Details of HS | The government still plans to change its Kela reimbursement model for private healthcare, which has been criticized

Government is planning bigger changes to Kela reimbursements for private healthcare than planned, Helsingin Sanomat’s sources say. The decision is to be made public in October.

Helsingin Sanomat does not know how the government intends to change the plan.

The changes are based on the feedback received during the summer opinion round and the experiences of the beginning of the year with increasing Kela compensations. Despite the increase, the number of people using private medical services did not increase much.

Minister of Social Security Sanni Grahn-Laasonen (kok) does not want to comment on the preparation at this stage.

The government The draft presentation to change the Kela compensation model was in the opinion round in the summer.

In the draft presentation, the focus of reimbursements would be shifted to general practitioner visits and reimbursements would be increased to 50 euros from the current 30 euros. According to the proposal, in the future, a visit to a specialist’s office would only be reimbursed if the patient had first received a referral from a general practitioner.

An exception to this would be, for example, visits to a specialist in gynecology and obstetrics, a specialist in ophthalmology, a specialist in psychiatry and a specialist in oral and maxillofacial surgery, for which you would be reimbursed even without a referral.

For example, Lääkäriliitto presented the so-called personal physician model in the opinion round, where a person would always be treated by a doctor.

Government increased the Kela compensation lump sums for the first time since the beginning of the year. A visit to a private doctor’s office is now reimbursed 30 euros, while previously it was reimbursed 8 euros.

The increases have been justified by the fact that by raising compensation, queues for primary care on the public side would be shortened, when more and more people would visit a general practitioner on the private side.

However, the increase in the number of users was only 1.3 percent in January–July. In practice, the increased Kela compensations have therefore gone to the same Finns who already used private health services during the lower compensation period. At the same time, costs rose by 30 million euros.

In its government program, the government has already decided to add 500 million euros to Kela compensation for private care in the years 2024–2027. The state’s financial contribution is EUR 335 million.