Occupational health care for employees is funded with obligatory earned income insurance contributions collected from employers and employees as well as with employer client fees (Image 1, Heikkinen and Räsänen 2013). In 2017, occupational health care costs amounted to approximately EUR 815 million, or 4.3% of total health care costs (EUR 20.6 billion). Average costs per employee covered by occupational health care amounted to EUR 439 and Kela compensations to EUR 189. Average occupational health care costs per citizen were EUR 145 while total health care costs per citizen were EUR 3,774. (Kela 2017, THL 2019, Finance tree for health care and social services)
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In 2017, Kela’s compensation details showed that 1,855,000 employees were covered by occupational health care arranged by the employer, which was 86% of wage earners and one third of the entire population (see Image 2 below). Occupational health care coverage and costs vary in different parts of the country. According to the Finnish Institute of Occupational Health’s study on the status and operational quality of occupational health care (Takala et al. 2019), the offering of occupational health care services among employed workforce was highest in Southern Finland (83%) and lowest in Northern Finland (55%). According to Statistics Finland’s Yrittäjät Suomessa 2017 (Entrepreneurs in Finland 2017) survey, 75% of entrepreneurs had arranged occupational health care for their employees and the corresponding figure was 63% among agricultural entrepreneurs acting as employers, 42% among self-employed people in agriculture and 26% among other self-employed people (Sutela 2018). The majority of occupational health care costs come from the Uusimaa region (37%) and regional centre cities, which have many companies and employees (Kela 2017). In hospital districts, the share of occupational health care is 20–30% of outpatient care costs in basic health care services (Hujanen & Mikkola 2013).
Total occupational health care costs have nearly tripled from the year 2000. When calculated per wage earner, they have doubled (Image 2). Factors explaining the increase in total costs include, for instance, the rise in the cost level, the increase in the number of people covered by occupational health care from 2.35 million to 2.4 million, the ageing of the employed population, sector-specific stress and loading factors, work-related diseases as well as tasks associated with supporting work ability and return to work that have been defined for occupational health care in legislation.
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The share of preventive occupational health care activities has grown in relation to medical care appointments, which have decreased by 10% in 2010–2017 (Kela 2017). This has occurred even if occupational health care has moved increasingly to private service providers and an earlier study indicated that medical care has increased (Kankaanpää 2013). Annually, the number of occupational health care appointments is approximately 6 million, while the number of basic health care appointments is approximately 26 million. The number of appointments with various occupational health care professionals is roughly three per employee per year, while in basic health care, the corresponding figure is five appointments per employee per year (Heikkinen 2013). Women use occupational health care services more frequently than men and their occupational health care costs are higher than those of men. Costs among 60-year-olds are double those of 30-year-olds. (Hujanen & Mikkola 2016).
In his doctoral dissertation (Hujanen 2019), Hujanen compared the costs of primary-level health care in health centres, occupational health care, private health care and the Finnish Student Health Service (FSHS). In this comparison, the costs of an illness-related doctor’s appointment, including the laboratory tests and radiological examinations performed in connection with the appointment, were lowest in occupational health care (EUR 102) and highest in private health care (EUR 134). The appointment costs in health centres (EUR 120) and FSHS (EUR 117) were between these two extremes.
Approximately 10% of occupational health care clients use 40% of the services, which generate the majority of the costs (Reho et al. 2019). Consequently, the focus should be on those who use services significantly more than others and, as a result, generate more costs. At the same time, preventive services should be targeted so that people with risks related to work ability are identified at an early stage and provided with cost-effective services.