FCCA assessed realisation of freedom of choice in the present health care system

Although the right of patients to freedom of choice is enshrined in legislation, the present system-oriented method of implementation in many instances negates the actual possibility of exercising choice in the place of treatment, the Finnish Competition and Consumer Agency (FCCA) finds in its latest report. The economic and health policy-related benefits – such as the creation and adoption of new, innovative operating models – which, in principle, ensue from freedom of choice have thus, so far, failed to materialise.

Since the beginning of 2014, patients in Finland, too, have been able to choose their health centre and treatment location themselves and, with certain restrictions, their specialised medical care treatment location out of all the public health centre units and hospitals. Patients also have the right to choose, within reason, the physician or other health care professional treating them. In addition, patients have the right to seek treatment in any EU or EEA country or in Switzerland.

The provisions concerning freedom of choice are dispersed in different acts, however, and uniform modes of operation have not yet been achieved. The possibilities of utilising of freedom of choice therefore essentially depend on, among other things, the patient’s health, knowledge and economic resources. The realisation of freedom of choice also involves logistical difficulties, such as problems in transferring patient data between locations. The greatest problems involve cross-border health care. If the legislation is not developed further and, for example, the basis for the compensation of treatment costs is not changed, the option of choosing a treatment location abroad will be in danger of being the right only of the affluent in the future as well.

According to the report, active utilisation of the freedom of choice could, in the best scenario, lead to improvement of the service process, the quality of treatment and patient safety. The most important possibility involves the option to choose the treatment location from the private or third sector. The significance of freedom of choice should be taken into consideration above all in the future service structure reform of social welfare and health care and in the associated financing solutions.

Service voucher system broadens freedom of choice

The service voucher system is already expanding freedom of choice in some municipalities to apply to private health care services and even to the specifics of treatment content. If the service voucher does not cover all service needs, the patient may, if he or she so desires, purchase additional services from the service provider with their own funds. In the future, the service voucher system could be developed further and utilised more widely than is currently the case as an alternative to competitive tendering based on the system-oriented operating model. Decision-making power would thus be transferred in part from providers of health care services to patients.

The potential applications of service vouchers could be broadened regionally, too, in such a way that services could be purchased from sub-regionally or nationally approved service providers as well as from service providers approved by the patient’s own municipality of residence. The task of the municipality as the body responsible for approving private service providers could also be made easier, thus reducing the bureaucracy relating to service production.

Follow-up report to be published in the autumn

The report was written by FCCA’s Senior Research Officer Helena Tuorila, PhD, Soc.Sc., and representatives of, among other organisations, the National Institute for Health and Welfare, the National Insurance Institution of Finland (KELA), the Ministry of Social Affairs and Health and the Association of Finnish Local and Regional Authorities, were interviewed in conjunction with the report. The second part of the report, which will examine the provision of information about freedom of choice and the utilisation of the service voucher system in health care services, will be published in the autumn. The follow-up will be carried out in cooperation with the Regional State Administrative Agencies.

See the report (in Finnish):
Potilaan valinnanvapaus julkisessa terveydenhuollossa, osa I: Sääntelykehikko kansallisessa ja rajat ylittävässä terveydenhuollossa
(pdf, 52 s.)