Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-06-07T07:47:56.443Z Has data issue: false hasContentIssue false
  • English
  • Français

Not Free at All: Home Care User Fees in a Nordic Care System

Published online by Cambridge University Press:  20 May 2022

Katja Ilmarinen Open the ORCID record for Katja Ilmarinen [Opens in a new window] ,
Lina Van Aerschot  and
Teppo Kröger Open the ORCID record for Teppo Kröger [Opens in a new window]
Katja Ilmarinen*
Affiliation:
National Institute for Health and Welfare, Finland
Lina Van Aerschot
Affiliation:
Department of Social Sciences and Philosophy, University of Jyväskylä, Finland
Teppo Kröger
Affiliation:
Department of Social Sciences and Philosophy, University of Jyväskylä, Finland Centre of Care Research West, Western Norway University of Applied Sciences, Norway
*
*E-mail: katja.ilmarinen@thl.fi
Get access Rights & Permissions [Opens in a new window]

Abstract

In Finland, older persons are entitled to needs-tested public home care services. Home care mainly assists with personal care, activities of daily living and medical needs. It is complemented with auxiliary services that offer help with instrumental activities of daily living. In Finland, municipalities are responsible for organising public home care services. These services are mainly tax-funded, but user fees are also charged. In this article, we examine the levels of user fees of home care and auxiliary services in Finnish municipalities in 2018. The data analysis consists of descriptive statistics and exemplary cases of costs to the service users. The results show that user fees may represent a significant share of older persons’ monthly incomes. Consequently, home care users, especially those with low incomes, are at risk of economic deprivation and non-take-up of the services. We also found substantial variation in user fees across municipalities, causing regional inequality.

