Client fees in social welfare and health care may increase at a higher rate in the future – Government wants to link the fees to the wellbeing services county index
At the end of April, the Government submitted a draft proposal for amendments to the legislation on social welfare and health care client fees, and the amendments have not garnered much public attention so far.
One of the proposed amendments is that, in the future, the maximum amounts of client fees would be increased annually according to the wellbeing services county index. The index follows wage level developments by 60%, price level developments by 30% and the social security contributions for wellbeing services county employers by 10%. In the past, the flat-rate payments have been fully tied to developments in the general price level with an increase every two years.
With the exception of some outlier years, wages have historically risen faster than prices, and this is likely to be the case in the future as well. That is why the proposed index change is very likely to mean that the majority of client fees will undergo higher increases in the future.
During Petteri Orpo’s government term, client fees have been increased several times. An index increase of 10% was made in 2024, and fees were increased by 22–45% in 2025. As a result, for example, the fee for an appointment at a specialised medical care outpatient clinic has increased from EUR 41.80 to EUR 66.70 within the span of two years. The newly proposed amendment differs from the previous ones in that it entails not a one-off increase but recurring small increases instead.
According to an estimate by the Ministry of Social Affairs and Health, the index amendment would increase the total sum of client fees by about EUR 64 million in 10 years compared to current legislation. For comparison, it should be noted that the increases in 2025 grew the total sum by EUR 150 million.
It would be justified to increase fees at the same rate as pensions
The Government justifies the index amendment by stating that it would strengthen public finances, but from the clients’ perspective, it mainly means tighter purse strings. According to the government proposal, fees would increase for about 44% of the population and by only 2%, while fees would decrease for some people paying income-related fees for long-term care. The rest do not use paid services, or the amendment would not affect them for some other reason.
From the clients’ point of view, it would be justified for the fees to increase at the same rate as their income. Still, according to THL’s calculations, pensioners pay more than half of the total sum of accumulated client fees (excluding income-related fees). Pensions are increased mainly or entirely based on the general price level, which is a slower pace than the proposed rate of fee increases in the future.
Wage earners and entrepreneurs pay about one third of client fees. For them, having the fees be tied to the development of earnings may be more justified.
Reducing payment burdens by developing information systems
Extremely high payment burdens arising from client fees are more common in Finland than in other Nordic countries (WHO 2023). The newly proposed amendment would gradually squeeze more and more funds from the majority of client fee payers. If the amendment is enacted, it would be important to protect the solvency of low-income persons by other means.
It is good that the proposed index change would not affect the level of the payment ceiling, which is the amount of client fees that can be accrued by a customer per year before the service is free of charge. Nevertheless, it would be reasonable for the service providers – the wellbeing services counties – to be responsible for monitoring the payment ceiling, not the clients themselves. This requires the development of regional information systems.
Secondly, social assistance can be used to compensate the client fees of patients with the lowest income. If fees threaten to jeopardise a person’s ability to pay, lowering the fees with relation to social assistance should be a “priority” under the law. In practice, however, this function of priority is not effective: according to the data we collected, only about one third of the wellbeing services counties offer the opportunity to lower equal fees.
In administrative terms, it is not very effective to ask patients to provide various income vouchers to have individual client fees lowered. If the regions were to receive information on the recipients of basic social assistance from their information systems, fees could be automatically waived for the recipients of social assistance.