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Legislative proposal may change model for reimbursing cost of seeking treatment abroad
The Government proposes amendments to the Act on Cross-Border Health Care. In future, the Social Insurance Institution of Finland (Kela) would reimburse costs of seeking treatment independently up the amount of the cost for the same or corresponding care in the patient’s wellbeing services county. In practice, the change would increase the compensation that patients seeking treatment abroad independently receive for their treatment.
Under current legislation, a patient can travel abroad for treatment either independently or with a prior authorisation. If a patient seeks treatment independently, Kela will reimburse the costs of treatment given in another EU or EEA country or in Switzerland in the same manner as for private health care services provided in Finland. The patient must first pay for the treatment and then apply for Kela reimbursement.
The amendments proposed by the Government would make it so that, in future, Kela would reimburse the costs of seeking treatment independently up the amount of the cost for the same or corresponding care in the patient’s wellbeing services county. The patient would have to pay the client fee that would be charged for similar treatment in public health care in Finland. In this reimbursement model as well, the patient must first pay for the treatment and then apply for treatment Kela reimbursement. In practice, the new reimbursement model would mean higher reimbursements for treatment provided abroad.
Treatment must be justified to entitle to reimbursement
Only treatment that is deemed necessary on medical or dental grounds would entitle patients to reimbursement. The treatment must also be part of the range of public healthcare services in Finland. Patients would also need a referral for the treatment abroad if they would need one for similar treatment in Finnish public health care.
The right to reimbursement would exist for treatment received in an EU or EEA country, Switzerland or the United Kingdom of Great Britain and Northern Ireland.