Keywords

Care of older peopleuser feesuniversalismNordic welfare stateFinland
Type
Article
Information
Social Policy and Society , First View , pp. 1 - 16
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aaltonen, K., Miettinen, J., Airio, I., Martikainen, J-E., Saastamoinen, L-K., Bell, J. S., Hartikainen, S. and Norris, P. (2015) ‘Cost-related barriers to use of health services and prescription medicines in Finland: a cross-sectional survey’, European Journal of Public Health, 25, 3, 368–72.CrossRefGoogle ScholarPubMed
Act 710/1982, Social Welfare Act, Unofficial translation, https://www.finlex.fi/fi/laki/kaannokset/1982/en19820710_20140491.pdf [accessed 14.06.2021].Google Scholar
Act 734/1992, Laki sosiaali- ja terveydenhuollon asiakasmaksuista (Act on Client Fees in Social Welfare and Health Care), Valtion säädöstietopankki Finlex, https://www.finlex.fi/fi/laki/ajantasa/1992/19920734 [accessed 14.06.2021], in Finnish.Google Scholar
Act 980/2012, Act on Supporting the Functional Capacity of the Older Population and on Social and Health Care Services for Older Persons, https://www.finlex.fi/en/laki/kaannokset/2012/en20120980?search%5Btype%5D=pika&search%5Bkieli%5D%5B0%5D=en&search%5Bpika%5D=services%20 [accessed 14.06.2021].Google Scholar
Ahonen, K., Kuivalainen, S., Liukko, J., Nivalainen, S., Palomäki, L-M. and Polvinen, A. (eds.) (2019) Tutkimuksia eläkeläisten toimeentulokokemuksista ja taloudellisesta hyvinvoinnista (Study of Retirees’ Subjective Perceptions of Making a Living and of Economic Well-Being), Eläketurvakeskuksen tutkimuksia 2/2019, Helsinki: Eläketurvakeskus, https://urn.fi/URN:ISBN:978-951-691-006-5 [accessed 04.04.2022], in Finnish with English summary.Google Scholar
Anttonen, A. (2002) ‘Universalism and social policy: a Nordic-feminist revaluation’, NORA – Nordic Journal of Feminist and Gender Research, 10, 2, 71–80.CrossRefGoogle Scholar
Anttonen, A., Häikiö, L., Stefansson, K. and Sipilä, J. (2012) ‘Universalism and the challenge of diversity’, in Anttonen, A., Häikiö, L. and Stefánsson, K. (eds.), Welfare State, Universalism and Diversity, Cheltenham: Edward Elgar, 1–15.CrossRefGoogle Scholar
The Constitution of Finland 731/1999, translation from Finnish, https://www.finlex.fi/fi/laki/kaannokset/1999/en19990731.pdf [accessed 14.06.2021].Google Scholar
Decree 912/1992, Valtioneuvoston asetus sosiaali- ja terveydenhuollon asiakasmaksuista (Decree on Client Fees in Social Welfare and Health Care), Valtion säädöstietopankki Finlex, https://www.finlex.fi/fi/laki/ajantasa/1992/19920912 [accessed 14.06.2021], in Finnish.Google Scholar
Finnish Institute for Health and Welfare (2019) Statistical Yearbook on Social Welfare and Health Care 2019, Helsinki: Finnish Institute for Health and Welfare, http://urn.fi/URN:ISBN:978-952-343-388-5 [accessed 14.06.2021].Google Scholar
Finnish Institute for Health and Welfare (2020) Social Protection Expenditure and Financing 2018. Social Protection Expenditure in Relation to GDP Went Down for the Third Consecutive Year, Statistical report 10/2020, Helsinki: Finnish Institute for Health and Welfare, http://urn.fi/URN:NBN:fi-fe2020042822823 [accessed 13.12.2021].Google Scholar
Finnish Institute for Health and Welfare (2021) Information on the RAI Assessment System, https://thl.fi/en/web/ageing/assessment-of-service-needs-with-the-rai-system/information-on-the-rai-assessment-system [accessed 25.11.2021].Google Scholar
Health and Social Services Reform (2021) https://soteuudistus.fi/en/frontpage [accessed 13.12.2021].Google Scholar
Hjelmar, U. and Rostgaard, T. (2020) ‘Supplemental home care and topping-up: a shift from service universalism towards a new and privatised public service model?’, International Journal of Social Welfare, 29, 2, 118–28.CrossRefGoogle Scholar
Ilmarinen, K., Mukkila, S. and Tervola, J. (2020) ‘ Kotihoidon asiakasmaksut iäkkäillä (Home care user fees for the elderly)’, Yhteiskuntapolitiikka, 85, 4, 407–15, http://urn.fi/URN:NBN:fi-fe2020091669818 [accessed 11.02.2022], in Finnish.Google Scholar
Johansson, E. (2010) The Long-Term Care System for the Elderly in Finland, ENEPRI Research Report, No. 76 (The ANCIEN project, Centre for European Policy Studies), https://www.ceps.eu/ceps-publications/long-term-care-system-elderly-finland [accessed 14.06.2021].Google Scholar
Kalliomaa-Puha, L. and Kangas, O. (2018) ESPN Thematic Report on Challenges in Long-Term Care: Finland, European Social Policy Network (ESPN), Brussels: European Commission.Google Scholar
