Numerous complaints have been submitted to the Parliamentary Ombudsman criticising the social security institution Kela for refusing to grant basic social assistance for medication prescribed by doctors, or other health care expenses.
In the autumn of 2017, Kela changed its policy concerning the granting of basic social assistance for health care expenses, reducing the likelihood that basic social assistance customers can obtain medication prescribed by their attending physician and endangering the continuity of medical treatment.
Deputy-Ombudsman Pölönen states that Kela’s new requirement, that the expenses for medicines must be ”essential and necessary”, is not based on the wording of the Social Assistance Act, which only requires that the expenses are ”necessary”.
Furthermore, Kela’s new policy raises the question of equal access to health care services for persons receiving basic social assistance, compared to those who can afford to pay for their medication themselves. In both situations, the attending physician has considered the medicine to be necessary for the person in question.
In its public statement, Kela stated that one of the purposes of their changed policy is to address the abuse of medication. The Social Assistance Act authorises Kela to assess the necessity of expenses for medicines. However, the Act does not authorise Kela to perform a more extensive medical evaluation of the applicant’s state of health, or to supervise health care professionals. The Deputy-Ombudsman therefore finds that Kela’s policy stigmatises basic social assistance customers.
Furthermore, the Deputy-Ombudsman criticised the fact that Kela has categorically excluded certain medicines from the scope of basic social assistance and defined in Kela’s expert group medicines about the use of which the customer is in principle without individual assessment asked to provide additional information.
In his decision, the Deputy-Ombudsman also assesses Kela’s right to request additional information, as well as the content of such requests. The Deputy-Ombudsman states that an authority requesting information should set a deadline by which it is possible for the customer to provide such information in practice.
Deputy-Ombudsman Pasi Pölönen’s decision EOAK/6468/2017 is available in Finnish on the Ombudsman’s website www.oikeusasiamies.fi/en
Further information is available from Legal Adviser Riikka Jackson, tel. +358 (0)9 432 3385.