Information package: Rehabilitation

One of Kela’s responsibilities is to provide access to rehabilitation and to offer financial assistance during it. The following is a brief overview of the current state of Kela’s rehabilitation programme and of recent developments. At the end, you will find links to rehabilitation statistics produced by Kela and to ongoing studies on rehabilitation.

Kela has a statutory obligation to offer access to vocational rehabilitation, intensive medical rehabilitation and rehabilitative psychotherapy. In addition, Kela can offer access to, and provide compensation for, rehabilitation on a discretionary basis within a budget allocated yearly by Parliament.

Rehabilitative psychotherapy is the most common type of rehabilitation offered by Kela

In 2024, a total of 172,000 individuals underwent rehabilitation offered by Kela, representing 3% of the Finnish population. The number of Kela rehabilitation clients was 0.4% lower than in 2023. The most common type of rehabilitation provided is rehabilitative psychotherapy, received by 66,000 persons. This is equal to 38% of all rehabilitation clients.

Rehabilitation was provided on a statutory basis to 142,000 clients, representing 83% of all rehabilitation clients. Among them, 46% received rehabilitative psychotherapy, 35% intensive medical rehabilitation and 19% vocational rehabilitation. A total of 37,000 clients underwent rehabilitation provided on a discretionary basis, representing 22% of all rehabilitation clients.

Some clients may have received rehabilitation on more than one statutory basis over the course of the year. Rehabilitation allowance was paid to a total of 51,000 persons.

Kela spent a total of EUR 528 million on rehabilitation services in 2024. At EUR 292 million (55% of the total expenditure), intensive medical rehabilitation accounted for the largest single share of expenditure.  Rehabilitation allowance payments totalled EUR 242 million.

The number of rehabilitation clients has doubled from 2010

The number of Kela rehabilitation clients and the inflation-adjusted rehabilitation expenditure increased by nearly 70% between 2010 and 2024.

There was a particularly strong increase in rehabilitative psychotherapy, with both the number of clients and the inflation-adjusted expenditure increasing over five-fold since 2011, when the provision of rehabilitative psychotherapy was placed on a statutory footing. In recent years, however, the rate of increase has slowed, with 2021 remaining the peak year in terms of rehabilitative psychotherapy expenditure.

Before 2011, Kela provided compensation for psychotherapy as a discretionary rehabilitation measure. The number of clients was limited by the amount of funds budgeted for the purpose.

The number of clients in vocational rehabilitation and intensive medical rehabilitation has doubled since 2010. However, given the fact that these two types of rehabilitation do not share a legal basis, the trends in the respective numbers of rehabilitation clients have diverged in recent years, with the number of vocational rehabilitation clients decreasing for three years in a row and the number of intensive medical rehabilitation clients rising consistently year by year.

Among the services provided as intensive medical rehabilitation, speech therapy and occupational therapy have seen the greatest increase in terms of costs and recipient totals.

In discretionary rehabilitation, both the expenditure and the number of recipients declined from 2010 to 2020. This could be due to the fact that, prior to 2011, Kela provided compensation for psychotherapy as a discretionary rehabilitation measure, or alternatively to the cuts made in discretionary rehabilitation funding around 2015. After 2020, the number of recipients again grew significantly, but decreased in 2024.

In 2020, the COVID-19 pandemic brought about a decrease particularly in the number of clients enrolled in discretionary rehabilitation. This was most likely caused by the fact that discretionary rehabilitation services are provided mainly in rehabilitation facilities, which were forced to suspend some services to comply with social distancing rules.

Participation in rehabilitation varies according to age group

In the under-16 age group, intensive medical rehabilitation was the most common type of rehabilitation in 2024, received by 87% of the clients in this age group. Speech therapy (received by 63% of the clients) was the most common type of service.

In the 16‒29 age group, rehabilitative psychotherapy and vocational rehabilitation were the most common types of rehabilitation, received respectively by 50% and 30% of the clients in this age group. The most common types of vocational rehabilitation were NUOTTI coaching and vocational training and education, which were received by 22% and 38% of the clients in the 16‒29 age group.

In the 30‒64 age group, the most common types of rehabilitation were rehabilitative psychotherapy and rehabilitation provided on a discretionary basis, which were received by 50% and 22%, respectively, of the clients in this age group. Rehabilitation courses were the most common type of rehabilitation received by discretionary rehabilitation clients, attended by 68% of the clients. The most common types of courses were those targeted at persons with musculoskeletal diseases. They were attended by 59% of all in this age group who participated in discretionary rehabilitation courses.

Vocational rehabilitation was provided to 15% and intensive medical rehabilitation to 17% of working-age rehabilitation clients. Kiila rehabilitation was the most common type of vocational rehabilitation service. It was provided to 27% of all vocational rehabilitation clients in the 30‒64 age group. Physiotherapy was the most common type of intensive medical rehabilitation, received by 76% of all intensive medical rehabilitation clients in this age group.