Karsio, O. and Anttonen, A. (2013) ‘Marketisation of eldercare in Finland: legal frames, outsourcing practices and the rapid growth of for-profit services’, in Meagher, G. and Szebehely, M. (eds.), Marketisation in Nordic Eldercare: A Research Report on Legislation, Oversight, Extent and Consequences, Stockholm Studies in Social Work 30, Stockholm: Department of Social Work, Stockholm University, 85–125, https://vbn.aau.dk/ws/portalfiles/portal/80766101/Marketisation_in_Nordic_eldercare.pdf#page=87 [accessed 13.12.2021].Google Scholar
Kröger, T. (2011) ‘Retuning the Nordic welfare municipality: central regulation of social care under change in Finland’, International Journal of Sociology and Social Policy, 31, 3/4, 148–59.CrossRefGoogle Scholar
Kröger, T., Anttonen, A. and Sipilä, J. (2003) ‘Social care in Finland: stronger and weaker forms of universalism’, in Anttonen, A., Baldock, J. and Sipilä, J. (eds.), The Young, the Old and the State. Social Care systems In Five Industrial Countries, Cheltenham: Edward Elgar, 25–54.Google Scholar
Kröger, T. and Leinonen, A. (2012) ‘Transformation by stealth: the retargeting of home care services in Finland’, Health and Social Care in the Community, 20, 3, 319–27.CrossRefGoogle ScholarPubMed
Kröger, T., Mathew Puthenparambil, J. and Van Aerschot, L. (2019) ‘Care poverty: unmet care needs in a Nordic welfare state’, International Journal of Care and Caring, 3, 4, 485–500.CrossRefGoogle Scholar
Laihiala, T. (2019) ‘Eläkeläiset hyväntekeväisyysruoka-avun asiakkaina (The retred as customes of food-aid)’, Yhteiskuntapolitiikka, 84, 4, 443–55, https://www.julkari.fi/bitstream/handle/10024/138581/YP1904_Laihiala.pdf [accessed 11.02.2022], in Finnish.Google Scholar
Lievonen, M. and Mattila, M. (2021) Yksinasuvat esiin! Miten huomioida yksinasuvat politiikassa (How to Take into Account Single Persons in Policy), Kalevi Sorsa -säätiö, https://sorsafoundation.fi/wp-content/uploads/2021/11/KSS_Yksinasuvat_esiin_Web.pdf [accessed 11.02.2022], in Finnish.Google Scholar
Mathew Puthenparambil, J. (2018) ‘Outsourcing within the Nordic context: care services for older people in Finland’, Journal of Aging and Social Policy, 30, 5, 440–57.CrossRefGoogle ScholarPubMed
Mielck, A., Kiess, R., von dem Knesebeck, O., Stirbu, I. and Kunst, A. E. (2009) ‘Association between forgone care and household income among the elderly in five Western European countries – analyses based on survey data from the SHARE-study’, BMC Health Services Research, 9, 52.CrossRefGoogle Scholar
Ministry of Social Affairs and Health (2018) Quality Recommendation to Guarantee a Good Quality of Life and Improved Services for Older Persons 2017–2019, Publications of the Ministry of Social Affairs and Health 2018:1, Helsinki: Ministry of Social Affairs and Health, http://urn.fi/URN:ISBN:978-952-00-3906-6 [accessed 13.12.2021].Google Scholar
Ministry of Social Affairs and Health (2020) Proposal for Reforming Act on Client Charges in Health and Social Services to Parliament – More Cost-Free Health and Social Services, Press release, https://stm.fi/en/-/proposal-for-reforming-act-on-client-charges-in-health-and-social-services-to-parliament-more-cost-free-health-and-social-services- [accessed 13.12.2021].Google Scholar
Ministry of Social Affairs and Health (2021) Kotihoito ja kotipalvelut (Home Care and Home Services), https://stm.fi/kotihoito-kotipalvelut [accessed 14.06.2021], in Finnish.Google Scholar
Moberg, L. (2017) ‘Marketisation of Nordic eldercare – is the model still universal?’ Journal of Social Policy, 46, 3, 603–21.CrossRefGoogle Scholar
Muir, T. (2017) Measuring Social Protection for Long-Term Care, OECD Health Working Papers, No. 93, Paris: OECD Publishing, DOI: doi.org/10.1787/a411500a-en.Google Scholar
Nykänen, S. (2007) ”Kot on paras paikka”. Kotona asumisen merkitys ikääntyvälle (”Home is the Best Place”. The Importance of Living at Home for the Elderly), Rovaniemi: Rovaniemen yliopisto, https://www.ulapland.fi/loader.aspx?id=b60f1f16-b935-4f6c-a50c-0a843f0958c6 [accessed 04.04.2022], in Finnish.Google Scholar
Organisation for Economic Co-operation and Development (OECD) (2005) Long-Term Care for Older People, The OECD Health Project, Paris, France: OECD, DOI: doi.org/10.1787/19901291.Google Scholar
Räsänen, K. (2019) Kotona asuvien iäkkäiden näkemyksiä muuttohalukkuudesta ja asumismuodosta (Views of the Elderly Living at Home on the Willingness to Move and the Form of Housing), Pro gradu -tutkielma, Kuopio/Joensuu: Itä-Suomen Yliopisto, https://erepo.uef.fi/bitstream/handle/123456789/21954/urn_nbn_fi_uef-20191396.pdf [accessed 13.12.2021], in Finnish.Google Scholar
Rintala, T., Jämsä, A. and Soukainen, J. (2010) Vanhuspalvelut, Säännöllinen Kotihoito (Services for Older People, Regular Home Care), Valtiontalouden tarkastusviraston tuloksellisuustarkastuskertomus 214/2010, https://www.vtv.fi/app/uploads/2018/07/02132256/vanhuspalvelut-214-2010.pdf [accessed 14.06.2021], in Finnish.Google Scholar
