The health insurance is paid for by the insured, their employers and the state. The health insurance pays, among others, the national sickness allowances, medicine reimbursements, parent’s allowances and other expenses, such as travelling expenses.
The trend in the medicine reimbursements paid by the Social Insurance Institution Kela is followed not only by the authorities but also the other actors in the sector. There have been various measures to contain the growth in the reimbursement expenses. Generic substitution introduced in 2003 created a new type of price competition on the market. The wholesale price of the reimbursable medicines was cut by 5% and the year 2009 saw the introduction of the reference price system. The reimbursement expenses are further contained by the temporary validity of the reimbursable medicine prices, since it is customary for the prices to drop at each price adjustment.
Individual European countries have very different reimbursement systems since the decisions on healthcare are taken nationally. This is reflected, for example, in the size of the patient co-payments is various countries.
A growing number of patients receives special reimbursements for the treatment of a chronic or permanent disease. As the population ages, this number will continue to grow. The diseases eligible for the special reimbursements are defined in the legislation.
The reimbursement status applications are made to the Pharmaceuticals Pricing Board PPB. At the same time, PPB adopts the reasonable wholesale price for the medicine. The main rule is that the company applies for the reimbursable status for its product. The time required of a novel medicine from marketing authorisation application to the decision of its reimbursable status will take about 3 years in the case of medicines with basic reimbursability while the time required is 5 years on average if the medicine is in the special reimbursement group. Compared with other European countries, it takes long for a medicine to become reimbursable in Finland.