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Guest Column: Wendell Garwood on Finland’s Health Care and Social Security System

Last updated on 2013.07.22

My friend and Madison ex-pat Wendell Garwood moved to Finland in 1999. Finland's universal health care system hasn't killed him yet. Wendell has his waits, and he misses having his own regular doctor, but the Finnish system is keeping him, at age 85, relatively healthy and mobile.

Wendell wrote me back in April to give a man-in-the-katu perspective on Finnish health care and other aspects of Finnish social welfare. Here's a lightly edited version of his account:

I just got a bill from our medical system—27.50 euros [about $36]—as a result of a one-hour visit to my diabetes MD on Monday. It reminded me I'd read your story the other day about 'nationalization,' and you should know about the keen but imperfect system here in Finland. The bill was not for the visit to the doctor; it was double the cost of the visit, and I am obligated to pay half of it for that visit. If I pay the whole thing, I'll have paid for all/any MD call for the rest of this calendar year. OK?

Prior to that visit I was told to go to the lab. I could have made an appointment as they had all the info they needed about what to do, but it's easier for me to walk in, take my book, and wait. I was there less than an hour. They took seven vials of blood, did an EKG, and sent me packing. There will be no bill; those services are included.

Last December I had a laminectomy (spinal stenosis in the lower half) which I should have had years ago (that's part of the downside) following an MRI which was ordered in May but given in September (another drawback). The MRI was free. I was then referred to the orthopedic surgeon (for which consultation I paid about 28 euros) who examined me, told me what was wrong, and recommended surgery. However, I needed to be 'cleared/approved' because of my age (84 at the time) so she ordered a visit to the anaesthesiologist—three-plus weeks—and she wanted me to have a chest x-ray (no charge) and then we consulted.

That charge was about the same as for the orthopod—less than 30 euros [~$39]—and she said all appeared well but she wanted me to have an ultrasound of the heart and made the arrangements. That was another three weeks. The procedure was at no cost but another 30 euros, and the cardiologist (she was Swedish, preferred to WORK here, didn't like Finnish though she could speak it, but was delighted I needed English!!! a doll!) did the procedure. She cleared me, so I was checked into the hospital the 9th of December, surgery on the 10th, discharged the 13th ... and sent a bill for under $200 which included the five days in hospital, room/board, nurses, doctors, operating room, recovery room, and all other things. It sort of felt like free, but not quite. So you are looking at that surgical procedure and the 'foremath' for less than $300. I had a follow-up with orthopod in March for another under 30 euros. I think I got a deal.

From the time I arrived here in 1999 with a temp residence permit (permanentized 2 years later), I was covered by the system. The Finns' high social security payroll deduction covers that health care cost, but it also includes retirement, sick leave, short- and long-term disability, nine months of maternity leave at 60% pay for the Mom, and three weeks of paternity leave for Daddio (not sure about pay limitation). My cost is determined by the size of my USA income. I file that with Finland's tax authority but we originally arranged for there to be 45 euros [$59] deducted from my non-check-checking account each month. That continued until this year when they've altered the system, have set a rate in advance (not sure if it will be adjusted after the get my tax filing), which is less than 500 euros [$651] and which I pay in semi-annual payments (along with the cost of the telly which is charged to all adults in the household no matter the number of sets), and that's that.

Additional costs? [By the bye, I deduct all those costs, plus taxi fares to and from clinic or hospital or Acute Care center or polyclinic, from my USA tax. Also medications. I'll cover that later.] The cab fare from here to clinic is about 10 euros [$13] each way. I get a receipt since I pay my debit card (no checks in Finland) and he just grinds out another slip of paper. This year I had my usual trips to clinic, two rotten sessions of ruusu which required 3 drips or injections each day either at clinic or acute care, some before hours, some after. (Ruusu is an infection in the lower legs which, if it advances upward, can cause dreadful things like strokes and heart problems; in English it is cellulitus.) The May occurrence lasted eight days, the Aug-Sept occurrence thirteen days.

Sideline: I had a similar attack in 2001. At that time the nurse came to the house (and some did during the recent May occurrence) three times a day and brought her bag of equipment and the drip stand, etc., and administered it to me here. I think that was about six euros [$8] per call (and at that time I was sitting keeping my leg elevated when 9-11 happened, so I had aught to do but watch the telly without feeling guilty). On the final visit the doctor came along to do a double check to be sure I could be left on my own. This time it was vacation time and there were not enough nurses to do house-calls ... and I was one who could manage three trips a day to the center ... so that's how that went.

Medicine? It is 'included' in the health-care policy to some extent. There is a max which the patient is expected to pay, about 750 euros [$980] a year right now, and some of the drugs are discounted as much as 45%. Diabetes drugs, no matter the cost, cost me only three euros each for 90 days, and all the strips and equipment and needles are free. Originally I paid the max for many years—if I overpaid, it is refunded or credited—but now I've not reached the max for meds because most of mine are already discounted.