Roland, D., Forder, J. and Jones, K. (2022) ‘What is out there and what can we learn? International evidence on funding and delivery of long-term care’, Social Policy and Society, 21, 2, 261–74.CrossRefGoogle Scholar
Saarela, T. (ed.) (2016) Raportti kyselystä Asiakasmaksulaki 11 § (A Report on the Survey on the Act on Client Fees in Social Welfare and Health Care, 11 §), Helsinki: European Anti-Poverty Network Finland, EAPN, http://www.eapn.fi/wp-content/uploads/2017/01/asiakasmaksulain-raportti_final.pdf [accessed 14.06.2021], in Finnish.Google Scholar
Saarela, T. (ed.) (2020) Asiakasmaksut aiheuttavat ahdinkoa: Raportti kyselystä julkisen sosiaali- ja terveydenhuollon maksuista johtuvasta taloudellisesta ahdingosta paljon palveluja käyttävien arjessa (User Fees are Causing Economic Distress), Helsinki: European Anti-Poverty Network Finland, EAPN, http://www.eapn.fi/wp-content/uploads/2020/05/Asiakasmaksut-aiheuttavat-ahdinkoa.pdf [accessed 11.02.2022], in Finnish.Google Scholar
Scheil-Adlung, X. and Bonan, J. (2013) ‘Gaps in social protection for health care and long-term care in Europe: are the elderly faced with financial ruin?’ International Social Security Review, 66, 1, 25–48.CrossRefGoogle Scholar
Schokkaert, E., Steel, J. and Van de Voorde, C. (2017) ‘Out-of-pocket payments and subjective unmet need of healthcare’, Applied Health Economics and Health Policy, 15, 5, 545–55.CrossRefGoogle ScholarPubMed
Statistics Finland (2020) Tulonjakotilasto, 2018 (Income distribution, 2018), Helsinki: Statistics Finland, http://www.stat.fi/til/tjt/2018/06/index.html [accessed 11.02.2022], In Finnish.Google Scholar
Statistics Finland (2022) Statistics Finland’s free-of-charge statistical databases, Income distribution statistics, Tables: Dwelling population by income decile, main income source of household-dwelling unit, and age of person, 2010–2020, and Distribution of households and persons by income decile and age of reference person, 1966–2020, and Household population’s risk of poverty indicators by age and sex, 1966–2020, https://pxnet2.stat.fi/PXWeb/pxweb/en/StatFin/StatFin__tul__tjt/ [accessed 11.02.2022].Google Scholar
Szebehely, M. and Meagher, G. (2018) ‘Nordic eldercare – weak universalism becoming weaker?’ Journal of European Social Policy, 28, 3, 294–308.CrossRefGoogle Scholar
Tervola, J., Aaltonen, K., Heino, P., Kajantie, M., Kari, H. and Ollonqvist, J. (2020) Kotitalouksien terveysmenojen vaikutukset köyhyyteen Suomessa (Impact of Household Health Expenditure on Poverty in Finland), INVEST Working Paper 1/2020, Turku: University of Turku and Finnish Institute for Health and Welfare, http://urn.fi/URN:ISBN:978-951-29-7977-6 [accessed 11.02.2022], in Finnish.Google Scholar
Tervola, J., Haaga, T. and Ilmarinen, K. (2019) Terveydenhuollon asiakasmaksujen alueellinen vaihtelu Suomessa (Regional Variation in Healthcare User Fees in Finland), Tutkimuksesta tiiviisti 48, 2019, Helsinki: Finnish Institute for Health and Welfare, https://urn.fi/URN:ISBN:978-952-343-433-2 [accessed 04.04.2022], in Finnish.Google Scholar
Tervola, J., Mukkila, S., Ilmarinen, K. and Kapiainen, S. (2018) The Distributional Effects of Out-of-Pocket Health Payments in Finland 2010–2018, Discussion Paper 35/2018, Helsinki: Finnish Institute for Health and Welfare, http://urn.fi/URN:ISBN:978-952-343-220-8 [accessed 04.04.2022].Google Scholar
Vaalavuo, M. (ed.) (2018) Sosiaali- ja terveydenhuollon asiakasmaksujen kohdentuminen, vaikutukset ja oikeudenmukaisuus (User Fees of Social Welfare and Health Care Services, Targeting, Impacts and Equality), Valtioneuvoston selvitys ja tutkimustoiminnan julkaisusarja 30/2018, Helsinki: Valtioneuvoston kanslia, http://urn.fi/URN:ISBN:978-952-287-534-1, in Finnish with English summary.Google Scholar
Vaalavuo, M. (2019) ‘Use of public health and social care services among the elderly in Finland: an under-examined mechanism of redistribution’, Journal of European Social Policy, 30, 2, 176–89.CrossRefGoogle Scholar
Vabø, M. and Szebehely, M. (2012) ‘A caring state for all older people?’, in Anttonen, A., Häikiö, L. and Stefánsson, K. (eds.), Welfare State, Universalism and Diversity, Cheltenham: Edward Elgar, 121–43.Google Scholar
Van Aerschot, L. (2014) Vanhusten hoiva ja eriarvoisuus. Sosiaalisen ja taloudellisen taustan yhteys avun saamiseen ja palvelujen käyttöön (Care of Older People and Inequality: How Socio-Economic Background is Related to Receiving Care and Using Services), Tampere: Tampere University Press, http://urn.fi/URN:ISBN:978-951-44-9568-7, in Finnish with English summary.Google Scholar
Vero.fi. Finnish Tax Administration (2019) Tax Credit for Household Expenses, https://www.vero.fi/en/individuals/tax-cards-and-tax-returns/income-and-deductions/Tax-credit-for-household-expenses/ [accessed 28.06.2021].Google Scholar