High-Cost Users of Private Health Care: On Whom Are the Costs and National Health Insurance Reimbursements Concentrated?
Abstract
Background
Little is known about the distribution of expenses for private health care reimbursed by the Social Insurance Institution of Finland. This study assesses the distribution of yearly costs and national health insurance reimbursements in the adult Finnish population. In addition, the study aims to find out which factors are associated with being in the group of high-cost users, defined on the basis of total yearly costs.
Methods
The data consisted of a 50% random sample of the Finnish population aged 25 and over in 2011. Register data on yearly costs and NHI reimbursements of private health care (separated into three types of services: doctor visits, dental care, and examination and treatment) paid during 2011 were linked to data on gender, age, income, place of residence and entitlement to special medicine reimbursements. The 5% of the population whose total yearly costs were highest were defined as high-cost users. Using descriptive methods and multinomial logistic regression models, high-cost users were compared to those with lower costs and to those with no use of private health care during the year.
Results
The high-cost users accounted for 40% of total yearly costs of reimbursable private health care and 39% of the total yearly reimbursements paid by the Social Insurance Institution. Women, older age groups, those with higher income and those living in the Helsinki-Uusimaa region and in urban municipalities were more often than average in the group of high-cost users. Chronic morbidity, measured by entitlement to special medicine reimbursements, was not clearly associated with being in the high-cost user group.
Conclusions
Instead of reducing the NHI reimbursement rates for private health care services, cost cuts could be targeted at the minority of users who receive the highest amount of reimbursements.
Authors
Jenni Blomgren, Lauri Virta
Additional Information
- Peer-Reviewed: yes.
- Open Access: no.
- Cite as: Blomgren, J., & Virta, L. (2015). Yksityisen sairaanhoidon kustannukset ja Kela-korvaukset keskittyvät: Keitä suurkuluttajat ovat? Suomen lääkärilehti, 70(38), 2419–2424. https://www.laakarilehti.fi/tieteessa/terveydenhuoltoartikkelit/yksityisen-sairaanhoidon-kustannukset-ja-kela-korvaukset-keskittyvat-keita-suurkuluttajat-ovat/
