Funding and costs of occupational health care

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). In 2020, occupational health care costs amounted to approximately EUR 879 million (Image 1, Kela), or 3.8% of total health care costs of nearly EUR 23 billion (THL). Average costs per employee covered by occupational health care amounted to EUR 453 and Kela compensations to EUR 191 (Kela). In addition, entrepreneurs’ occupational health care costs were approximately EUR 5.1 million, of which the state’s share was roughly EUR 1.6 million, or 31.3% (Kela).

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Image 1. Distribution of occupational health care costs among different payers (KELA 2017) (HIA, Health Insurance Act = funding through earned income insurance)

In 2020, Kela’s compensation details showed that 1,939,000 employees were covered by occupational health care arranged by the employer, which was 89% of the 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 in 2017 (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).

Total occupational health care costs have tripled since 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 1.60 million to 1.94 million, the ageing of the employed population, sector-specific stress 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. However, the share of occupational health care costs of all health care costs has been decreasing in recent years (Image 2).

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Image 2. Occupational health care costs and coverage

The share of preventive occupational health care activities of total costs has increased in relation to medical care costs in 2010–2021 (Image 2). In 2010, the costs of preventive activities was approximately 38% whereas in 2020, it was roughly 47%. Medical care costs also increased from 2010 to 2020. The increase was approximately 20% whereas the costs of preventive activities increased by about 76% during the same period (Kela).

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.