There are three key themes describing market access for medical technologies in Finland:
- Reimbursement: payment mechanism via the DRG system and regional price lists
- Funding: recommendations by the national Council for Choices in Health Care
- Health technology assessment: obtaining recommendations from the national and local HTA bodies
There is no national reimbursement or funding model for healthcare services in Finland. Wellbeing counties in Finland are funded in different ways. Local price lists (fee-for-service), activity-based funding on the basis of diagnosis-related groups (DRGs), and global budget adjusted for DRG activity are the three most common ways of financing health care services.
Finland shares the DRG system (NordDRG) with several other countries, including Sweden and Norway. However, all inter-regional care is reimbursed on a case-by-case basis via the DRG system. Therefore, the role of DRG is higher for procedures, which are concentrated only in several hospitals across the country, and which provide care for patients from other Finnish wellbeing areas.
DRGs are determined by the combination of a procedure code (THL) and a diagnosis code (ICD-10). THL nomenclature is maintained by the Finnish Institute for Health and Welfare and released a few times a year. The Finnish version of the NordDRG system is approved annually.
Finland has no nationally defined list of health benefits that are guaranteed to the Finnish population. Decisions on which treatment methods to use and which new technologies to introduce are made by the hospitals.
In order to promote equal access, cost-effective, and efficient use of medical technologies in the country, the Council for Choices in Health Care in Finland (COHERE) evaluates technologies and provides recommendations for the adoption of novel technologies to payers (wellbeing areas) and healthcare providers.
Health technology assessment
HTA is performed on the national level (as part of the COHERE recommendations or stand-alone assessments by the Finnish Coordinating Center for Health Technology Assessment) or on the local level (which can inform hospital decision-making).
Specifics for IVD tests
There is no specific reimbursement framework for in-vitro diagnostic tests in public laboratories. IVD tests are funded using a global budget principle as part of the laboratory funding.
The Social Insurance Institution of Finland (Kela) reimburses IVD tests performed in private laboratories ordered by private physicians.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, policy and HTA considerations)