When I was discharged from the hospital I was given a sheet that told about maximum payments. The total I read for medical care (not including meds) was less than 700 euros [$910] a year. That does not include the 'premium' I may for coverage. I need to take my cab slips and my listing of costs to the center and inquire about how one handles the overpayment. The years I paid more for meds than the max they credited my account. Nothing has happened this year, but they do not know about the cab tab, though I think the regular med exceeds that top limit as well.

That's all the goodies... except if I need to go to resident care, that's also included. I've been in only one facility (and that was not in Rova) it appeared not to be classy, but not like the old ones which were re-done large homes and rickety and not exciting nor super-pleasant. These were OK, and I'd not mind.

I've had a cart for 17 months—my red caddy!—with a basket so I can go marketing and get around downtown. It's ideal for me and much easier than the cane (which I paid for originally) and for transporting things. When I was home from surgery Jyri got a second, smaller cart for around the house—we paid for it—one is the limit and I understand that. It is easier than the bigger one for outdoors. If I needed a wheelchair or other things, they'd be provided, and they prefer my staying home rather than being in an institution.

Also under social security and under the We Are a Couple Act of 2002, Jyri and I are spouses, and it shows on the public records. Should he die first, I would be entitled to his pension (or some part of it) as long as I am here, all part of social security. He is not entitled to my USA pensions (Social Security, SDRS, an annuity) since we are not 'espoused' under USA law. That's OK; we were not spouses when I retired and arranged for those things and had not paid premiums so that a spouse could 'inherit' the benefits. We are not married, and the act did not allow us to adopt children or to take the surname of the other. There is a proposal now before the parliament to amend that to full rights. The right is stalling it, but we are sure it will happen. Recently there was a "supercommittee" vote not to advance it to the Parliament, but that can be overridden by public petition ... and in the first day they had treble the amount of signatures needed to make it move in the system, though it will be lento, not allegro.

Finally, I do not have a doctor of my own. Most of my town is assigned to a clinic with four sections, and mine is the oddball one. The other three sections have permanent staff of nurses and doctors, but ours has only the nurses, several nurses-plus, which are like physician's assistants, and the doctors are from 'outside' via contract with someone far away. None of them is permanent, though the diabetes MD has been here two years, his predecessor about five, and an MD I was given to during the first ruusu situation is still here. Others I have gone to have been helpful but are soon GONE and one must 'explain from scratch' what has been wrong for a long time. The records are all on computer, but I'm not certain how up-to-date it is.

Anyhow, I'd complained about my stenosis (not my name) for years and was told it was non-treatable and the pain meds I'd been assigned for arthritis would handle it, though perhaps they could give me a SHOT now and again if it were 'really bad' or one suggested there might be an 'implant system' wherein the drug would be embedded and work when needed. No one followed up, and I tend not to be pushy.

One day I had a swollen leg, feared for more ruusu, (that's Finnish for rose, the color of the foot and leg during the disease; similarly they call the itching around the waist that some get rose-belt) so I was given to this lady doctor who immediately sent me to acute care for a test (ultrasound to see about clots) and treatment. I asked her about the nerve pain, she examined me, and said you need an MRI. She made the arrangements, and that led to the surgery. I was pushy enough to persist about that, and if it could have been two or three years earlier life would be simpler today.

Generally speaking, it's tough to see a doctor. The nurses are very capable and a delight. One can choose to go to acute care on one's own. It is part of the ER at the hospital, quite handy if treatment or measurements are needed.

Basically I have good coverage and good care and am not upset. I miss having my doctor (Rich Sample when I left, Kim Wilde before him, and Art Lampert from time to time), but now I have a nurse to whom I turn for advice or care or direction, and that's been very helpful. I'm presently on a med to lower or moderate the likelihood of clotting. The nurse has to take measurements every third or fourth week so there is always an appointment scheduled, and I have her phone.

That's a lot more than you'd like to know, but the key is we are taken care of, more than modestly, and all Finns have coverage no matter what. Surely the costs are not overwhelming or they could not continue. There is a way, and hardheads should be able to realize that non-profit might be the way, but I'll not live to see it truly happen.

Greed is the problem in America. There is a private system here—that is, although nurses and doctors are trained at no cost for their education and are partially stipended along the way, there is no long-term commitment to serve in the KELA medical system. KELA does allow 'credit' for seeing non-KELA MDs. I, e.g., use a private ophthalmologist. His charge I pay in full and then submit to KELA and they credit me for the difference—not big, maybe 20%. But that ophthalmologist also charges me for a 'service fee' (as he does all others) for having a clerk/receptionist to do the paper work. It's not high but it's a pain in the ass since the fee is not small. The cost of the spectacles is HIGH-to-the-max but can be done by what they call an optician (I think the equivalent of our optometrist) in the glasses shop. The exam is free and so are the lenses it would seem but you may dearly for the frames.

