Information package: Rehabilitation

Kela’s duties include organising rehabilitation and securing income during rehabilitation. This information package outlines the current status and recent development of Kela rehabilitation. At the bottom, you will find links to, for example, statistics and recent studies on rehabilitation produced by Kela.

Kela has a statutory obligation to organise vocational rehabilitation, intensive medical rehabilitation and rehabilitative psychotherapy. Kela arranges and provides reimbursement for discretionary rehabilitation within the limits of a budget appropriation allocated by Parliament on an annual basis. With rehabilitation allowance, Kela can secure clients’ income during rehabilitation.

Rehabilitation organised by Kela is most commonly rehabilitative psychotherapy

In 2022, a total of 165,000 people underwent rehabilitation organised by Kela, which equals 3 per cent of the total population. Compared to 2021, 6 per cent more people were granted rehabilitation services. The most common legislative basis for rehabilitation was rehabilitative psychotherapy, which was granted to a total of 63,000 persons. This was 38 per cent of all those who were granted rehabilitation services.

A total of 43,000 (26%) persons underwent intensive medical rehabilitation, 35,000 (21%) underwent vocational rehabilitation, and 33,000 (20%) underwent discretionary rehabilitation. Recipients of rehabilitation may have received rehabilitation in accordance with several legal grounds during the year. A total of 52,000 persons received rehabilitation allowance.

The costs of Kela’s rehabilitation services in 2022 amounted to EUR 464 million. When examined by legal grounds, the costs of intensive medical rehabilitation were the most significant, at EUR 232 million. A total of EUR 243 million was paid in rehabilitation allowance.

The number of people granted rehabilitation has increased in the 2010s

The number of people granted Kela’s rehabilitation services doubled between 2010 and 2022.

In particular, the number of people granted rehabilitative psychotherapy has increased. The number has increased almost fivefold since 2011, when the service became statutory. Before 2011, Kela reimbursed psychotherapy as discretionary rehabilitation, and at that time, the number of service recipients was limited by the annual amount of money allocated to organising the service.

The number of people granted vocational rehabilitation almost tripled, and the number of people granted intensive medical rehabilitation doubled, between 2010 and 2022. The number of people granted discretionary rehabilitation has almost halved. The decrease is mainly due to the fact that before 2011, Kela reimbursed psychotherapy as discretionary rehabilitation.

In 2020, the COVID-19 pandemic decreased the number of people granted rehabilitation, particularly discretionary rehabilitation. This is probably due to the fact that discretionary rehabilitation is mainly provided in rehabilitation institutions and, therefore, cannot be provided as telerehabilitation.

Rehabilitation needs vary between different age groups

Participation in rehabilitation differs between age groups.

In 2022, children and adolescents under the age of 16 most commonly received intensive medical rehabilitation, which was provided to 85% of the people granted rehabilitation in that age group. The most commonly used service was speech therapy, which was provided to 63% of the recipients of intensive medical rehabilitation in the age group.

Young people aged 16‒29 were most commonly granted vocational rehabilitation (44% of recipients of rehabilitation in the age group) and rehabilitative psychotherapy (44%). The most common forms of vocational rehabilitation were NUOTTI coaching (41% of recipients of vocational rehabilitation in the age group) and vocational training (37%).

People of working-age, i.e. 30‒64 years, most commonly underwent rehabilitative psychotherapy (51% of recipients of rehabilitation in the age group) and discretionary rehabilitation (21%). The most common from of discretionary rehabilitation service were rehabilitation courses, in which 70% of the recipients of discretionary rehabilitation in the age group participated. The most common courses were Tules courses for people with musculoskeletal disorders (64% of people who participated in discretionary rehabilitation courses in that age group).

Vocational rehabilitation was provided to 16% of working-age rehabilitation recipients. The most common service was the vocational rehabilitation assessment, which was granted to 30% of recipients of vocational rehabilitation in that age group.

Elderly people, i.e. those aged 65 or over, most commonly underwent discretionary rehabilitation (92% of people granted rehabilitation in that age group). The most common form of rehabilitation were rehabilitation courses, in which 71% of people granted discretionary rehabilitation in that age group participated. Of all discretionary rehabilitation course participants, 38% attended rehabilitation courses intended for people who are not currently in employment and who suffer from musculoskeletal disorders, 30% participated in IKKU courses for elderly people with multiple illnesses, and 23% participated in rehabilitation courses for informal caregivers caring for an adult friend or family member.

