Reducing health differences through service optionsWork is underway in Finland to determine which health care services will and will not be reimbursed from public funds. The EU directive on patients' rights on cross-border health care provides the most recent impetus for this, but the move would have anyway been on the agenda in Finland. "The increase in treatment choices as well as costs forces us to consider how resources can be used as efficiently and equitably as possible," says Jaana Leipälä, General Secretary of the newly-formed Council for Choices in Health Care in Finland.
The patients' rights directive states that EU citizens are entitled to choose their place of treatment with the same reimbursement as in their home countries. In this way, Kela -the Social Insurance Institution of Finland - can reimburse someone from Finland for treatment received in another EU country. Conversely, someone from an EU member state is entitled to treatment in Finland the same way that residents are. The directive does not, however, limit the rights of countries to decide on their services.
"Treatment from abroad is not reimbursed unless it is among the Finnish service range. Neither do we have to provide others with treatment that does not belong to the range available here, even if it is available in a patient's own country," Leipälä explains.
As much as possible for as many as possibleThe Council for Choices in Health Care will meet for the first time in September. The main criteria on accessing treatment options are contained in legislation. In 2013, the Health Care Act was amended to provide for the creation of the new Council.
The Council's mandate is to monitor and evaluate health care service choices and make recommendations for health and medical procedures and methods that are to be included or excluded from the array of service options reimbursable from public funds.
"The key factors are that there is sufficient evidence on a particular treatment's effectiveness and safety. We also have to consider this in terms of society as a whole. When the aim is to have as many health benefits as possible for as many people as possible, the costs of treatment have to be acceptable. If a new form of treatment is very expensive in relation to its benefits, it should not be included in the selection of services."
Though the start of work on the determining the scope of service options is one impact of the EU directive, its chief advantage, Leipälä says, could be the standardisation of services on a domestic level. National policy aims to make the system where service access depends on one's municipality of residence more equitable. For instance, the aim is not that patients' freedom to choose possible benefits should not simply aid the better off in society.
"Reducing health differences has been on the agenda of many governments, and yet the differences have continued to increase. I hope that we can contribute to changing this trend."
Prioritising and implementationThe new Council will not be starting its work with nothing to go on. It will draw on, for example, the Current Care Guidelines, which are independent, evidence-based clinical practice guidelines for use by health care professionals in making treatment decisions. It will also use the Ministry of Social Affairs and Health's (MSAH) uniform criteria on access to non-emergency treatment, which in part aim to secure access to treatment on equal grounds irrespective of people's place of residence in Finland.
The Council nevertheless has its work cut out.
"Setting priorities has not been at all easy. We can learn form the experiences of others, but we have to create our own method wisely," Leipälä stresses.
The Council comprises representatives of the MSAH, the National Institute for Health and Welfare, the Association of Local and Regional Authorities and the National Supervisory Authority for Welfare and Health. It will also have specialist inputs from the medical and dental medical, legal, health economics and the social and health care service systems.
This emphasis on government authorities prompts the question of whether the Council will hear from patients themselves. Leipälä says that the issue is important but not especially simple.
"Patient organisations were created to further the interests of their members. The Council, on the other hand, has to look at the issue comprehensively. This requires not only the management of issues, but also containing them. The EU directive in itself already strengthens patients' rights, and the work of the council will not be deaf to the spirit of the directive. It will consult with patients' representatives and other groups extensively, and a network of experts will be assembled to support the work."
The creation of the Council has also looked at the experiences of Norway and Sweden in setting national priorities on reimbursable treatment choices, where the implementation of the national recommendations has turned out to be a challenge.
"Initially, the aim in Finland was to give the Council a stronger say in decision-making, but in the end we ended up with recommendations only. It may be that in the future the mandate will have to be strengthened," says Leipälä. She also points to the situation in Sweden, where recommendations are made at national level, but resources are disbursed regionally."
Decisions on choices in health care services represent a general policy line that will influence how the whole system functions. The new Council will not deal with the cases of individual patients, which will continue to be handled by relevant health care bodies.
Text: Paula Mannonen and Mark Waller