Information in brief: Reimbursements for travel costs
Kela pays reimbursements for travel costs to healthcare or rehabilitation. This text contains information about the current travel cost reimbursement policy and recent developments. At the bottom of this page are links to statistics and studies on reimbursements paid, among other things.
Kela pays almost EUR 350 million in reimbursements for travel costs
In 2024, Kela’s expenditure on reimbursements for travel costs was EUR 343 million, which translates into an increase of approximately 11% from 2023.
The increase is largely explained by structural factors as the reimbursement available for medical transports was raised by 11% and the reimbursement for taxi fares by 4.5% at the beginning of 2024. Furthermore, domestic passenger transport services were exempt from VAT for a period of four months in 2023, which makes the difference between the years seem larger than usual.
Kela paid reimbursement for travel costs to 600,000 individuals, which amounts to approximately 11% of the total population. The percentage remained at the previous year’s level when considered on a per-capita basis. The number of reimbursed trips increased by 5% from 2023 to 4.5 million trips.
Taxi rides account for the majority of reimbursed trips and reimbursement expenditure
The majority of Kela’s travel cost reimbursement expenditure in 2024, i.e. over EUR 200 million, was comprised of taxi fares paid for rides in a regular taxi, a wheelchair taxi or a stretcher taxi. Taxi rides also accounted for the majority of reimbursed trips in almost all age groups.
The number of taxi rides increased by 6% from 2023 to a total of 3.2 million trips. The amount of taxi rides per capita increased in almost all age groups with the largest increase observed among those aged 80 to 89.
Kela paid reimbursement for travel costs especially to the elderly as the passenger was 70 years of age or older in approximately half of all reimbursed trips.
As morbidity increases with age and with the elderly increasingly living at home or in a home-like place of care instead of in a care facility, the elderly now have to travel to a healthcare facility to receive care and pay the fare for the trip themselves. In addition, many of the elderly have reduced capability to use public transport or drive their own car or cannot easily get a ride from a close relative, which translates into a higher use of taxis than observed among the younger generations. The need for urgent ambulance transport is also higher among the elderly than other cohorts.
Decrease in ambulance rides due to stricter criteria
One factor that may explain the increase in the number of taxi rides is the fact that some trips that used to be made in an ambulance are now made in a taxi. Kela paid a little less than EUR 100 million in reimbursements for just under 0.5 million ambulance rides (including both completed emergency transport missions and cancelled trips where the patient could be treated on site) in 2024. These figures are the lowest they have ever been since 2010.
Various media have published articles on how it has become more difficult to get a ride in an ambulance. Kela’s statistics reflect this reality as well: the occurrence of ambulance rides clearly decreased especially among the oldest age groups in 2023 and 2024.
The decline in the number of ambulance rides is likely due to the revised national guidelines for Emergency Response Centres published in 2023, which require dispatchers to apply stricter criteria when assessing whether an ambulance should be dispatched and to encourage callers to seek treatment independently.
Significant regional differences in reimbursement for travel costs
Large variation exists between both age groups and regions in the amount of reimbursements paid and in the number of reimbursed trips and the distance travelled. Factors that vary by region include morbidity and the age structure of the population as well as which transport options are available and the distance between the customer’s home and the services they need.
The percentage of travel cost reimbursement recipients varied from 7% in Helsinki and Western Uusimaa to 18% in Kainuu in 2024. These percentages have remained more or less the same in each region over the past few years.
Kela’s expenditure on reimbursements for travel costs was the highest in wellbeing services counties with large populations, with the exception of Uusimaa, and in Northern Finland, where customers have to travel long distances.
In 2024, Kela’s expenditure on reimbursements for travel costs calculated per capita was the highest in the wellbeing services counties of Kainuu and Lapland at approximately EUR 140 per capita with the reimbursement calculated per trip being EUR 119 in Lapland and EUR 104 in Kainuu.
Kela’s expenditure on reimbursements for travel costs has traditionally been the lowest in Uusimaa, which comprises the City of Helsinki, the wellbeing services county of Vantaa and Kerava, and the wellbeing services counties of Western, Central and Eastern Uusimaa. The reimbursement calculated per capita is similarly the lowest in the country. However, in 2024, Kela’s expenditure increased the most in Uusimaa where reimbursements for travel costs increased by 21% and the number of reimbursed trips by 13%. In the wellbeing services county of Vantaa and Kerava, Kela’s expenditure on taxi fare reimbursements increased by as much as 31% and the number of trips by 19%.
The majority of reimbursements for travel costs are paid to pensioners
In the long term, the total number of reimbursed trips has remained relatively similar despite the changes that have been made to healthcare services over time and the ageing of the population. Kela’s expenditure on reimbursements for travel costs has also not been impacted to a great degree by the wellbeing services counties beginning their operations at the beginning of 2023.
The factor with the largest impact so far would seem to be the changes made to the deductible that applies to Kela’s travel cost reimbursements. In the early 2010s, the number of reimbursed trips and Kela’s expenditure on reimbursements decreased when the deductible was raised in stages between 2013 and 2016 from EUR 9.25 to first EUR 14.25 and then EUR 16 before it settled at the current EUR 25. As the deductible increased, less expensive trips were no longer eligible for reimbursement, and the number of reimbursed trips decreased as a result.
The year 2020, which was the height of the Covid-19 pandemic, shows in statistics only as a small drop, and afterwards the number of trips has increased again across all age groups with the exception of persons under 15. The decrease in Kela’s expenditure on reimbursements for travel costs that has occurred after 2021 is likely due to the start of a new contract period for taxi operators that has resulted in lower prices. In 2023, cuts were made to the Kela reimbursement available for the costs of private medical care, which may also be reflected in the number of reimbursed trips.