Women undergo rehabilitation more often than men ‒ there are differences between the forms of rehabilitation

Participation in rehabilitation varies between the sexes. In 2022, the majority (62%) of all rehabilitation participants were women.

When examined by legislative basis, women underwent vocational rehabilitation, rehabilitative psychotherapy and discretionary rehabilitation more often than men. Men underwent intensive medical rehabilitation more often.

For example, 69% of children and adolescents under the age of 16 who participated in intensive medical rehabilitation were boys. Women and girls accounted for 83% of young people aged 16–29and 77% of working-age people aged 30–64 who underwent rehabilitative psychotherapy. On the other hand, more men than women participated in, e.g., cardiac rehabilitation courses organised as discretionary rehabilitation.

The grounds for receiving rehabilitation are most often a psychological or behavioural issue

The most common reason for participating in Kela rehabilitation in 2022 was a mental or behavioural disorder. A total of 115,000 persons (70% of participants) were granted rehabilitation due to a psychological or behavioural disorder. Most commonly, rehabilitation was granted on the basis of a psychological or behavioural disorder due to mood disorders (36% of those who were granted rehabilitation based on this main disease category), anxiety disorders (30%) and mental development disorders (18%).

The number of rehabilitation recipients due to a psychological or behavioural issue tripled between 2012 and 2022. The number of people receiving rehabilitation for mood disorders more than doubled and for anxiety disorders it more than quadrupled. Disorders of psychological development as grounds for receiving rehabilitation have doubled, and early-onset behavioural and emotional disorders more than tripled between 2016 and 2022, since they have been indicated in statistics as separate disease categories.

In 2022, 10% of rehabilitation recipients were provided rehabilitation for musculoskeletal disorders, 7% for nervous system diseases and 3% for circulatory diseases. The number of people receiving rehabilitation for musculoskeletal disorders has almost halved from 2012 to 2022.

A psychological or behavioural disorder was the most common reason for undergoing Kela rehabilitation in the age groups of children and adolescents aged under 16 and 16–29 (89% and 80% of rehabilitation recipients in these age groups respectively) and working-age people aged 30–64 (63%).

When examining disease categories in more detail, the most common disease category among persons aged under 16 was disorders of psychological development. For the first time, the most common disease category among girls aged 16‒29 was anxiety disorders. In the past, mood disorders were the most common disease category in this age group. For boys in the same age group, mood disorders were still the most common disease category. Mood disorders were also the most common disease category among people of working age.

For all persons aged over 65, the most common reason for undergoing rehabilitation was a musculoskeletal disorder (26% of people granted rehabilitation in that age group). However, among men of over 65 years of age, cardiovascular disease was the most common reason for rehabilitation. Nearly one-fifth (18%) of all working-age people (aged 30‒64) were granted rehabilitation due to musculoskeletal disorders.

Regional variation has been identified in referrals to Kela rehabilitation and the stages of referral

The study on regional differences in rehabilitation examined regional differences in referrals to Kela rehabilitation and their potential causes.

The study indicated that there are regional differences in participation in Kela rehabilitation. In 2018, participation in vocational rehabilitation and rehabilitative psychotherapy was highest in the North Karelia Hospital District and lowest in the Länsi-Pohja Hospital District. Participation in intensive medical rehabilitation was highest in the Lapland Hospital District and lowest in the Vaasa Hospital District.

According to professionals, referrals to Kela rehabilitation are hampered by the scarcity of resources and the availability of services. Professionals also say that of the stages of referral, the application stage performs the most poorly. The strongest-performing stage was the assessment of the need for rehabilitation and the preparation of a rehabilitation plan, which, however, saw the most variation between regions.

Regional variation in referrals to Kela rehabilitation can be explained by:

• the professionals’ knowledge of services and the rehabilitation system
• operating models and operating cultures in referral to rehabilitation
• organisation of services in different regions
• available resources.

