Direct Request (CEACR) - adopted 2008, published 98th ILC session (2009)

Medical Care and Sickness Benefits Convention, 1969 (No. 130) - Finland (Ratification: 1974)

Articles 13, 17 and 30 of the Convention. With reference to its observation, the Committee notes the observations attached to the Government’s report for the period ending 31 May 2007, in which the Central Organization of Finnish Trade Unions (SAK), The Finnish Confederation of Salaried Employees (STTK) and the Confederation of Unions for Academic Professionals (AKAVA) state that the resources of municipalities for preventive and basic health care are inadequate, the public health service suffers from a shortage of doctors and nursing staff, access to health care is unequal and there are substantial differences in the health status of different socio-economic groups. The unions indicate that sickness insurance compensation for private health care has not been raised since 1989 and covers only about 30 per cent of the cost of care. They consider that endemic diseases, obesity, substance abuse, mental health, etc., require an extensive social welfare policy programme and better evaluation of health impacts.

The Government states that in the last decade there were significant changes in the funding of health-care services. In 1996, households accounted for 21.5 per cent of total health care expenditure, while the part of the central Government was 24.3 per cent, local authorities – 36.8 per cent, and Social Insurance Institution (sickness insurance) – 13.6 per cent. By 2007, the share of the central Government has dropped to less than 20 per cent, while the share of local governments has increased to 43 per cent. The share of fees charged directly to beneficiaries stayed at the level of 20 per cent. The charges payable by beneficiaries are laid down in the Act and Decree on Social Welfare and Health-care Charges. The Act on the status and rights of patients requires health care to be of good quality and empowers an appellate authority to take remedial measures, if necessary. Municipal health centres provide primary health care. Municipalities are also responsible for arranging specialized hospital care and ensuring that the level and quality of services meet their residents’ needs. They may arrange services independently or buy them from a service provider. The role of private service providers has increased and accounts for some 25 per cent of health spending. Part of the cost of health care given by private providers is compensated by sickness insurance: 60 per cent of doctors’ fees and 75 per cent of medical examination and treatment at rates approved by the Sickness Insurance Institution (SII). The approved rates for medical services in the private sector are fixed by the Government. For amounts paid in excess of these rates no compensation is provided by the SII. In 2006, the average compensation of doctors’ fees attained only 27.5 per cent (39.1 per cent in 1997) and of the cost of medical examination and treatment – 31.75 per cent (42.8 per cent in 1997). Although the real level of compensation has dropped below the 30 per cent level, according to the Government, this has not led to a fall in the demand for private health-care services or made it more difficult for lower-income classes to have access to them. The report further indicates that, as from 1 January 2005, an examination or treatment prescribed by a physician is compensated for a maximum of 15 times during a year (previously 15 times in three months). From 1 January 2006 medicines are compensated at a fixed percentage of the price, the basic compensation covering 42 per cent of the price of an approved medicine. From 1 January 2006 the funding of sickness insurance was revised. Sickness insurance was divided into earnings security insurance funded by the employers and the employees and medical care insurance funded by the insured and the state.

The Committee also notes that, in 2001, the Government adopted a public programme “Health 2015”. In 2002–07, two national development projects were implemented: the “National Health Care Project” and the “Development Project for Social Services”. In 2005, the nationwide immunization programme was revised. The Commission for Local Authority Employers (KT) points out that the number of health personnel, particularly of nurses, has increased faster than in any other area of administration in the municipal sector. The Committee observes that the measures highlighted in the Government’s report show that the Government assumes its responsibilities for the sound administration of health institutions and for the provision of the medical benefits (Article 30 of the Convention). With regard to the question of the effectiveness and sufficiency of these measures raised by the workers’ organizations, the Committee draws attention to Recommendation No. 1626 (2003) of the Parliamentary Assembly of the Council of Europe on the reform of health-care systems in Europe, which states that “the main criterion for judging the success of health systems reforms should be effective access to health care for all without discrimination, which is a basic human right. This also has the consequence of improving the general standard of health and welfare of the entire population.” On its part, the Convention also emphasizes that medical benefits should not be limited to curative medical care but aim at actually improving the health of the protected persons (Articles 8 and 9). Reforms of health care must be implemented in such a manner as to take into account the economic situation and avoid hardship to persons of small means (Article 17). Bearing this in mind, the Committee would like the Government to state the main indicators used to monitor the general standard of health and welfare of the population in Finland and trends in this standard in the last few years, paying particular attention to the situation of the low-income categories of the population. The Committee would also appreciate information on the measures taken or envisaged to ensure the financial sustainability of the sickness insurance system in the long term.

Article 27. The Committee recalls that the burial grant paid under the National Pension Act was abolished in 1996, but can be applied for under section 16 of the Accident Insurance Act. In 2007, the amount of the burial grant was 4,040 euros. The report also indicates that nearly all persons covered by compulsory insurance under this Act fall within the scope of the employees’ group life insurance, which the employer may be obliged to set up under the generally binding collective agreements. The Committee would like to point out that compensation paid by the group life insurance for the death of an employee could not be regarded as a funeral benefit in the sense of Article 27 of the Convention. The Committee would, therefore, like the Government to explain in its next report the extent of the personal coverage of the Accident Insurance Act and to show that the survivors of all persons protected in Finland in application of Article 19 of the Convention who were in receipt of, or qualified for, the sickness benefit shall be entitled to a funeral benefit guaranteed by Article 27. Please explain whether the current amount of the burial grant is sufficient to cover the real expenses of the funeral.