Fig. 1

The structures for introducing and paying for medicines in Finland. a Assessment, price negotiation and introductory decision of medicines in Finland. b Financing of reimbursable outpatient and hospital medicines in Finland. After the market approval by the EMA, the assessment and reimbursement decisions for outpatient care (OC) medicines are made at national level by the Pharmaceuticals Pricing Board (PPB) and implemented by the Social Insurance Institution of Finland (KELA) (a Route 1). OC medicines carrying reimbursement decisions are co-financed by national funds of KELA and patients themselves (b). Regarding hospital medicines, the Finnish Medicines Agency (Fimea) assesses their therapeutic and economic value. The Council for Choices in Health Care (Cohere) issues national service recommendations, including hospital medicines, on what should or should not be included in different public health services (a Route 2a). Alternatively, if no Fimea assessment exists, the hospital districts make their own assessment, called mini-health technology assessments (mini-HTAs) (a route 2b). The Finnish Coordinating Center for Health Technology Assessment (FinCCHTA) coordinates the assessments done by hospitals districts. The 21 hospital districts, further grouped in to five university hospitals and financed by the municipalities, are in charge of procurement and payment of hospital medicines. During hospitalisation and with polyclinic treatment at a hospital, medicines are included in the patient fee (b). From the patient’s point of view, there is a marked difference in costs depending on whether the medicines are provided by the hospital or bought from the pharmacy, and the cost reimbursement is in practice a necessary prerequisite for affordable purchasing of NCMs. The various structures involved have distinct accountabilities, involving the Ministry of Social Affairs and Health (PPB, Fimea, Cohere), the Parliament (KELA) and the municipalities (hospital districts). The ongoing reform of social and health services will bring marked changes to the structure, financing and lines of accountability, with a new administrative layer, wellbeing services counties, being responsible for organising social and health services with (at least initially) national budget funding