Based on the study, the regional equality of referral to Kela rehabilitation can be supported by the following means:

1. Kela and the wellbeing services counties clarify the understanding of situations in which a client is referred to Kela rehabilitation, and which actor is responsible for the process of referring a client to rehabilitation.
2. Kela and the wellbeing services counties jointly build and maintain operating models for referral to Kela rehabilitation.
3. Kela and the wellbeing services counties ensure a common understanding of Kela rehabilitation and the processes of referral to rehabilitation.
4. The wellbeing services counties will make rehabilitation a visible part of their region’s strategy and services as a whole.
5. Regardless of the situation, health care services react to clients’ established or potential needs for rehabilitation.
6. Kela ensures that clients receive appropriate rehabilitation by developing criteria for making positive rehabilitation decisions along with new types of services.
7. Kela ensures that there is data available on Kela rehabilitation and referral to rehabilitation.

 

The benefits of Kela rehabilitation are assessed annually

Kela uses a model to assess the benefits of rehabilitation. The model is used annually to collect information on the benefits of Kela rehabilitation services. Data is collected using four indicators.

In addition, the model asks rehabilitation service providers for an assessment of the benefits and timeliness of rehabilitation. The register data is to examine the employment and life situation of rehabilitees one year prior to rehabilitation, during the year of rehabilitation, and one year after rehabilitation. The service description of rehabilitation services indicates whether the service falls within the scope of assessment and reporting of rehabilitation benefits.

In 2018, Kela’s assessment of the benefits of rehabilitation focused on mental health and working ability. The ability to work and study, as well as the physical and mental quality of life of the people who underwent rehabilitation, improved in all service groups examined in the study. More than half had achieved the goals they had set for rehabilitation at least as expected. Symptoms of depression decreased in all service groups.

The 2019 assessment of the benefits of Kela rehabilitation examined vocational rehabilitation in more detail than before. The ability to work and study improved in all service groups examined in the study. The most significant changes were observed in vocational rehabilitation that supports integration into work. Quality of life improved in almost all service groups. More than half had achieved the goals they had set for rehabilitation at least as expected. Symptoms of depression decreased in all service groups. The share of those working and studying increased during rehabilitation, especially in vocational rehabilitation supporting integration into work.

The 2020 assessment of the benefits of Kela rehabilitation examined the effects of the exceptional situation caused by COVID-19 in some of Kela’s rehabilitation services. Those who participated in mental health courses and vocational rehabilitation supporting integration into work suffered the most from the exceptional situation caused by COVID-19. The ability to work and study, as well as the physical and mental quality of life, improved in nearly all service groups examined in the study. Symptoms of depression decreased in nearly all service groups.

At the beginning of 2022, Kela launched the Rehabilitation Effectiveness research project, which examines the impact and effectiveness of Kela’s vocational, discretionary and intensive medical rehabilitation services from different perspectives. The first step is to examine the effectiveness of telerehabilitation and the effects of vocational rehabilitation that supports integration into work.

Kela has developed the organisation and procurement of rehabilitation services using a registration procedure. In this procedure, the terms and prices for the provision of rehabilitation services are specified by Kela. The service provider can approve the terms and thereby be able to register as a rehabilitation service provider. The aim is to promote the timeliness and flexibility of access to rehabilitation as well as the client’s freedom of choice.

According to the study, service providers consider the registration procedure to be a smoother way to act as Kela’s service provider than participating in competitive tendering.

All in all, the service providers felt that the right to provide services acquired through the registration procedure included a suitable amount of responsibility for the quality, marketing and design of the service, as well as the freedom to implement the service. They also consider it possible to differentiate themselves from other service providers through quality factors, while differentiation through marketing was not considered as significant.

Rehabilitation organised by Kela

Kela organises various types of rehabilitation for all age groups. Rehabilitation can support clients to live with an illness or injury or continue their studies or work. Kela can also secure clients’ income during rehabilitation. During rehabilitation, clients may be entitled to rehabilitation allowance. Rehabilitation organised by Kela is usually free of charge for the client.

In order for a person to receive rehabilitation from Kela, the doctor must have written a statement on the need for rehabilitation caused by an illness or injury. By way of exception, vocational rehabilitation services for young people can be obtained without a diagnosed illness if the person is 16‒29 years of age and their functional capacity has significantly deteriorated.

In addition to Kela, rehabilitation is also organised by, for example, public health care services, earnings-related pension and insurance institutions, and employment and economic development services.