or if the service they need requires an official decision. Health and social services centres are not authorities and thereby do not have the power to make official decisions. The client may also be referred to receive peer support from a third-sector operator if there is no need for actual health and social services.
The plan is that as of 1 January 2022 health and social services centres will provide specialist services in the specialties of internal medicine, paediatrics, geriatrics and ophthalmology. Health and social services centres can offer even other specialist services, if the county so decides.
County residents can choose, as of 2022, a public or private dental clinic (oral health services unit). If a resident has not chosen a dental clinic before 1 January 2024, the county will refer him or her to the unit closest to the person. Dental clinics will offer oral and dental care, as at present. Services for children and young people are given by the unincorporated county enterprise. Counties can decide to grant services vouchers for orthodontic treatment and dental prosthetic treatment.
Your county will keep an online record of service providers (incl. service units of the unincorporated county enterprise, health and social services centres, dental clinics and other services). The record must also include information on the quality and availability of services.
Health and social services centres and dental clinics will be obliged to provide online up-to-date information about their effective waiting times.
Clients will have the right to receive the information provided in the online service even orally or in writing.
No. The county will decide which service provider will be used if clients do not decide themselves. Family members can participate in the decision-making, if necessary. Clients who have not chosen a service provider will be assigned a health and social services centre and/or a dental clinic by the county.
The service provider for a minor will be chosen by the person responsible for the child’s care and custody or his or her other legal representative. Young persons aged 15 may themselves choose their services providers.
When necessary, clients can get support to choose the service providers that suit them. All service providers are obliged to give advice and guidance to clients. There will be an online service with information that helps clients compare different service providers. In addition, clients can get assistance and support through a telephone helpline, from service coordinators or from their designated primary social worker. Clients who do not want to exercise their right to choose a service will be guided to suitable services by their county.
Small enterprises have good chances of becoming service providers that deliver services against health and social services vouchers and personal budgets. Moreover, health and social services centres and unincorporated county enterprises can supplement their own service provision by purchasing services from small and micro enterprises. Small enterprises could provide services for health and social services centres by means of cooperation agreements or joint enterprises. Small enterprises could also offer various support services, such as cleaning and catering, as part of home services according to the client care plan.
There will be no changes in the access to urgent care. The right to seek urgent treatment will remain as it is, regardless of the person’s home municipality or place of residence. In emergencies people can call 112 or go to the nearest emergency care services.
Clients can be charged for using a service, as at present. The client charge will be the same for services provided by an unincorporated county enterprise, a company or a third-sector operator. The amount of the client charge will be defined by law. The act on client charges will be amended and the amendment work is already going on. Client charges will be clarified and harmonised. At the same time it will be ensured that the payment burden will not become too heavy for anyone. It will always be the county who collects the client fees, not the service provider.
Unincorporated county enterprises can grant their clients health and social services vouchers. Clients can then choose a service provider and buy the agreed service from that provider. Services vouchers can be granted if the unincorporated county enterprise has assessed the client’s need for services. Clients can be get services vouchers for buying home services, for example. In that case clients will choose a service provider that best suits them.
A service voucher is not money or a banknote given to the client. Health and social services voucher means that the county is committed to compensate the costs of the service given to a client, up to a pre-determined value. Service types and their maximum costs will be defined in the service voucher. Counties pay compensations directly to service providers. Clients only pay a client charge that is the same for the same service, irrespective of service provider. The value of the services voucher covers the service purchased. Clients can buy additional services at their own cost if they want.
With services vouchers clients can themselves choose a service provider approved by one of the counties. Unincorporated county enterprises must give their clients information on those service providers whose services the client can use against a services voucher.
A client may refuse a services voucher offered to him or her. In that case the unincorporated county enterprise must arrange the services for the client in another way.
Unincorporated county enterprises must take into use health and social services vouchers for services defined by the Act on Clients' Freedom of Choice in Healthcare and Social Welfare. Services vouchers must be offered, for example, in the case of services for older persons and persons with disabilities, rehabilitation services and certain surgical procedures.
Personal budget is a sum of money for buying a service package defined in the client care plan. Before granting a personal budget, the unincorporated county enterprise must assess the client’s need for services and draw up a client care plan for him or her. The content of the personal budget and the sum of money that can be used against the budget will be defined on the basis of the client care plan and the services it includes. A personal budget must be offered to older people and people with disabilities who need continuous and broad-based support.
