UNOFFICIAL TRANSLATION
4.3.1996 Ministry of Social Affairs and Health, Finland

No. 951/94

Decision by the Council of State on the criteria for reimbursement of costs for occupational health care, medical care and other health care

Issued in Helsinki on 27 October 1994

Under Section 29a of the Health Insurance Act enacted on 4 July 1963 (364/63), as amended by the Act of Parliament of 25 August 1994 (782/94), the Council of State has, upon the proposal of the Ministry of Social Affairs and Health, decided the following:

Section 1

Maximum amount

Employers shall be reimbursed for the costs of activities referred to in Section 29 (1) of the Health Insurance Act, to the extent that such costs are necessary and reasonable. The reimbursement shall be determined on the basis of a computed maximum amount established for each employee covered. The maximum amount shall be set on the basis of the resources necessary to implement a service consonant with good occupational health practice. As resources shall be considered:

1) the services of health care professionals;

2) the expert services needed by health care professionals;

3) laboratory, radiology and other exami-nations; and

4) other resources related to the estab-lishment and operation of an occupational health station.

The reimbursement may, where necessary, be increased in respect of extraordinary

costs resulting from the small number of employees covered, particular health hazards inherent in the work, the establishment of occupational health care activity, the setting-up of an occupational health station, or a reorientation of the service.

Section 2

Allowable costs

Allowable costs shall include the expense of setting up and operating an occupational health service, to the extent that such costs are necessary and reasonable.

Allowable costs of establishing an occupational health care service shall include the costs of purchasing essential examination, treatment and office equipment and furnishings, and of information and monitoring systems used in occupational health care. Allowable costs shall not include the costs of building, acquiring or repairing the premises of an occupational health station.

Allowable costs of operating an occupational health care service shall include the remuneration of occupational health personnel, statutory payroll expenses, and other costs of maintaining an occupational health station, such as the costs of maintaining the premises, the costs of examination and treatment equipment, and other costs directly resulting from the implementation of an occupational health service.

Allowable costs shall further include the fees and charges levied by an institution or individual authorized under the Occupational Health Care Act (743/78) to provide occupational health services or by a health centre referred to in the Public Health Act (66/72), to the extent that such costs correspond to the costs of establishing and operating an occupational health service referred to in this Section.

Section 3

Medical care and other health care

Employers shall be reimbursed for the cost of providing medical and other health services of the kind referred to in Section 29 (3) of the Health Insurance Act, to the extent that such costs are necessary and reasonable, and on condition that the services are available to the employees free of charge. Where applicable, the reimbursement shall be carried out in accordance with the provisions of Sections 1 and 2 above.

The computed maximum amount established for each employee shall be determined on the basis of the resources needed to provide general practitioner-level out-patient medical or other outpatient health services.

Section 4

Monitoring costs and the occupational health activity

In determining a claim for reimbursement, the degree to which the costs of employer-provided occupational health services are necessary and reasonable shall be examined on the basis of the claim information defined in Section 30c of the Health Insurance Act by comparing, separately for each reimbursement class, the costs incurred by the employer and the services actually provided with the criteria for determining the computed maximum amount described in Sections 1 and 3 above.

Section 5

Payment of reimbursement to entrepreneurs or other self-employed persons

Entrepreneurs and other self-employed persons shall receive compensation for the necessary and reasonable costs of arranging occupational health services of the kind referred to in Section 29 (1) of the Health Insurance Act in accordance with the provisions of Sections 1, 2 and 4 above, as applicable.

Section 6

Payment of reimbursement to municipal authorities

If a municipal health centre provides occupational health services of the kind referred to in Section 29 (2) of the Health Insurance Act to an entrepreneur or other self-employed person at a price from which the reimbursement referred to in Section 29a of the Health Insurance Act has been deducted, the municipal authority shall be entitled to a reimbursement of this amount up to the computed maximum amount established for each employee covered in accordance with the provisions of Sections 1 and 2 above, as applicable.

Section 7

Entry into force

This Decision shall enter into force on 1 January 1995.

This Decision replaces the Council of State Decision (988/78) respecting the criteria for reimbursement of the costs of occupational health care and other health care given on 4 December 1978, together with its subsequent amendments.

This Decision shall be applied to employers' financial periods beginning on or after 1 January 1995 and to the costs incurred by an entrepreneurs or other self-employed persons on or after the said date. The provisions superseded by this Decision are applied to the employers' financial periods that began before the said date.

Helsinki, 27 October 1994

Jorma Huuhtanen, Minister for Social Affairs and Health

Matti Lamberg, Chief Medical Officer