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Pre-reform health service vouchers underutilised

Few people seem to be using health care service vouchers that can freely be used to get care at any location or institution that patients choose, says a municipal official. Adopted in 2009, the voucher is expected to be the cornerstone of the freedom of choice element of the government's ambitious overhaul of healthcare and social services.

Hoitaja kuntouttaa kättä.
Service vouchers, to be used after the health care reform as well, are an unknown resource to most. Image: AOP

Freedom of choice has long been trotted out as one of the highlights of the government's proposed social service and health care reform (or 'sote').

But exceedingly few Finns know that a preliminary version of the same principle has existed since 2009 – the service voucher, which can be used to get care at the location or institution of the coupon-holder's choice.

In 2015 less than 1 percent of all  municipal 'sote' expenses went towards the voucher system. In money that amounts to some 100 million euros out of a 20-billion-euro pot annually.

Juha Jolkkonen from the City of Helsinki Social Services and Health Care Sector department says that the vouchers are essential for city residents, even if their use has been minimal.

"I don't consider the service vouchers redundant, it increases the consumer's freedom of choice," Jolkkonen says. "In areas such as dental services and gastroscopy, the vouchers have helped take off some of the time-related pressure. But its primary function of increasing freedom is directly applied in elder care, for instance."

Lack of information

Jolkkonen says that people are simply unaware of the existence or details of the vouchers, and that municipalities and the government should better inform the public.

"Ignorance and timidity are part of it. People are unwilling to seek different solutions to a service we already provide."

Jolkkonen says that the ungainliness of the current voucher system also scares away potential users. The value of each coupon has to be decided separately by the Social Service and Health Care Committee.

Worth thousands

The value of the service vouchers varies from some tens of euros to thousands, depending on the care or service in question. Municipalities use that money to pay for part of the expenses, and the rest is left for the patient to cover.

"There are sixteen different types of service vouchers in Helsinki," Jolkkonen says. "Use among elder care service housing units is about 10 percent. Dental hygiene services are another big sector."

The service vouchers will get a new name once the reform actually hits, to be called "customer vouchers" instead. Jolkkonen says he hopes the eventual voucher system will be better streamlined than the current, unpopular form.

Entrepreneurs say they want the law to include some kind of stricture that forces people to increase their voucher use. Draft legislation already includes a similar obligation clause.

"This way the service provider is mandated to offer the vouchers to customers as an alternative to other methods of payment," says Susanna Kallama from the Federation of Finnish Enterprises.

Service vouchers are provided by municipalities to offer patients an alternative to services they produce or purchase. The municipality determines the value of the voucher and accepts service providers who can be paid with the coupon.

To get a voucher, a patient must contact the municipal department responsible for providing the service for which the voucher is required. Patients have a deductible, which is the difference between the price charged by the service provider and the value of the service voucher.

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