Rehabilitation provided by Social Insurance Institution Kela

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Rehabilitation provided by Social Insurance
Institution (Kela)
Social Insurance Institution Health
Department Rehabilitation Section

• Tiina Huusko
• Head of the Rehabilitation Section
• RI-Norden
• Oslo 5.3.2009

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Rehabilitation provided by Kela
Kela rehabilitation act (15.7.2005/566)
Improving, maintaining and restoring work ability
and functional capacity
Rehabilitation
Income security during rehabilitation
Rehabilitation allowance
Cooperation between rehabilitation organizations
Act on Cooperation on Rehabilitation Client
Service (13.6.2003/497)
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TAT/Tilastoryhmä 27.2.2002
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(No Transcript)
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Kelas rehabilitation activity (86,000 clients
per year)

• Statutory services
• vocational rehabilitation for persons with
  impaired functional capacity
• medical rehabilitation for persons with severe
  disabilities
• Discretionary services financed with earmarked
  allocations
• other vocational and medical rehabilitation
• research and development

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Reduced work capacity and benefits provided by
Kela

• Work capacity Benefits

Reimbursement for occupational health
100
Healthy
Rehabilitation allowance for preventive
rehabilitation
Early signs of problems
Sickness allowance and discretionary medical
rehabilitation by Kela
Long-run risk of disability
Vocational rehabilitation and rehabilitation
allowance
Risk of disability
60
Severe disability
Medical rehabilitation for persons with severe
disabilities
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(No Transcript)
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Rehabilitation services for persons with severe
disabilities Qualifying criteria

• severely disabled, meaning that
• he or she has a medical impairment due to an
  illness or injury which results in a need for
  rehabilitation lasting at least one year
• he or she has significant difficulty in coping
  with everyday tasks at home, at school and in
  other situations.
• Disability Allowance has been awarded at the
  increased rate or at the special rate
• not institutionalised
• a rehabilitation plan has been drawn in public
  health care by the treatment provider

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• Inpatient rehabilitation services
• Periods of treatment in a rehabilitation
  institution
• Rehabilitation and adaptation training courses
• Rehabilitative treatment in the Rheumatism
  Foundation hospital
• Outpatient therapies
• Physical therapy
• Speech therapy
• Occupational therapy
• Music therapy
• Psychotherapy
• Neuropsychological rehabilitation

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Assessment of the need for rehabilitation

• Kela has a responsibility to
• assess the need for rehabilitation by the time a
  person has been paid Sickness Allowance for more
  than 60 days
• ensure that a persons rehabilitation prospects
  have been evaluated before a decision is made
  concerning his/her entitlement to a disability
  pension

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Eligibility criteria for vocational rehabilitation

• Significant reduction in earnings capacity and
  fitness for work owing to illness, defect or
  injury (2/5) or imminent risk of disability over
  the next 5 years
• Young persons and those with precarious labour
  market status
• Vocational rehabilitation may not previously
  arranged under
• the Act on the Public Employment Service
• the legislation on earnings-related pensions
• the statutory provisions on special-needs
  education

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Vocational rehabilitation services for persons
with impaired functional status (14,260 clients
in 2008)

• Assessments of rehabilitation need
• Work and education trials
• Training aimed at the maintenance and improvement
  of work ability (4,270 / 2008) TYK
• Work coaching
• Training and education
• Start-up grant for self-employment
• Assistive devices for persons with severe
  disabilities

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Rehabilitation services provided on a
discretionary basis (53 300 clients in 2008)

• Medical rehabilitation targeted to individuals
• Inpatient rehabilitation periods
• Rehabilitation courses (19 360)
• ASLAK courses (Vocationally oriented medical
  rehabilitation) (13 660)
• Adaptation training
• Psychotherapy (13 620)
• Neuropsychological rehabilitation
• Vocational rehabilitation targeted to individuals
• Research and development

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Psychotherapeutic services provided by Kela

• Costs reimbursed from National Health Insurance
  funds
• Provided as medical rehabilitation for persons
  with severe disabilities
• Rehabilitative psychotherapy (13,620 clients /
  2008)
• improvement and restoration of the ability to
  work or study with the aim of
• helping the client remain in or return to work.
• Kela offers clients with mental health problems
  many other rehabilitation services besides
  psychotherapy (total cost in 2008 67.1 million )

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Rehabilitative psychotherapy

• 16 to 25-year-olds
• Individual, group and family therapy
• Music and art therapy
• Parent counselling visits
• 26 to 67-year-olds
• Individual and group therapy
• Art therapy in individual and group settings

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Vocational rehabilitation by Kela and pension
insurance institutions, and psychotherapy by Kela
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Kela and pension insurance institutions

• Division of resposibilities clarified by the
  Advisory Board for Rehabilitation 2003-07
• Definition for vocational rehabilitation
  recipiency harmonised (Kela rehabilitation act
  2005)
• Single entry point possible (in Kela)
• Mutual application for vocational rehabilitation
  (2007) with assessment of a clients need for
  rehabilitation in Kela

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• Kelas development projects relating to
  rehabilitation
• services provided on a discretionary basis
• Psychiatric family rehabilitation of children and
  adolescents2000
• Geriatric rehabilitation 2001
• Mental health rehabilitation 20062009
• Rehabilitation into work 20072011
• Rehabilitation for persons with severe
  disabilities 20062013

