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Inequalities in the provision of assistive devices

Parliamentary Ombudsman identifies illegal practices


Parliamentary Ombudsman Petri Jääskeläinen criticises practices and guidelines that some hospital districts and health centres have followed when providing wigs for persons who need them as assistive devices for medical rehabilitation.

Jääskeläinen stresses the importance of the Ministry of Social Affairs and Health's duty to direct and supervise.

Major differences uncovered

On request of the Ministry, the National Institute for Health and Welfare investigated practices followed by Finnish hospital districts and larger health centres in providing wigs as assistive devices for medical rehabilitation to patients.

The study indicates that the care practices of certain hospital districts and health centres restricted the provision of wigs supplied as assistive devices in a manner that cannot be considered legal.

The wigs were mainly made of artificial fibre, and upper thresholds had usually been set for their prices. There were considerable differences in the price thresholds between different service providers. One provider had also set a price limit for women's wigs that was lower than the one for men's wigs.
Additionally, not all parties had recognized the fact that under the law, the maintenance of a wig provided as an assistive device is free of charge for the patient.

In almost all organisations, patients could also purchase wigs made to measure.

Helsinki changed its practices

The Parliamentary Ombudsman investigated this issue after receiving a complaint. The complainant had an incurable disease that had resulted in hair loss. The City of Helsinki had annually provided an artificial fibre wig which, however, caused violent symptoms in the complainant.

According to information provided by the Social Services and Health Care Department in Helsinki, the city may take a patient's individual needs into account when providing wigs. To this extent, Jääskeläinen finds the city's practices legal.

On the other hand, not reimbursing the maintenance costs of the wig was a breach of the act on patient fees (asiakasmaksulaki, 734/1992). Under this act, assistive devices and their fitting, maintenance and replacement are free. Helsinki has announced that the city will change its practice.

Access to services must be equal

In his decision, Parliamentary Ombudsman Jääskeläinen stresses the equality provision in the Constitution.

- When assessing the implementation of health services, attention should be paid not only to the equality of residents in a single municipality but also to equality between the residents of different municipalities.

In his decision, Jääskeläinen stresses that the supervision of adequate health service provision is a key method for safeguarding the implementation of this fundamental right.

Jääskeläinen asks the Ministry to report on actions taken by the end of the year.

Provision of assistive devices a frequent target for criticism

Even before this case, the Parliamentary Ombudsman has intervened in shortcomings observed in the provision of assistive devices.

In 2011, the Joint Municipal Health Care Authority of Central Satakunta was reprehended by the Parliamentary Ombudsman for not granting a patient a wig on individual grounds.

The Parliamentary Ombudsman considered it vital that the Ministry issue a decree under which equal access to assistive devices for medical rehabilitation is secured. The decree on the provision of assistive devices for medical rehabilitation (asetus lääkinnällisen kuntoutuksen apuvälineiden luovutuksesta, 1363/2011) entered into force from the beginning of 2012.

In that year, the Finnish Association of People with Physical Disabilities complained to the Parliamentary Ombudsman about hospital districts refusing to provide the assistive devices they needed for persons with severe disabilities who were living in sheltered housing units, including shower seats, electric beds and hoists.

At that time, the Parliamentary Ombudsman also requested that the Ministry issue hospital districts instructions for following the practices prescribed in the decree. The Ministry stated that they would draw up detailed guidelines on this issue and monitor the application of the decree.

The full text of decision no 1077/4/13, (in Finnish).

Further information is available from Kaija Tanttinen-Laakkonen, Principal Legal Adviser, tel. +358 (0)9 432 3377.