In the age group 65 and over, the most common type of rehabilitation was rehabilitation provided on a discretionary basis, received by 92% of all clients in this age group. Altogether 23% of the recipients of discretionary rehabilitation services were aged 65 or over.

Rehabilitation courses were the most common type of rehabilitation, attended by 64% of all clients in receipt of discretionary rehabilitation. Among those who attended rehabilitation courses arranged on a discretionary basis, 20% attended courses focusing on musculoskeletal diseases, while 26% participated in courses for informal caregivers.

The number of recipients of Kela rehabilitation aged 65 or over increased in the 2010s across all types of rehabilitation. The increase in the number of older rehabilitation clients may be attributable to the fact that the age group has grown larger. However, the number of retirement-age clients dropped in 2024, which may have been caused by the termination of IKKU rehabilitation courses for elderly clients at the beginning of 2024. For persons aged 65 and over, rehabilitation is most commonly arranged in the public sector by social welfare and healthcare organisations.

Women are more likely to participate in rehabilitation, but the gender mix varies across different types of rehabilitation

There are differences between the genders in rehabilitation participation rates. The majority (62%) of rehabilitation clients in 2024 were women.

Women had a higher participation rate than men in vocational rehabilitation, rehabilitative psychotherapy and discretionary rehabilitation services. More men than women underwent intensive medical rehabilitation.

For example, boys accounted for 68% of clients under 16 in intensive medical rehabilitation. In rehabilitative psychotherapy, 83% of clients between 16 and 29 and 76% of clients between 30 and 64 were women. Conversely, men were more likely than women to attend such discretionary rehabilitation services as cardiac rehabilitation courses.

Mental health and behavioural disorders are the most common causes of rehabilitation

In 2024, mental health and behavioural disorders were the most common reason for seeking access to rehabilitation through Kela. A total of 124,000 persons, or 72% of all clients, received rehabilitation on account of a mental or behavioural disorder.

In rehabilitation for mental health and behavioural disorders, mood disorders (32% of all clients in this category of rehabilitation), anxiety disorders (19%) and neurodevelopmental syndromes (19%) were the most common reasons.

Of all rehabilitation clients in 2024, 10% underwent rehabilitation for musculoskeletal disorders, 7% for neurological illnesses, and 3% for circulatory diseases. The number of clients with musculoskeletal diseases has declined by nearly 30% since 2010.

Analysed by age group, mental health and behavioural disorders were the most common reason for participation in Kela rehabilitation among those under 16 years of age (91% of all clients in the age group), among those aged between 16 and 29 (88%) and among those between 30 and 64 (65%).

Among clients aged 65 and over, musculoskeletal diseases were the most common reason for seeking rehabilitation (27% of all clients in the age group). However, among men over 65, diseases of the circulatory system were the most common reason. Among persons of working age (the 30‒64 age group), 17% underwent rehabilitation because of musculoskeletal diseases.

Regional variation in rehabilitation pathways and processes among Kela rehabilitation clients

Some regional differences can be observed when it comes to participation in Kela rehabilitation. In 2018, the participation rates for vocational rehabilitation and rehabilitative psychotherapy were highest in the North Karelia hospital district and lowest in the Länsi-Pohja hospital district. The participation rates for intensive medical rehabilitation were highest in the Lapland hospital district and lowest in the Vaasa hospital district. 

According to rehabilitation professionals, access to Kela rehabilitation is made more difficult by a lack of resources and service shortages. They find the process of seeking access to rehabilitation as the most problematic part of the pathway to rehabilitation. Assessing the individual need for rehabilitation and drawing up a rehabilitation plan are, according to the professionals, the part of the rehabilitation process that works the best. However, it is also the part of the process with the greatest disparities among the different regions of Finland.

The following factors may explain the regional variation in the rehabilitation pathways:

• differences in the information available to professionals about the rehabilitation system and services
• differences in professional practices and cultures in referring clients to rehabilitation
• the way the services are organised in the different regions
• the available resources.

Regional parity in the pathways to Kela rehabilitation can be supported, and research can point to a number of different ways of doing so.

The advantages and challenges of using a registration method in the procurement of rehabilitation services

Competitive tenders are the main method of procurement used by Kela in connection with rehabilitation services. Along with tenders, Kela has developed a registration method, whereby Kela defines the requirements for each service and sets a fixed price. All service providers that meet the minimum requirements can register with Kela as a rehabilitation service provider.

Two studies that looked at rehabilitation procurement found that while purchasing the service at a fixed price was more costly than a competitive tender, the number of qualifying providers was higher. Competitive tenders have a potential for large savings, but the registration method can make for longer patient-provider relationships and improve continuity of care.

When purchasing new services, at least one round of competitive tenders should be organised in order to get a better understanding of price formation and any challenges therein. According to the studies, service providers found the new method more convenient than the competitive tender process.