By the bye, I also get a once-every-third year photo of my eyes for the diabetes to be sure that things have not gone to pot.

Dental care is separate, but about 1/3 is covered by the KELA system. It is dear as well.

I think Jyri has deducted from his paycheck about 45% each time for the FULL social security biz, but I'm unsure. On the other hand, after ten years at his current job he gets three weeks of winter vacation and four weeks of summer. That's fairly standard in this country, so people can afford to have cottages and spend three weeks at the lake in the worst of summer (after mosquitos have quit, of course) and most are two-income households.

Oh, if you have the wheat or milk food problem, you are entitled to some weekly/monthly payment from someone in govt to cover the excess cost of the foods that are lactose-free or gluten-free. Whee.

[Wendell Garwood, personal communication, April 2013]

Update 2013.07.22 07:55 CDT: See also this discussion of the relative merits of Sweden's health care system. One key passage:

Another important difference is that, unlike many American health insurance providers, the government groups that manage Swedish health care are nonprofit entities. Because their charge is to provide quality care for all citizens, they don’t face the same incentive to withhold care that for-profit organizations do. That more hip-replacement operations are performed per capita in Sweden than in most other countries is almost certainly a reflection of the generous care options rather than of any inherent deficiency in Swedes’ hip joints [Robert H. Frank, "What Sweden Can Tell Us about ObamaCare," New York Times, 2013.06.15].


  1. JC 2013.07.15

    An excellent model. Like he said though.. not perfect. I'm not sure a perfect system is possible- but an excellent model. I would just be curious about the Finnish finances. The fins can afford this because they don't have a regular military.. they have what's called a homeguard (similar to our national guard)

  2. Joan 2013.07.15

    I have a hunch this is similar to most of the countries that have what we refer to as national health care. I have yet to hear of any complaints from any of the countries. The people in these countries might pay more in taxes, but then the benefits that they have takes care of items that Americans have to pay out of pocket for. College is free or mostly free, healthcare is free cheap, more vacation time, etc. I would be willing to bet it balances out for the better.

  3. caheidelberger Post author | 2013.07.15

    Hey, the Finns fought the Soviets head to head and beat them.

  4. caheidelberger Post author | 2013.07.15

    On Finn finances: the Finns were bringing down debt as percentage of GDP until 2008. But their current 53% debt/GDP ratio is still lower than the United States' 107%

  5. JC 2013.07.15

    Not too shabby then I would say

  6. Douglas Wiken 2013.07.15

    SD could save a bunch of money if the State Board of Pharmacy and Health Department, etc would decide that they could set up a "prescription" system like that for influenza inoculations for vaccination against pneumonia.

    Medicare or Medicaid pays for the influenza vaccination and will also pay for the pneumovax injections. The Winner area last winter had more than a few elderly residents die of pneumonia often after days or weeks in the hospital and also some who survived after similar times in an out of hospital.

    As far as I can tell this a a public health program that could save a lot of money and reduce a lot of misery with little danger to residents. We or government should not have to pay Physicians $50 or $100 to write a presecription for the vaccine or to actually make the injection.

    Next they can think about the vaccination against shingles and see if there is some way to get that much more expensive vaccination cost reduced.

    South Dakota government should get over the idea that they serve only the special interests of large manufactures, or insurers. Sometimes that model ends up costing everybody including the special interests more money.

  7. Edward Monroe 2013.07.15

    I had the same surgery as Wendell in September, 2012 and my hospital alone was over $21,000 and I was in overnight because I was the last surgery for the day and wasn't awake enough when the recovery room closed.

  8. caheidelberger Post author | 2013.07.15

    Ouch! Did you have insurance to cover that amount, Edward?

  9. I think a lot of Americans would go through that whole description and focus on the "waiting" part. We don't like to wait. We will pay crazy amounts to have what we want NOW.

    I don't have a whole lot of direct experience with the Finnish system, though I have visited the clinic on several occasions when I was in Finland and paid something like 10 or 20 euros a visit.

    My mom (who is from Finland) has told me that sometimes people have died while on the waiting list for a surgery, but that doesn't necessarily mean they died waiting for that surgery—they may have been lower on the list for the surgery because they weren't a good candidate because their general health was poor, and in the interim died of something else. And nothing stops a person from paying for care outside of the system if they want to. But few do. Finns don't like to put on airs—few would consider themselves special enough to step outside the system that is available for everyone.

    The part that has impressed me the most is comparing the cost of having my kids in the U.S. with the cost that my Finnish and especially Swedish relatives paid having their children. The difference is phenomenal—and I had pretty good insurance. Just imagine if I had to pay the listed rate for two C-sections. Yowza.

    Some of you may have seen this article on Facebook ("Why Finnish babies sleep in cardboard boxes"): . I think it highlights the value that Finnish society places on children and child-rearing. Rich and poor alike get the same box. What great "we're all in this together" thinking to start life with!

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