Municipalities to decide on service voucher options

Under the new regulations, municipalities can select the social and health care services to be provided by service voucher. Clients and patients, on the other hand, can choose whether to use service vouchers and which service providers to use. The exception to the procedure involves services that do not come under self-service or service provider options.

"Municipalities have already been able to use service vouchers, but the law clarifies their use," says Virpi Vuorinen, Senior Officer at the MSAH, who dealt with drafting the new legislation.

MPs held a debate on the government bill on the use of service vouchers during the summer session of Parliament, at which they aired reservations and concerns to do with the system. One of the concerns is that the voucher system could exacerbate inequalities and health differences within the population, which is the opposite of what the programme of the current government intends. The fear is that better-off clients and patients will use the vouchers and get swifter attention, while poorer ones will have to queue up for municipal services.

Virpi Vuorinen points out that it is incumbent on municipalities to reduce health differences and to improve services for those who need them the most. It is up to municipalities to decide how to arrange services, whether to produce them themselves, to procure them or to provide clients and patients with service vouchers.

Service vouchers can help reduce health differences by focusing on ‘lighter' forms of care and treatment, leaving municipal services to attend to clients and patients needing more attention and multiprofessional care.

"When drawing up a service plans for a client, thought must be given to whose service provision is the most suitable," says Vuorinen. "Vouchers can be used to cut queues. If some of those waiting for municipal services use service vouchers, it will speed up the service provision for everyone."

It is up to municipalities to determine the value of the service vouchers they use. Their value has nevertheless to correlate reasonably to client and patients' fees and the various service arrangement costs borne by municipalities. Vouchers cover either wholly or in part the service that has to be procured. The value of the vouchers may be earnings related, which means that the client/patient fees for people on lower incomes will be less than those for the wealthy.

When municipalities use vouchers to procure services that are otherwise free of charge when they organise them, the vouchers cover the entire cost of the service. The new law also contains a clause on the value adjustment of service vouchers. This is to ensure that the value of vouchers is adjusted if clients' or patients' income or maintenance responsibilities are undermined due to having to buy services.

"No one must end up needing income support because of the service vouchers' deductible portion," Vuorinen points out.

When receiving a service voucher the client or patient can buy the service they require from one of the service providers listed by the municipality. The list contains service providers who meet the criteria set by the law.  Service providers do not have to compete to be put on a municipal list. They can, however, compete on quality and price in providing their services to people who use the vouchers.

"Competition for service purchase agreements generally favours larger service producers. The service voucher is a lighter alternative that also allows services to be bought from small service providers, although the municipality cannot guarantee that services will be bought from the particular service providers they list. It's the clients who decide."

The MSAH will be providing guidelines on the use of service vouchers. Virpi Vuorinen stresses that municipalities can start to use the voucher system gradually, and that if a municipality has sufficient services, there is no need for it to use the system at this point.

"The new law does not give clients a subjective entitlement to service vouchers for social and health services. It is up to municipalities to decide on the use of the vouchers."

Merja Moilanen