The Finnish Health Care System - Institute for Strategy and ...

do not have access to the occupational health care services commonly used byemployed people as an alternative to the municipal system.The scope of voluntary insurance coverage (both sickness insurance andaccident insurance) is usually limited, and great variation exists across differentschemes. Private insurance might cover the costs of treatment and othercompensation due to permanent disabilities, loss of income, or death. Publicregulation of voluntary insurance is limited, and insurance companies can designtheir schemes freely.Most individuals who purchase voluntary health insurance do so to limittheir out-of-pocket payments for private care and the portion of outpatientdrug charges not covered by the NHI. Additional reasons include shorter waitingtimes, the ability to choose a physician, direct access to a specialist, andthe perception of better quality services. Patients do not need referrals to privatehospitals if they intend to pay for their care with partial reimbursementfrom the NHI. Private providers can also offer patients shortcuts to municipality-runhospitals, as private providers may be more willing to refer patientsfor specialty care. In contrast, public health centres may be more conservativeabout referrals because they are run by the municipalities that also pay forspecialty care delivered by public hospitals.Occupational health care systemThe Occupational Health Care Act of 1979 obliges employers to provide occupationalhealth care services for their employees (see Section 5 on Employers).The Act defines compulsory occupational health care as health servicesnecessary to address work-related health risks. Services must include physicalexaminations and first aid for employees at the workplace, and employers areobliged to check the health status of all employees whose work might endangertheir health.Most large or medium-sized employers also provide curative outpatientservices through their occupational health care programmes; about 13% of alloutpatient physician visits in Finland are provided by the occupational healthcare system. In 2004, approximately 90% of employees with access to compulsoryoccupational health care services also received some curative servicesfrom their employers. Significant differences exist in the scope of curative servicecoverage across employers. Notably, despite a separate funding mechanismand distinct legislative framework, occupational health care services most oftenfall functionally within the scope of primary health care.43