Questions and answers on multisource financing

  • What is multisource financing?

    Multisource financing means that financial resources are assembled from various sources. These are then channelled to the services via different financial resource providers. Financial resources for healthcare and social welfare are collected through taxation, obligatory insurance contributions, voluntary insurance premiums, employer’s contributions, fees charged from clients for using services and deductibles paid by clients. The main financial resource providers include central and local government, households, employers and private insurance companies.

  • What is cost-effectiveness?

    Cost-effectiveness means the comparison of the relative costs of services and the effects of those services on people’s health, wellbeing and functional capacity. The cost-effectiveness of a treatment is the higher the more health benefits it generates with the available resources.

  • What is partial optimisation?

    Partial optimisation means that an operator aims to ensure its own benefits without taking into consideration what would be best for the whole system. In healthcare and social welfare, partial optimisation can mean that the choices that benefit one operator can increase the total costs of the whole service system. Partial optimisation can also have negative effects on people’s health and functional capacity.

  • Who will be responsible for the financing of healthcare and social welfare in the fu-ture?

    The responsibility for financing healthcare and social welfare will be transferred from the municipalities to the future counties. The funding for counties will be based on the central government’s responsibility for financial resources. The current system of multisource financing will be replaced by a more simple system.

  • How will people get to health services and rehabilitation if/when Kela no longer reim-burses for travel expenses?

    Provisions on the client’s right to reimbursement for the expenses for travelling to health services and rehabilitation will be laid down in the forthcoming legislation on services. In the future, the counties, or their collaborative areas, will be responsible for the organisation of the system of travel expense reimbursements. Kela can continue as the national operator paying clients the reimbursements.

  • How about the costs of travelling to private health services?

    In the future, there will no longer be any reimbursement for the costs of using, or travelling to, private health services. People can still use private health services at their own expense or by using a private health insurance, for example.

  • How will people get rehabilitative psycho-therapy if/when Kela no longer reimburses for its costs?

    In the future, rehabilitative psychotherapy would be organised and financed by the counties. There will be piloting projects to test the new system before the final transfer of responsibilities. Provisions on the client’s right to necessary rehabilitative psychotherapy will be laid down in the forthcoming legislation on services. The right to receive necessary services will be based on law and national criteria.

  • What will happen to private rehabilitation therapists?

    Although the counties will be responsible for organising the services, it is likely that most services will be delivered against health and social services vouchers or organised as purchased services. This means that private rehabilitation therapists could continue as service providers even in the new system.

  • How will people get intensive medical rehabilitation if/when Kela no longer organ-ises it?

    The plan is that the responsibility for organising intensive medical rehabilitation will be transferred from Kela to the counties, or their collaborative areas. There will be piloting projects to test the new system before the final transfer of responsibilities. Provisions on the client’s right to necessary intensive medical rehabilitation will be laid down in the forthcoming legislation on services.

  • Will clients still have a subjective right to rehabilitative psychotherapy and intensive medical rehabilitation?

    The retention of the subjective rights will be evaluated as part of the drafting of the relevant legislation. The goal is that the availability of service will not be affected negatively.

  • Will people still have the right to appeal against decisions concerning travel ex-penses and rehabilitation?

    The retention of the right to appeal will be evaluated as part of the drafting of the relevant legislation. Professor Emeritys Kaarlo Tuori and Professor Raija Huhtanen have been asked to give their opinions on clients’ legal safety and right of appeal in terms of the constitutional law. The aim is to safeguard people’s fundamental rights.

  • At the moment, clients are charged a co-payment for each trip to health services or rehabilitation. Copayment is also used in rehabilitative psychotherapy, while inten-sive medical rehabilitation is free-of-charge. What will happen in the future?

    Provisions on client charges and any free-of-charge services will be laid down in the forthcoming new act on client charges. The government proposal for a new client charges act will be sent out for comments in May. It will be submitted to Parliament in autumn 2018.

  • Clients who have a lot of trips and/or long trips reach eventually the annual out-of-pocket maximum, which means that for the rest of the year Kela will pay their travel costs in full. What will happen in the fu-ture?

    There will be an annual out-of-pocket maximum or a similar system even in the future.

  • Where will the counties get the financing for their new organisation duties?

    The state financing share of the discontinued Kela reimbursements and benefits will be transferred to the counties. The financing share funded by wage-earners, entrepreneurs and benefit recipients with their health insurance contributions will not be transferred to the counties. However, a corresponding amount of financing can be allocated to the counties from the central government funds.

  • Will the financing continue to be ear-marked?

    There will be no earmarked funding for the counties regarding their responsibility for organising healthcare and social welfare services. The counties will draw up a service strategy where they determine the allocation of their funds and the associated targets. County councils will decide on the strategy and the county budget. This means that the counties will decide how they allocate their funds to support and improve the health, wellbeing and safety of their residents. However, the allocation of resources must be based on the framework defined by law, and it must take into account the county residents’ service needs. There will be national criteria determining, for example, the client’s right to rehabilitative psychotherapy. If a client has the right to a therapy based on national criteria, the county is obligated to organise that service.

  • How will the availability of rehabilitation and psychotherapy services be safeguard-ed in a situation where there is no ear-marked funding although there is a cap on the increase of costs in the counties?

    Reviews to be conducted as part of legislation reforms and relevant pilot studies will examine how access to these services can be safeguarded when the counties are responsible for organising them. For the counties, it is a better alternative to help their residents maintain their work and functional capacity, for example through rehabilitation and psychotherapy, than to have the residents claim benefits and possibly use other healthcare and social services to a greater extent.

  • What safeguards will there be against neg-ative effects on equal access to services?

    Equal access to most services will be improved when the counties are given the responsibility for organising services. It is required by law that the methods used in psychotherapy and psychosocial services be evaluated and that professional skills be maintained. There are national criteria that determine the client’s right to rehabilitative psychotherapy and other rehabilitation. If a client has the right to a service based on national criteria, the county is obligated to organise that service.  The Ministry of Social Affairs and Health will draw up a recommendation on the psychotherapies the counties should include in their service range.

  • Will Kela continue to reimburse for medi-cine expenses?

    The national medicine reimbursement system will remain unchanged. Kela will continue to reimburse for outpatient medicine expenses based on the relevant legislation and the decisions of the Pharmaceuticals Pricing Board. The system of outpatient and inpatient pharmaceutical services and its future will be examined later. At the same time, it will also be determined whether the responsibility for financing the reimbursement system will be transferred to the counties in full or in part.