Clients can then themselves decide where to buy the services defined by the client care plan, and they can also influence the content of their services. In this way clients will get services that best suit their situation. The service providers receive compensation from the counties for services delivered against personal budgets. Clients do not get money from the counties.
Service supply cannot be as good in sparsely populated areas as it will be in towns and cities. Some areas in Finland may in practice have one service provider only. Those areas, too, will have services because counties have a statutory obligation to safeguard services in sparsely populated areas. Some services can also be offered in new ways, for example as online or home-delivered services.
Not everybody can become a service provider. Service providers must be registered in a national register of providers of health and social services. Only service providers fulfilling the requirements laid down by legislation can be entered in the register.
A registered service provider can express their interest to operate as a health and social services centre or an oral health services unit. Counties must approve the service providers on the basis of their expression of interest and conclude contracts with them.
A national licencing and supervisory authority will monitor the service providers’ activities. In addition, counties will have a responsibility to monitor health and social services centres, dental clinics and other providers of freedom of choice services.
The counties will be responsible for ensuring that all residents get the services they need and that services by all service providers form a well-functioning system that runs smoothly and efficiently. Counties can set out conditions regarding service chains and service integration, and the service providers must fulfil these conditions.
The unincorporated county enterprise will be responsible for each client’s services as a whole, even when it grants services vouchers which clients can use to buy the service from another provider. Similarly, health and social services centres will be responsible for their service package for the client, even when the centre purchases some of the services from another service provider.
A client care plan based on the client’s need for services would be the central tool for integrating the services for the client. Each client would have one client care plan, drawn up when necessary. It would contain a plan on all health and social services for the client, irrespective of service provider. One operator (the unincorporated county enterprise or the health and social services centre) would be responsible for drawing up the plan in accordance with the client’s need for services. The plan would be drawn up in cooperation with the client’s other service providers. All service providers would have to follow the client care plan.
The Freedom of Choice Act will lay down provisions on openness and corporate social responsibility which will apply to providers of direct-choice services in healthcare and social welfare and to providers delivering services against services vouchers. Those provisions would not, however, apply to the healthcare and social welfare sector in general. According to the Freedom of Choice Act, health and social services centres’ and dental clinics’ private service providers would be obligated to issue annual reports on revenue, taxes paid and place of taxation, profit and loss, management salaries and bonuses as well as on corporate social responsibility. The same would apply to private service providers operating health and social services centres and dental clinics or delivering services against health and social services vouchers. In large companies this regulation would also apply to information regarding the whole company group. All information must be available in data systems related to the freedom of choice, which makes it easier to find the information. This will safeguard openness and give opportunities to assess companies’ activities.
People will be encouraged to get involved in the improving of health and social services. County residents can, for example, participate in developing health and social services by attending client panels or councils for older people or people with disabilities. Voting in county elections will also be an important way to contribute. Clients can influence, for example, by choosing the provider of their health and social services. Clients will have the right to change their service provider.
Clients have the right to seek non-urgent care abroad in an EU or EEA country and receive compensation. The Social Insurance Institution of Finland will afterwards pay reimbursement for the costs of medical care acquired in another EU or EEA county or Switzerland. The reimbursement grounds are the same as for treatment by private healthcare providers in Finland. A prerequisite for the reimbursement is that the treatment received must be part of the service selection of the Finnish healthcare system and reimbursable under the Finnish Health Insurance Act.
- How to seek care abroad (hoitopaikanvalinta.fi)
Persons seeking care in another EU country would get health services on the same reimbursement grounds as in Finland. In the case of direct-choice services referred to in the Freedom of Choice Act, the person would not need any prior authorisation or notification. Reimbursement for other health services would be subject to a prior assessment of need for care or referral.
Persons seeking care in another EU country would still be obliged to pay their care and travel costs first themselves. Costs would be reimbursed retroactively up to an amount corresponding with the costs of organising the same care in the health services of the county where the person is a resident. Persons seeking care in another EU country would still have to pay themselves for the client fee charged from patients receiving the same or corresponding care in Finland.
- Costs of seeking care in another EU country will decrease (Press release, 1 June 2017)