Government proposes changes to reimbursements for private medical expenses

The Government’s proposal would do away with most reimbursements for examinations and treatments ordered by doctors practising in the private sector. Kela would continue to pay reimbursements for the costs of consulting a private doctor. The changes would take effect on 1 January 2023.

The Government proposes changing the Health Insurance Act to make a large part of the examinations and treatments performed in the private medical sector no longer reimbursable. Kela would continue to provide reimbursements for private examinations and treatments ordered by a psychiatrist, an oral and maxillofacial surgeon or a dentist. Reimbursements would also be available for tests performed by a psychologist. Other treatments and examinations would no longer be covered by Kela reimbursements. Physician-performed procedures, with certain exceptions, would also become non-reimbursable.

The Government proposes further that all GP and specialist consultations would be reimbursable at a standard fixed rate. However, the reimbursements would be higher in the case of treatments provided by a psychiatrist or specialist dentist. Kela will confirm the euro amounts of the reimbursement tariffs later on the basis of a Government decree.  

The Government is also proposing to no longer offer reimbursements for the costs of medical care provided in Switzerland, Great Britain or Northern Ireland.

According to the Government’s estimate, the proposed changes would save 64 million euros. The savings would be allocated towards meeting the mandated minimums for staffing in elderly care. The proposed legislative change is intended to take effect on 1 January 2023.

In 2021, Kela paid reimbursements for costs of treatments and examinations performed by private practitioners to 1.3 million persons, while 1.4 million individuals received Kela reimbursements for private physicians’ fees. A total of 0.9 million persons were paid reimbursements for costs of private dental care. Kela paid a total of 212 million euros in reimbursements.

Additional information for customers:

• Government’s proposal to Parliament for the amendment of the Health Insurance Act (1224/2004).
• Ministry of Social Affairs and Health press release (stm.fi): Hallitus esittää sairausvakuutuslain muuttamista yksityisen sairaanhoidon hoito- ja tutkimuskorvausten osalta - Sosiaali- ja terveysministeriö (stm.fi)