The State Health Service
The government social insurance agency called Kansanelakelaitos or more popularly known as KELA, is responsible for co-ordinating the state contribution system. KELA will reimburse all registered citizens for treatment by doctors, dental care, hospital examination and treatment. Reimbursement is calculated based on a set of fixed fees, which means that citizens may be eligible to pay some of the costs themselves.
State healthcare is only available if you are employed and paying into the healthcare insurance fund or if you are a dependant of an employed person or if you belong to one of the vulnerable groups like the disabled and even these groups sometimes have to contribute towards the cost of treatment. The size of each person’s contribution depends on how much they earn. It is deducted directly from people’s wages.
Preventive healthcare, maternity care and child health is free to everyone. Children below the age of 18 receive all of their medical care free. However, parents may sometimes have to pay a daily fee (up to seven days) for inpatient hospital treatment.
Employers must provide preventative healthcare for all employees. Some also provide medical treatment and other health services. KELA gives back 50 percent of all necessary costs incurred through the provision of work-based healthcare, while the municipal health centre. Some employers offer private healthcare insurance as a job benefit.
To claim back fees, you may be able to submit all of the necessary documentation through your workplace or you can take it along to your local KELA office. You need to submit an itemised invoice from your doctor, proof of any diagnostic tests or treatments and proof of payment. Reimbursement can take up to six months.
The KELA card
KELA issue all qualifying citizens with a card, which must be shown whenever you need medical attention, or when you collect prescription medicine from a pharmacy and whenever you make any claims for reimbursement.
Private healthcare is growing in Finland. Private practices operate alongside the state system. Private health services offer mainly physiotherapy, private GP care, occupational healthcare and laboratories. KELA sometimes use private services for rehabilitation treatment. Citizens must pay for private healthcare themselves or through a private insurance policy.
Doctors and Health Centres
GP’s are usually based in health centres, which are managed by the municipal councils. You must register with a doctor local to your area. If you need to consult with a doctor, you must make an appointment with the health centre; otherwise, you may have a long wait. Municipal Health Centres are known as Terveysasemat in Finland. They are open during set hours in the working week. Healthcare centres provide general care, health counselling, routine examinations and screening, school health services, home visits and care, dentistry and maternity care.
Health centres are usually staffed by three general practitioners, a midwife, nurses and administrative staff. Nurses in Finland are highly skilled and perform some of the duties that are only provided by doctors in other countries. Many health centres have short stay inpatient wards attached to them.
Health centres are required by law to give immediate telephone contact and patients must be attended to within a maximum of three working days of calling. This does not mean that the patient has to visit the health centre because it may be possible to assess their condition over the phone by either a doctor or nurse.
Maternity and childcare, appointments with the nurse, laboratory and X-ray examinations are free, but the health centre can charge a one-off charge of 11 euros or annual payment of 33 euros for doctor’s appointments. The annual payment however only covers three appointments. It costs 15 euros to visit the emergency clinic. Citizens who are aged over 14 may have to pay a fee of 27 euros if they fail to attend an appointment. People requiring medical certificates have to pay 27 euros to receive them.
All hospital doctors are specialists and are paid salaries by the government. If a patient requires specialist care or treatment, they must be seen by a specialist doctor within three weeks of being referred by their GP.
Telephone Health Service
Finland has a 24-hour telephone health service, where you can obtain a free phone consultation or information from a qualified medical practitioner. The number in Espoo, Helsinki, Kauniainen or Vantaa is (09) 10023. The phone call is charged at standard local rates.
Hospitals are called Sairaalat in Finland. There are 20 hospital districts, with the district of Helsinki and Uusimaa being the largest (32 hospitals). You can dial 118 to find out the name and address of the nearest hospital.
Patients in need of non-emergency care must be admitted to hospital within six months of their referral by a GP or specialist. If the hospital is unable to work within this period then the local authority or municipal board must arrange for the patient to be treated at no cost privately or at another state hospital.
Hospitals charge fees for outpatient visits and surgery and for series of treatments and rehabilitation. Outpatient fees are set at 22 euros per visit. Outpatient surgery costs a maximum of 72 euros. Inpatient charges cost around 26 euros a day (up to seven days) and 12 euros in a psychiatric ward. Patients requiring long-term care are charged up to 80 percent of their monthly income. 80 euros must remain for the patients own use.
Patients who need a series of treatments like dialysis are charged 6 euros for each appointment up to a maximum of 45 appointments a year.
Mentally and physically handicapped people have to pay 9 euros a day for rehabilitation.
Once a ceiling of 590 EUR a year has been reached, patients no longer have to pay. Costs for children count towards their parents medical fee limit. Citizens are responsible for monitoring whether or not they have reached the fee limit.
Dentists are called Hammaslääkärit in Finland. Dentists work out of the health centres and you must make an appointment in advance of your visit. Dentists charge a basic fee of 7 EUR for a visit and in addition to this, they can charge for the treatment they provide.
Chemists are known as Apteekkit in Finnish. You can only buy medicines including over-the-counter medicine, from a pharmacy. Prescription medicine is subsidised and you will have to pay some of the costs. All pharmacies must by law offer patients the choice of a generic medicine, where one is available. Generic products must contain the same ingredients as the medicine prescribed by the doctor, but they are usually cheaper to buy. The patient is free to choose whether they want the generic version of the drug they have been prescribed.
Pharmacies operate during normal working hours, but there is usually one, which opens late in every town. Also, the national chain of Yliopiston Apteekki open on Sundays and for longer hours than the rest.
More information is available at www.stm.fi