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Kelas Public procurement prosedure
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Public procurement of rehabilitation services

• Open competition and responsibility to invite
  tenders
• Quality management
• Kela defines the minimum standards and service
  content by reference to Kela standards
• Quality audits
• Research and development
• Customer feedback and service provider reports

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Number of current contractor and period of
contracts in Kelas medical rehabilitation

• 3,000 psychotherapists
• Outpatient services for persons with severe
  disabilities and about
• more than 2.700 therapists
• expiry day 31st December 2010
• Periods of institutional rehabilitation
• 50 institutions
• expiry day 31st December 2011
• Adaptation training and rehabilitation courses
• 130 providers
• expiry day 31st December 2008

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Main procurement procedure based on the Act on
Public Contracts (348/2007) / Development
activity in rehabilitation

• Open procedure
• Under which Kela publishes a contract note in
  HILMA (www.hankintailmoitukset.fi)
• All interested providers may submit a tender
• Negotiated procedure
• Under which Kela publishes a contract note in
  HILMA (www.hankintailmoitukset.fi)
• Any provider may request to participate
• Candidates/service providers are shortlisted on
  the basis of applications
• Kela negotiates the content and terms of the
  contract with the selected providers
• An invitation to tender is sent to all of the
  candidates still in contention after the
  negotiation stage
• Cooperative funding
• Kela selects the best service providers or best
  applications from providers for further
  negotiation on a cooperative funding basis
• Kela negotiates the content and terms of the
  contract with the selected providers

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Main procurement procedure based on Act on Public
Contracts (348/2007) / Usefulness of selected
procedures in procurement for development projects

• Open procedure
• Requires a clear and detailed specification of
  the service content by Kela
• The number of expected candidates should be
  reasonably small
• Negotiated procedure
• Requires a clear and detailed specification of
  the service content by Kela
• Useful if the rehabilitation model to be applied
  is novel and difficult to fully appreciate
  without Kela offering guidance and involving the
  shortlisted service providers
• Or
• If service providers are invited to propose new
  rehabilitation models whose content is to be
  defined as a cooperative effort
• Cooperative funding
• Applicable to the procurement of typically
  research-related rehabilitation services whose
  provision requires special expertise
• Requires a funding partner the results must be
  made generally available

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• Kelas customers speak Finnish (94 ) or Swedish
  (5 )
• Rehabilitation services must be provided in
  Finnish (or Swedish)
• Kelas standard is in Finnish and in Swedish
• contract note in HILMA is in Finnish
• a tender must submit in Finnish or Swedish
• Kela does not refund for transportation costs in
  abroad

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Rehabilitation Towards a Better Life

• Rehabilitation Development Programme 2015

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Objectives of the Rehabilitation Development
Programme

• Ensuring the functioning and effectiveness of
  each clients rehabilitation process
• Strengthening Kelas role as a nationwide
  rehabilitation provider and developer
• Improving the flexibility, efficiency and
  customer focus of the procurement process
• Creating a robust reporting system in order to
  demonstrate the effectiveness of rehabilitation
  and to support development efforts

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• In planning and implementing rehabilitation
  interventions, we will refer to the International
  Classification of Functioning, Disability and
  Health adopted by the WHO General Assembly in
  2001
• Procurement process simplified
• Electronic tendering system implemented
• Vouchers, cooperation in the financing of
  development projects
• Cooperation in research and development
• E.g., Helsinki Psychotherapy Study, stroke
  rehabilitation
• National network on functional capacity
  assessment 2007-
• www.TOIMIA.fi

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Rehabilitation Towards a Better Life
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REHABILITATION SERVICES OF VARIOUS POPULATION
GROUPS IN FINLAND
Prevention, assessment, targetting,
rehabilitation planning and follow-up
Occupational accidents and diseases, traffic
accidents
Disabled students of primary and vocational
schools with special support needs
Children in need of rehabilitation
Disabled persons and those in risk of
becoming incapable to work
War invalids and veterans
EMPLOYED PERSONS
Severely disabled persons
Job seekers with disabilities
Significant reduction of working capacity
All
Reduced working capacity
THE MUNICIPALITIES OVERALL LOCAL RESPONSIBILITY
OF REHABILITATION
Special Education Services Primary and
Vocational Special Schools
SII Vocational Rehabilitation Services for
Persons with Disabilities
Employment Services for Persons
with Disabilities Employment Offices
Earnings Related Pensions Rehabilitation Pen
sions Insurance Companies
Occupational Accident and Motor
Liability Insurances Laws Insurance Companies
SII Discretionary Vocational and Medical
Rehabilitation Services
Occupational Health Care Municipal Health Care
SII Rehabilitation of severely disabled persons

Municipal Family Counselling Paediatric Medica
l Rehabilitation Services
The State Treasury War Invalids and
Veterans Rehabilitation
Employment Service Centers
REHABILITATION AT HEALTH AND SOCIAL WELFARE
SERVICES
EDUCATIONAL REHABILITATION
EMPLOYMENT SERVICES

• Counselling and support social workers,
  psychologists, nurses and special education
  teachers

• Medical rehabilitation
• primary health care
• specialized health care

Services for the disabled, activation and work
activity services, services for the elderly,
services for persons with substance abuse
problems

• job placement services
• career counselling services

Special care services of children, services for
the mentally retarded