In comparison with many other Nordic and EU countries, Finland has a relatively high degree of cost sharing in health care, with 20% of health spending coming from out-of-pocket payments. The distribution of these payments as a share of total household consumption is regressive, and the incidence of catastrophic health spending linked to these payments is relatively high compared to other Nordic countries (Tervola et al., 2021). The main objectives of the legislative amendments in 2021 were to remove barriers to accessing healthcare and to increase health equity.
The new measures to reduce co-payments for publicly provided care were introduced in 2021, as the Act on User Charges in Health and Social Services was reformed. The renewed legislation abolished co-payments for nurse consultations in primary care, all outpatient clinic visits by people under the age of 18, and matters related to the treatment of certain communicable diseases. Additionally, co-payments for long-term home-based care were reformed.
The annual payment cap for user charges for the services remains at EUR 692, but the scope of this ceiling was broadened to include, for example, user charges for dental care, temporary home nursing, temporary home hospital care, and certain remote services. User fees covered by social assistance were also included in the annual payment ceiling calculation. Service users must monitor the completion of their payment caps themselves. Separate annual cap for co-payments for medicines (EUR 592,16) remains.
The changes to co-payments and the payment cap were estimated to reduce co-payments for 18% of the population (Government proposal 129/2020). In addition to financial objectives, the amendments aim to ensure that people would not need to resort to social assistance just to pay their user charges. Therefore, the Act emphasizes the preference for reducing or not collecting user charges over granting social assistance.
The amendments to the Act on User Charges in Health and Social Services entered into force on 1 July 2021. Amendments concerning the payment caps came into effect at the beginning of 2022. The renewal of this legislation is two-phased, and the second part has been planned to coincide with the overall health system reform implemented in 2023. In the second phase, the fees will be examined as part of the goals set for the establishment of Wellbeing Service Counties.