Annual report

Summary of the Patient Insurance Centre’s 2018 annual report

The Finnish Patient Insurance Centre (PVK) is the central body handling all personal injuries that occur in connection with healthcare activities in accordance with the Patient Injuries Act. It also actively promotes patient safety by means of stakeholder cooperation, statistics and research activities and communications.

PVK serves as the cooperative body for all its member companies granting patient insurance policies. Its members are all the insurance companies granting patient insurance policies in Finland. PVK has provided patients and the medical staff with statutory cover since 1987.

Comprehensive overhaul of the Patient Injuries Act

On 21 January 2015, the Ministry of Social Affairs and Health set up a working group to revise the legislation on patient insurance and prepare a proposal for its amendment in the form of a government proposal. The legislation working group set up by the Ministry of Social Affairs and Health, in which PVK was also represented, submitted its unanimous report to the Ministry of Social Affairs and Health on 21 December 2016. The Ministry of Social Affairs and Health published the report of the working group on 19 January 2017. The Government Proposal to Parliament for the Patient Insurance Act and certain related acts (298/2018) was submitted on 5 December 2018, and it was sent to the Social Affairs and Health Committee on 11 December 2018. At the same time, the Government Proposal for the Act on the Traffic Accident and Patient Injuries Board (299/2018) was also submitted to Parliament, the purpose of which is to merge the Traffic Accident and Patient Injuries Boards. Parliament did not have the time to consider the proposals by the end of 2018.

In the advocacy of its legislative interests, PVK engages in cooperation with Finance Finland (FFI). Internal preparatory work was also carried out in 2018 in PVK’s insurance, compensation and actuarial affairs units in preparation for the acts to enter into force as planned on 1 January 2021.

New strategy 2018–2022

PVK’s Board of Directors adopted the new strategy for 2018–2022 at its meeting of 26 September 2017. PVK’s vision is to provide safety and information in support of the evolving health care and insurance system: We safeguard the rights of patients and the medical staff and produce useful information in support of the evolving insurance system and patient safety work.

The operational priorities according to the new strategy are:

  1. High-quality claims handling to safeguard patients and the medical staff
  2. Active information provider to promote patient safety
  3. Competent cooperative body to support the insurance system

High-quality claims handling to safeguard patients and the medical staff 

A total of 8,522 new notices of injury were received during the reporting period, which is slightly less than in 2017 (8,655). Potential reasons underlying the decrease in the number of notices include the improvement of patient safety in health care units and PVK’s active communications to increase the claimants’ awareness of the cases where compensations can be paid under the patient insurance.

PVK’s compensation affairs are tasked with determining whether the reported case of injury meets any of the grounds for compensation set out in the Patient Injuries Act and if so, paying the statutory compensations to the individual who sustained a patient injury.

Three strategic objectives were set for PVK’s claims handling operations in 2018:

  1. We are a dependable expert in patient injuries and compensations.Claimants and health care operators trust in our expertise and the impartiality of our claims decision process.
  2. We operate in an efficient and modern manner. Our personnel enjoy a good level of wellbeing, are motivated and productive. Our claims handling process is efficient, and our modern claims handling systems support optimally the smooth flow of the process. Our resources are correctly dimensioned and allocated.
  3. We provide a good customer experience. Our service is customer-oriented, smooth and multi-channelled. Our claims decisions are correct in their outcome and sufficiently reasoned and made within reasonable time. Our service can be satisfied with regardless of the outcome of the claim.

In 2018, we continued our active efforts to eliminate the backlog in claims handling, and improvement could be seen in performance at different handling stages. A total of 9,557 (8,633) claims decisions were made at the statement of grounds stage in 2018. The average processing time was 8.5 (8.8) months, the median being 8.6 (8.4) months. At the compensation stage, the average processing time was 36 (44) days, while at the pension processing stage, the average processing time was 68 (83) days. A total of EUR 40.7 (39.5) million was paid out in compensation for patient injuries occurring in different years, including the management expenses of claims handling operations.

