Sections 7a and 78a of the Health Care Act contain provisions on the range of health services financed from public funds and the National Council for Choices in Health Care in Finland. They entered into force at the beginning of 2014 (Act 1202/2013).
Section 7a Range of service options reimbursable from public funds
The range of public health services comprise medically and dentally justified disease prevention, examinations to detect an illness, and diagnosis, treatment and rehabilitation.
The range of public health services does not, however, include such health and medical care procedures, examinations, treatments and rehabilitation that involve an unreasonably high risk for the patient’s life or health in view of the health benefits to be gained or whose effect is limited or whose costs are unreasonably high in view of the health benefits to be gained and the therapeutic value.
A patient can be examined and treated by a medical or dental examination and treatment method that is not included in the public service range if it is medically necessary due to an illness or injury that seriously threatens the life or health of the patient taking into consideration the patient’s health state and the expected course of the illness.
Section 78a National Council for Choices in Health Care
The Council for Choices in Health Care in conjunction with the Ministry of Social Affairs and Health shall monitor and evaluate the range of public health services and issue recommendations regarding what health and medical care procedures, examinations and treatment and rehabilitation methods should be included in or excluded from the service range. When issuing recommendations the Council shall take into account research findings and other evidence from different sectors as well as ethical considerations related to health care and considerations related to the organisation of health care.
The Council shall have a permanent secretariat and a network of experts. The Government appoints the Council upon submission by the Ministry of Social Affairs and Health for three years at a time.
The Council shall have a chair and a maximum of 15 members, each with a personal substitute. The Council shall be appointed so that the Ministry of Social Affairs and Health, the National Institute for Health and Welfare, the National Supervisory Authority for Welfare and Health, the Social Insurance Institution and the Association of Finnish Local and Regional Authorities are represented in it. In addition, the Council shall include expertise in medicine, odontology, nursing care, science of law, health economics and the Finnish health care and social security system.
The Government covers the costs of the activities of the Council from an appropriation yearly included in the state budget.
Further provisions on the duties of the Council and its composition and activities are laid down by Government Decree.
For a full version of the Health Care Act, see the Finlex database (in Finnish and Swedish).
The range of public health servicesand private healthcare
The provisions of the Health Care Act do not apply to private healthcare, and examinations and treatments that are not part of the range of health services financed by public funding can thus be delivered within the scope of private care. Under Chapter 2, section 3(1)(9) of the Health Insurance Act (Act 1204/2013), however, treatment that is not part of the public service range is not eligible for health insurance reimbursements.
Chapter 2, section 3 of the Health Insurance Act
Restrictions concerning reimbursability
Under this Act, reimbursement is not granted for:
9) medical care expenses incurred for treatment that is not part of the range of health services referred to in section 7a of the Health Care Act.
For a full version of the Health Insurance Act, see the Finlex database (in Finnish and Swedish).
Other statutes and decisions relevant to the Council
More detailed provisions on the activities of the National Council for Choices in Health Care in Finland are laid down in Government Decree (63/2014) as well as the Rules of Procedure and the decision on fees and reimbursements approved by the Ministry of Social Affairs and Health.
Documents that underpinned the drafting of legislation
Patients’ rights directive
The need to pass legislation on the service choices was prompted by the so-called patients’ rights directive of the EU (Directive 2011/24/EU of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare).
Under Article 7(3) of the Directive, it is for the Member State of affiliation to determine the healthcare for which a person is entitled to assumption of costs and the level of assumption of those costs, regardless of where the healthcare is provided.
Memorandum of the Service basket sub-group
The Ministry of Social Affairs and Health appointed a steering group for cross-border healthcare to facilitate the implementation of the patients’ rights directive. The steering group further appointed a Service basket sub-group to prepare a proposition how the range of health services financed from public funds should be defined. The sub-group drew up a memo on this subject (in Finnish).
Government bill HE 103/2013 and its consideration by the Parliament