Fixed pricing may have an impact on service quality. While giving clients the freedom to choose their service provider may encourage providers to focus on improving the quality of their service, fixed pricing may also lead providers to compromise on quality in order to achieve savings. Setting an optimal price is a key challenge in fixed pricing.

At present, the registration method is used with such services as rehabilitation courses for adults with heart disease, the Oma väylä rehabilitation for young persons, individual rehabilitation provided on a discretionary basis, and LAKU family rehabilitation.

Rehabilitation for Sámi speakers: Deficiencies in meeting cultural and linguistic needs

Kela has conducted a study looking at the status of the rehabilitation services it offers for Sámi-speaking clients. Similarly to earlier studies, the study found deficiencies in recognising the specific cultural and linguistic needs of Sámi speakers.

According to the study, rehabilitation is not integrated adequately in Sámi speakers’ daily lives, access to rehabilitation is made more difficult by long travel distances, and there are deficiencies in how Kela communicates about rehabilitation. Sámi-speaking clients attending rehabilitation courses found it very important to experience a sense of community and wished to see more of that. However, it appears that the clients who participated in rehabilitation through Kela benefited from it and that the rehabilitation was a positive experience for them.

Based on the results of the study, a development project was started in 2024, which was followed in 2025 by an evaluative study. The purpose of the development project is to design and try out a new rehabilitation service targeted at working-age Sámi speakers, to promote coooperation with the Sámi community, to create better pathways to rehabilitation, and to clarify the respective roles of rehabilitation and healthcare organisations. The evaluative study looks at how well the goals of the development project were met.

Telerehabilitation

Telerehabilitation means rehabilitation services that are provided in part or entirely via a remote connection. The client and the professionals are at different locations. Telerehabilitation can be real-time (e.g. videoconferencing or voice communication) or asynchronous online rehabilitation. It can leverage various technologies such as videoconferencing, messaging, sensor technologies, online platforms, mobile applications, virtual reality, robotics, gaming or AI. Telerehabilitation is designed to help clients set and meet their own goals. It allows the clients to use technology to participate in the kind of rehabilitation they have agreed with a rehabilitation professional.

Kela has conducted several studies looking at the adoption and practice of telerehabilitation and has examined the use of telerehabilitation in psychotherapy. Their findings suggest that telerehabilitation can improve the regional availability of rehabilitation services, give clients an opportunity to integrate the rehabilitation into their daily lives, and offer professionals more flexibility in how they do their work. Telerehabilitation makes it possible to provide individualised support and is suitable for different types of clients both in individual therapy and group-based rehabilitation settings. An online connection has been found to be a more challenging environment than on-site rehabilitation for offering peer support and engaging in group-based activities. The technical proficiencies and skills of the clients and the involved professionals, along with a positive attitude and the availability of support to the participating clients, are key to the success of the telerehabilitation process. The professionals should also be skilled in communicating and offering guidance in the online setting. Telerehabilitation makes it possible for the clients’ loved ones to join the process and facilitates networking and cooperation.

The concept of self-rehabilitation highlights the client’s own role in the rehabilitation process

The concept of self-rehabilitation is a new way of looking at the client's role in the rehabilitation process. It highlights the client’s active role in their personal rehabilitation.

Studies have found that professionals are familiar with self-rehabilitation as a phenomenon, but that the concept is new. Practices that align with the concept of self-rehabilitation are part of all of the rehabilitation services that Kela offers.

A guide for implementing self-rehabilitation was written as part of the research project. The guide outlines various methods for planning, documenting and monitoring self-rehabilitation.

Self-rehabilitation is founded on four basic ideas:

1. Identifying and bolstering the client’s resources can increase their agency and active participation.
2. Finding solutions in the client’s daily lives and looking to the future can lead to tangible changes in daily life.
3. Interactions between the client and the professional can contribute to a better mutual understanding and encourage the client to come up with their own ideas.
4. Evidence-based practice can ensure that self-rehabilitation is effective and of a high quality.

Looking at the operational aspects of Kela rehabilitation through implementation studies

Given its role as a rehabilitation organiser, Kela has an interest in finding out how various entities are impacted by changes in the organising of rehabilitation, and particularly in the outcomes such changes have for clients and their rehabilitation process.  Kela has for ten years studied the implementation and functioning of its rehabilitation services and looked at how various entities involved in rehabilitation experience the benefits and impacts of rehabilitation. Taking the form of implementation research, these studies approach the research topic from diverse perspectives and utilise a variety of methods.

The information produced by the research improves the quality and evidence basis of Kela’s rehabilitation services. This goal is approached by:

1. making wider use of the framings and positions of implementation research in the study of rehabilitation
2. describing rehabilitation services by reference to their core elements

The research results can be applied more broadly to rehabilitation research and the study of rehabilitation in Finland, where implementation research and the theories, methods and concepts associated with it are only now being adopted as standard practice.