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With reference to its previous comments concerning the application of Article 17 of the Convention, the Committee notes the information provided by the Government in its report of 1991-94 together with the comments made by the Confederation of Unions for Academic Professionals (AKAVA) and the Central Organization of Finnish Trade Unions (SAK).

Both organizations point out that, as part of the Government's saving programme, compensation for medical treatment has been reduced and the share of the cost borne by the patient has grown, in particular for physicians' fees, out-patient and in-patient fees and medicines. At the same time, the right to deduct medical costs from the taxable income has been discontinued. The savings programme has particularly affected access to dental care, which has not been extended to unprotected segments of the population, despite the promises given. According to the AKAVA, central and local government cost cutting also threatens to reduce medical services in the public sector. The SAK considers that the scope and availability of medical care services, as defined in Article 13 of the Convention, is problematic because of scarcity and of the economic difficulties of those in need of such services.

In its report, the Government confirms that, as part of the Government saving programme, sickness insurance benefits have been cut, more costs have been shifted to patients, and as from 1992 medical costs are no longer tax deductible. As a result of the sharp decline in public resources, it has been considered justifiable to assign some health care responsibilities to the private sector. The new state subsidy scheme which took effect in 1993 has contributed to reinforcing the significance of the private sector, side by side with public services, by giving local authorities the chance of buying the services they offer from the private sector through competitive bidding. Over 27 per cent of all physicians' services in the community care sector compensated under the sickness insurance scheme were provided by private physicians. In principle, 60 per cent of physicians' fees are compensated, but in practice this compensation averaged about 36 per cent in 1993, as a result of the lower fee scale introduced by the Government. For medical examination and treatment ordered by physicians, the compensation is fixed at 75 per cent of the part exceeding the patient's "own risk" per medical order in accordance with the confirmed fees. However, the average compensation for these services amounted to only about 38 per cent in 1993. As regards dental care, about half of all expenditure on these services was spent in the private sector. The compensation percentage for dental treatment is 90 per cent and for other care 60 per cent of the confirmed fees. In practice though, it amounted to about 55 per cent on average in 1993. Generally, those born before 1956 are not entitled to compensation for costs incurred from dental care. This has been considered a real shortcoming and the Government has in fact been preparing to extend the coverage to the whole population. However, this has been postponed until the beginning of 1996 in order to curb government spending.

The Committee notes from the above information that, due to economic difficulties and the need to curb government expenses, the accessibility of medical care has been influenced in recent years, on the one side, by the continuous reduction of the level of compensation and the increase of the patient's own share in the cost of such care, and on the other side, by the significant shift in the provision of medical services from public to private sector to the extent that the above-mentioned occupational organizations have expressed concern with the "scarcity" of public medical services. At the same time, according to the figures given by the Government, compensation for care provided in the private sector by physicians and on their orders, as well as for dental care, attained in practice on average only 36, 38 and 55 per cent respectively of total cost, the rest of which has to be borne by the patient himself. In this situation, the Committee wishes once again to draw the Government's attention to the principle laid down in Article 17 of the Convention, according to which the rules concerning sharing by the beneficiary or his breadwinner in the cost of medical care should be so designed as to avoid hardship and not to prejudice the effectiveness of medical and social protection. It also draws the Government's attention to Article 30 according to which the State shall accept general responsibility for the provision of benefits due under the Convention and in particular for medical benefit provided for under Article 13. The Committee therefore hopes that in view of the situation the Government will reconsider its policy in light of Articles 13, 17 and 30 and reinforce public health care facilities, and will take the measures necessary to ensure that the level of compensation for medical care prescribed in the legislation actually is being applied in practice. In this respect, it asks the Government to continue to furnish in its next report the recent statistical data on the volume and proportion of medical care provided by each of the public and private sectors and on the average level of compensation by type of medical care provided by the private sector. Finally, as regards access to dental care, the Committee hopes that the Government will report on the progress made in extending coverage for dental care to the whole of the adult population, in accordance with its stated intentions.