Effects of the National Health Insurance Reimbursement System on Private Medical Services
Abstract
Background
The Finnish national health insurance (NHI) and its reimbursements for private medical care services are regularly the subject of critical discussion and the reimbursement system is under pressure for reform. The significance and the effects of the reimbursement system on the competitive environment have not previously been studied from the perspective of private health care firms and their stakeholders.
Methods
This research was performed by means of anonymous semi-structured theme interviews of 14 decision makers. Six of the interviewees represented the private sector, three the public health care sector and five other stakeholders.
Results
The interviewees were of the opinion that the significance and the incentive effects of the medical care reimbursement system were diminishing due to the steadily increasing co-payment share. Fee-for-service compensation may, however, steer the firms’ production decisions and curb the incentives to develop comprehensive services. Additionally, the reimbursement system creates some requirements for information technology in the private sector and adds bureaucracy. As the main strengths of the system the interviewees mentioned universality, the patient’s free choice of physician and that it supplemented the public services. On the other hand all the interviewees agreed that reform was needed.
Conclusions
The resources of the reimbursement system are scarce and scattered to all types of services. By prioritizing the reimbursements the steering effect of the system could be better utilized. Prioritizing should be based on supporting effectiveness and productive efficiency. It might also be acceptable to control the market mechanism. Reforms that introduce market control such as price regulation, however, carry the risk of building barriers for competition. Instead of adding control, the prices could be kept at a competitive level by improving the competitive conditions of the market, for example by improving price awareness of the patients. In the end the private health care reimbursement system should be evaluated as a part of public health care finance as a whole, which is awaiting reform now expected to take place in the next few years.
Authors
Riina Hiltunen, Hennamari Mikkola, Jukka-Pekka Halonen, Jouni Saarni
Additional Information
- Peer-Reviewed: yes.
- Open Access: no.
- Cite as: Hiltunen, R., Mikkola, H., Halonen, J., & Saarni, J. (2015). Sairaanhoitovakuutuksen korvausten merkitys lääkäripalveluyrityksille. Suomen lääkärilehti, 70(24), 1751–1758. https://www.laakarilehti.fi/tieteessa/terveydenhuoltoartikkelit/sairaanhoitovakuutuksen-korvausten-merkitys-laakaripalveluyrityksille/
