Reimbursement scheme for cross-border healthcare to be harmonised
The Government proposes amendments to the Act on Cross-Border Health Care. The most central amendments deal with renewing the right to reimbursement under the Directive on the Application of Patients’ Rights in Cross-border Healthcare.
Under the current Act, patients have the right to receive reimbursement from the Social Insurance Institution of Finland for medical costs related to treatment, medication and travel as provided in the Health Insurance Act if they seek non-urgent care in another EU Member State, Switzerland or a country belonging to the European Economic Area under the terms of the Directive. Patients who receive treatment for a sudden illness or who have a prior authorisation have the right to reimbursement based on the costs of corresponding treatment and client charges in the patients’ municipality of residence.
In future, the right to reimbursement would be almost the same in the three cases, i.e., non-urgent care, sudden illness and prior authorisation.
Medical costs would be reimbursed up the amount of the cost for the same or corresponding care in the patients’ wellbeing services county, the City of Helsinki or the joint county authority for the Hospital District of Helsinki and Uusimaa. However, the reimbursement would not exceed the costs the patients actually pay for the health services they receive. They would still have to pay themselves the client fee charged from patients receiving the same or corresponding care in Finland. Costs for travel and medication would be reimbursed as before as provided in the Health Insurance Act.
Only treatment that is deemed necessary on medical or dental grounds would entitle patients to reimbursement. Another condition for reimbursement would be that the service received abroad could be deemed part of the range of public healthcare services in Finland. To receive reimbursement for non-urgent care, patients would also need a referral if, by law, they would need one for similar treatment in the Finnish public healthcare.
As a rule, the reimbursement under the Directive would only apply to cases and services where, under national law, patients would be entitled to receive services from a wellbeing services county, the City of Helsinki or the joint county authority for the Hospital District of Helsinki and Uusimaa.
The right to reimbursement would exist for treatment received in EU and EEA countries, Switzerland and the United Kingdom of Great Britain and Northern Ireland.
The aim of the amendments is to ensure that the right to reimbursement for cross-border healthcare would correspond to the new legislation enacted as part of the health and social services reform. Another goal is to take into account the European Commission’s comments to Finland regarding the relationship between the current reimbursement scheme and the objectives of the Directive.
The intention is that the amendments would enter into force on 1 January 2023.
Inquiries:
Marika Lahtivirta, Legal Adviser, [email protected]
Sirkku Pikkujämsä, Senior Ministerial Adviser