Government proposal to improve access to GP services for older adults
The Government is proposing to amend the Health Insurance Act to allow persons aged 65 or over to see a private general practitioner by paying a copayment equal to the local user fee charged by primary healthcare providers operating in the public sector. The proposal is part of a trial aimed at improving older adults’ access to primary healthcare and reducing waiting times for public health services.
The Government is proposing to give persons aged 65 or over access to private general practitioner (GP) services at the price of the local user fee charged by public healthcare providers, with the remaining cost of the service covered by reimbursements from Kela. Kela would also provide reimbursement for a range of common laboratory and imaging tests ordered by a doctor. The changes are proposed to be introduced as part of a trial that would begin on 1 September 2025 and run until the end of 2027. The trial is part of the Government’s agenda for upgrading the reimbursement system operated by Kela and improving older adults’ access to quality healthcare.
The reimbursements would cover private service providers who have an agreement with Kela. Customers could get a reimbursement for up to two GP consultations in 2025 and and then for up to three GP consultations per year until the end of the trial.
The reimbursement would be provided directly at the point of care. Kela would confirm the list of tests covered for reimbursement and their maximum prices based on a Government decree. Kela would also publish the contact information of the participating service providers on its website.
The goal of the trial is to improve older adults’ access to GP services and to reduce the burden on the public healthcare system. Many people who are 65 or older are no longer covered by occupational health services, and private medical insurance can be costly and not easily available.
The trial expands customers’ freedom of choice, allowing them to choose a private rather than a public provider at no additional expense and to select the doctor that best meets their needs among the participating service providers. The goal is to provide quicker access to care, which can prevent more serious health problems and reduce the need for on-call and specialist services.
It is estimated that many customers currently using public health services will opt for private services instead, potentially reducing waiting times for treatment in the wellbeing services counties. This may free up resources particularly for those who predominantly use public services.