Before 2012, the age group with the highest number of reimbursed trips was persons between 15 and 64. Since then, as the number of elderly people has increased, people over the age of 65 have been the age group to receive the most reimbursements for travel costs.
Statistics show that customers do not claim Kela reimbursement for the majority of their trips. This factor explains why changes in a customer’s treatment or in their place of care are not immediately reflected in Kela’s expenditure on reimbursements for travel costs.
For example, according to statistics published by the Finnish Institute for Health and Welfare, almost 9 million visits were made to a place of care and there were almost a million inpatient care periods in 2024. As each visit to a place of care involves two trips, these visits alone accounted for approximately 20 million trips. In addition, the reimbursement Kela offers applies also to e.g. trips to and from facilities that offer Kela rehabilitation or private medical care covered by health insurance. As Kela only reimbursed 4.5 million trips during the same period, this means that reimbursement was paid for a fraction of the total number of trips.
Ride sharing saves on costs
The first year of operations for wellbeing service counties did not bring significant changes in terms of reimbursements for travel costs. Among other things, wellbeing service counties have recently published their service network plans, which include the closure of health centres in favour of remote and mobile services. At the same time, changes have also been planned in the hospital and emergency care network. These also have an impact on patient travel, so it is useful to monitor travel reimbursement trends.
Travel distance and journey times, as well as public transport connections, can be viewed using the route finder on Kela’s website.
Ride sharing has been reintroduced as an option after the Covid-19 pandemic, but it is not used as often as it was in the pre-pandemic years. In 2024, altogether 5% of all taxi rides were ride-sharing trips, and according to the service providers’ calculations, the savings achieved through ride sharing amounted to EUR 7 million with 5 million fewer kilometres driven.
Each region currently has two service providers for taxi rides instead of one. As such, the fact that trips are allocated between two companies does make it more difficult to offer ride sharing as an option. Taxi dispatch centres also exhibit major differences in if and how they provide ride-sharing services. The fixed fee Kela pays for ride sharing may not necessarily be sufficient to encourage taxi operators to provide ride-sharing services more widely. In terms of generating savings, ride sharing is a good option especially in cities because although the trips customers make may be short, they are plentiful.
Kela curbs its reimbursement expenditure especially by selecting its taxi operators through a competitive bidding process. Savings could also be generated by paying a higher rate of reimbursement for the use of the customer’s own car instead of the current EUR 0.33 per kilometre, with the assumption being that this would encourage some of the customers who ride in a taxi to opt for the more cost-effective choice of making the trip in their own car instead. For example, the tax-exempt kilometre allowance approved by the Tax Administration for trips made in your own car is EUR 0.59 per kilometre.
Liability for the reimbursement for travel costs unlikely to prevent the closure of care units
In 2024, wellbeing services counties presented their plans to balance their finances by e.g. scaling down their service networks, centralising their operations and using their facilities more efficiently. On the other hand, the Government is currently looking into a reform of the emergency services and hospital network as well as the surgical operations of hospitals. In practice, these changes translate into the closure of care units and impact a large part of the population. A recent study identified 138 health centres that will either be closed or whose closure is planned. These health centres serve almost 900,000 residents as their closest health centre. For many, the closure of care units means that they will have to travel farther to receive care and spend more time and money on travel to access services even if remote services, such as digital clinics, or mobile or at-home services are introduced as a replacement.
The National Audit Office of Finland (the NAOF) found in its recent report on the centralisation of health services that the closure of care units will result in not only patients but also their accompanying family members having to spend more time to travel to the closest place of care as it will be further away. The NAOF also noted that, when the social welfare and healthcare service network is reformed, the total costs generated by how accessible services will be after the reform (all vehicles, travel times and Kela reimbursements) should also be assessed as a part of the process.
In 2024, many entities concerned about the closure of care units proposed that liability for travel cost reimbursements be transferred from Kela to the wellbeing services counties. This proposal was based on the premise that if the same entity is responsible for both organising services and reimbursing patients for their travel costs, it would force these entities to take travel costs into consideration to a more significant degree and curb the urge to close care units.
However, transferring liability for the reimbursement of travel costs from Kela to wellbeing services county is not likely to prevent the closure of health centres, at the very least, as their closure is usually motivated by the desire to reduce property costs. Wellbeing services counties inherited rental properties from municipalities for the first few years of their operation, and the wellbeing services counties are now seeking to achieve savings by e.g. divesting these properties. The rental costs of the properties are likely to be very different in scale compared to the expenditure on the reimbursement of travel costs to and from them. Furthermore, when taking into consideration that reimbursement is not claimed for the majority of trips to and from places of care, the actualised expenditure on reimbursement for travel costs does not even accurately reflect the true travel costs incurred by the patients and their close relatives. However, insofar as other operations are concerned, liability for costs might prompt wellbeing services counties to take travel costs into consideration to a more significant degree than they do now. For example, the designated personal doctor model adopted in South Savo for the elderly is estimated to have concurrently resulted in a reduction in the number of ambulance rides.
If liability for the reimbursement of travel costs were to be transferred to the wellbeing services counties, these costs would then be paid from the general revenues of wellbeing services counties and not from earmarked National Health Insurance funds. A good example of what this might mean for travel cost reimbursements is what happened to emergency care, which previously seemed to have a relatively independent status. Now, emergency care is usually integrated into general public healthcare services and, as such, it has also been subjected to cuts. This is another factor that may have contributed to the introduction of stricter criteria for when an ambulance can be dispatched.
