Reimbursements for private medical costs to change from Jan

The government on Thursday submitted a proposal to the parliament to bring amendment to the Health Insurance Act, which would do away with most reimbursements for examinations and treatments ordered by doctors practising in the private sector.

The changes would take effect on 1 January 2023, said an official press release.

The national social insurance institution- Kela, however, would continue to pay some reimbursements including the costs of consulting a private doctor, said Kela in a press release.

The proposed amendment will make a large part of the examinations and treatments performed in the private medical sector no longer reimbursable.

Kela would continue to provide reimbursements for private examinations and treatments ordered by a psychiatrist, an oral and maxillofacial surgeon or a dentist.

Reimbursements would also be available for tests performed by a psychologist.

Other treatments and examinations would no longer be covered by Kela reimbursements. Physician-performed procedures, with certain exceptions, would also become non-reimbursable.

The government proposed further that all General Physicians and specialist consultations would be reimbursable at a standard fixed rate.

However, the reimbursements would be higher in the case of treatments provided by a psychiatrist or specialist dentist.

Kela will confirm the euro amounts of the reimbursement tariffs later on the basis of a Government decree.

The Government is also proposed to no longer offer reimbursements for the costs of medical care provided in Switzerland, Great Britain or Northern Ireland.

According to the Government’s estimate, the proposed changes would save 64 million euros.

The savings would be allocated towards meeting the mandated minimums for staffing in elderly care.

In 2021, Kela paid reimbursements for costs of treatments and examinations performed by private practitioners to 1.3 million persons, while 1.4 million individuals received Kela reimbursements for private physicians’ fees.

A total of 0.9 million persons were paid reimbursements for costs of private dental care. Kela paid a total of 212 million euros in reimbursements.