Topics for targeted research funding under Section 12 of the KKRL Act 2021

  1. Socioeconomic differences in likelihood of seeking access to Kela-subsidised rehabilitation
    Clients attending Kela’s rehabilitation programmes are referred by providers of public, private and occupational health services. Access to rehabilitation services requires timely and professional guidance, which may create disparities between clients referred through different channels. This project looks at obstacles in the way of accessing Kela-subsidised rehabilitation, the problem of timely referral, and the socioeconomic disparities in seeking access to rehabilitation. In particular, the project seeks answers to such questions as what are the channels through which persons with different socioeconomic backgrounds seek access to Kela rehabilitation, how the various channels and the clients’ awareness of available options influence the choice of different rehabilitation models, and what role do the clients’ personal financial circumstances play in their decisions to seek access to rehabilitation. Preference is given to studies with a focus on psychiatric rehabilitation.
  2. Telerehabilitation services
    Kela has published a number of literature reviews on telerehabilitation (https://helda.helsinki.fi/handle/10138/161341), but new information is constantly becoming available. We are therefore looking for updated literature reviews on the use of telerehabilitation for the following therapies:
    • psychotherapy and associated methods of remote rehabilitation and therapy
    • the role of physiotherapy in intensive medical rehabilitation
    • the role of occupational therapy in intensive medical rehabilitation
    • the role of neuropsychological rehabilitation in intensive medical rehabilitation
    • the role of music therapy in intensive medical rehabilitation
    • the role of speech therapy in intensive medical rehabilitation

      The reviews should draw together information on the use of telerehabilitation and its requirements, impact and efficacy as well as potential drawbacks in terms of the above types of therapies.

      The reviews should cover studies employing different methodologies, including quantitative, qualitative and mixed methods studies, as well as case studies and systematic reviews. The studies included in the review should be original studies published in 2016 or later. Depending on the quantity and quality of the available data, the reviews should take the form either of a scoping or systematic literature review or a meta-analysis. At their discretion, the researchers may define the target groups or methods more narrowly in the research plan.

      The outcome variables can be work capacity and functional status or a specific ICF class. 

      The evaluated interventions should be described carefully in the study report, which is intended to be released as part of Kela’s publication series. The quality of the studies and possibly also the strength of the evidence will be evaluated.
  3. Study examining the length of Kela-subsidised rehabilitative psychotherapies, possible changes in therapy length and associated factors
    The costs per client of Kela-subsidised rehabilitative psychotherapy have decreased for two years running, which indicates that there have been fewer consultations per client. The study should look at the length of Kela-subsidised rehabilitative psychotherapies and examine the changes in their length over the past few years. Has the observed reduction of psychotherapy length been the result of deliberate action, or have more therapies been terminated prematurely? In particular, the study should seek answers to which factors affect the duration and premature termination of rehabilitative psychotherapies. Can differences in the length of psychotherapies be attributed to changes in psychotherapeutic practice? Do the factors associated with the termination of therapy have to do with the therapeutic relationship itself, such as individual factors of the clients, the perceived adequacy of the therapeutic relationship, or the correct timing of the rehabilitation intervention? Or could the terminations be due to the availability of therapists or such sociopolitical factors as changes in personal circumstances or the economic situation of the clients? The study should include a register-based analysis of the changes observed in the length of Kela-subsidised rehabilitative psychotherapies as well as a register-based qualitative and statistically representative analysis (for example by means of surveys or interviews) of clients undergoing such therapy.
  4. Literature review of potential risks inherent in rehabilitative psychotherapy (incl. an analysis of the significance of different therapeutic approaches).
    While there is evidence of the efficacy of Kela-subsidised psychotherapy, a number of challenges have been identified which suggest that psychotherapy may also carry certain risks for clients. As an organisation that offers access to rehabilitation services, Kela needs information about the potential risks and is therefore commissioning a literature review to undertake a systematic analysis of the topic.

    The goal of the scoping review should be to collect data on the risks of psychotherapy and on any negative and unanticipated consequences; where possible, analysing them separately according to therapeutic approach. The review should also look at the potential risks related to the duration of therapy.

    The review should take in quantitative, qualitative and mixed methods studies, case studies and systematic reviews. It should include original studies, reports and surveys published in 2000 or later. It should be carried out as a scoping literature review, possibly accompanied by expert interviews. At the researchers’ discretion, the research plan may include further specifications concerning the target group or therapeutic approach.
  5. Impact of changes in occupational healthcare reimbursement rules on employers, occupational health providers and employees
    The rules governing the reimbursement of occupational healthcare costs were revised at the beginning of 2020. The new system is more geared towards incentivising actions that are preventive in nature or which support the client’s capacity for work. The study should look at how the changes have impacted employers, occupational health providers and employees.
  6. The Current Care Guidelines on sick listing and their impact on doctors
    The Current Care Guidelines on assessing the need for a sick leave were released in the autumn of 2019. This study should look at how well doctors know the Guidelines and how the Guidelines have changed doctors’ awareness of the principles governing sick listing and their attitudes and practices concerning sick certification. The study could for example be based on a survey conducted among doctors.
  7. Experiences with medical certificates issued in a telemedicine setting
    During the coronavirus epidemic, healthcare providers are increasingly offering remote consultations. We are looking for research on the experiences that healthcare providers, clients and insurance providers have had with medical certificates issued in a telemedicine setting for the purpose of applying for various social benefits (such as rehabilitation and work capacity related benefits). What benefits and challenges have they identified when comparing telemedicine-based medical certificates with certificates issued in a traditional setting? How well suited are remote consultations to the assessment of the client’s work capacity and functional status?
  8. Insurance medicine evaluations in other EU countries
    The objective is to look at insurance medicine practices in other EU countries and to compare them with the Finnish system. What arrangements have different countries made to secure the medical expertise needed to assess eligibility for benefits comparable to the Finnish health insurance benefits? What types of employment contracts do physicians specialising in insurance medicine have, how are patients and benefit applicants examined, how is functional status measured and documented, and how are evidence-based medical information and assessments of healthcare methodologies used in insurance medicine evaluations?
  9. Kanta Services: Monitoring of pharmaceutical therapy
    In recent years, a number of significant changes have been made in e-prescription systems, which have repercussions for the clinical monitoring of pharmaceutical therapy. The most important of these changes are the ability for patients to request the renewal of their prescriptions (introduced towards the end of 2015) and the extension of the period for which prescriptions remain valid (introduced at the beginning of 2017). Accounting for a significant portion of the pharmaceutical reimbursements paid out of National Health Insurance, long-term medication is an essential component in the treatment of most diseases with a high prevalence in the Finnish population. However, long-term medication may be associated with a number of different problems, and the treatment outcomes may be modest.

    The objective of this study should be to analyse the effects of the changes made in e-prescription systems on long-term medication practices, problems encountered with long-term medication, and the continuity of and compliance with care.
  10. Research on pharmaceutical waste
    The total amount of pharmaceutical waste produced in Finland has been estimated to be worth as much as EUR 100 million annually, of which EUR 63 to EUR 83 million represents expenditures made under the National Health Insurance scheme. At the same time, there are problems with the availability of pharmaceutical products and raw materials.

    The objective is to examine the reasons behind the production of pharmaceutical waste and to identify more effective measures to reduce it.  
  11. What innovations have private-sector actors introduced in Kela-subsidised services over the last several years, and how have they responded to such operational challenges as new market developments, digital services, COVID-19, and the health and social services reform?
    Using a mixed-methods approach, the study could look at occupational health services, psychotherapy and other Kela-subsidised rehabilitation services, physician and dentist services, and the taxi market.