In 2018, a total of 1,188 (1,157) requests for a recommended decision were made to the Patient Injuries Board. Of these, 1,033 (972) were filed by claimants to request for a revised claims decision, and 155 (185) were requested by PVK prior to the issuance of the claims decision. The Patient Injuries Board issued 1,089 (1,065) recommendations, of which 75 (83) recommended that compensation be paid to the injured party (grounds decision) and 97 (99) considered that additional compensation should be paid to the injured party. Of the cases decided by the Board in 2018, 15.8% (17.1%) were decided in favour of the claimant. The number of actions on patient injuries brought to court was 13 (4).

In 2018, a customer satisfaction survey was conducted for the first time on PKV’s compensation customers, the results of which were used in the development of our operations to improve the customer experience.

Active information provider to promote patient safety

The strategic objective of PVK’s patient safety work is to actively promote patient safety so that lessons can be learned from the cases of injury that have occurred. To attain this objective, we engage in active patient safety work in collaboration with other operators in the sector. We are profiled as a party that promotes patient safety and produces useful information in support of patient safety work.

PVK has its own patient safety strategy, the implementation of which is under the responsibility of a part-time patient safety physician. The key areas of the patient safety strategy are stakeholder cooperation, communications and research.

In 2018, the patient safety strategy was implemented by engaging in collaboration with other principal actors in the field of patient safety. PVK’s experts also participated in various events promoting patient safety, visited health care institutions, and promoted the utilisation of the electronic Patient Injury Report service portal designed for hospital districts in the quality and patient safety work of medical treatment facilities. 

Five new studies were started on the patient injury data, three of which were brought to completion. The results of the studies were utilised in patient safety communications.

Competent cooperative body to support the insurance system

PVK’s insurance operations address the duties related to patient insurance in the public sector and under the Patient Insurance Act. Actuarial and statistics operations are tasked with supporting the reliable operation and transparency of the system.

Insurance operations

Until 2012, PVK granted all the public sector health and medical care patient insurance policies on behalf of its member companies. By the beginning of 2018, two hospital districts had taken out patient insurance as a public procurement with a member company of the Centre.  During the reporting year, two hospital districts put their full deductible patient insurance policies issued by PVK on behalf of its member companies out to open tender, as a result of which they may be transferred directly under the responsibility of a PVK member company.

All the private sector patient insurance schemes are issued by our member companies. During the reporting period, there were 17,587 (16,995) insurance schemes issued by our member companies in force, of which nine (9) were group insurance schemes taken out by trade unions in the health care sector.

The number of public sector insurance schemes issued by the Patient Insurance Centre in force was 29 (29), and they were based on a policyholder-specific full liability principle with regard to the determination of insurance premiums. These insurance schemes cover almost the entire country with regard to public health care and medical care: the policyholders include the joint municipal authorities for all hospital districts except two and Ålands hälso- och sjukvård (Åland Islands healthcare services). Additionally, the policyholders include nine central government organisations with health and medical care operations. There were a total of 7 (9) insurance policies in force issued by the Patient Insurance Centre under the obligation to issue insurance policies (Section 7 of the Patient Injuries Act).

Actuarial and statistics affairs

The services provided by the actuarial and statistics unit include collecting information on the issued patient insurance policies from the member companies, maintaining and utilising data repositories in surveys and studies, determining the premiums charged by PVK, preparing and monitoring the calculation criteria for technical provisions, and preparing calculations for the pay-as-you-go system and annual accounts.

The calculations required for the pay-as-you-go system were prepared during the spring of 2018, based on which the final adjustment for 2017 and the advance adjustment for 2018 were made and the pay-as-you-go payment for 2019 was determined. Additionally, the Patient Insurance risk study for 2019 was carried out based on the statistical data collected from the member companies and in the possession of PVK.

The annual accounts for 2017 were submitted to the member companies in March and the preliminary annual accounts for 2018 in December. The increased insurance premiums charged to those failing to take out a patient insurance policy issued by PVK for 2019 were determined in December. An application for the ratification of the basis of the increased insurance premium was submitted to the Financial Supervisory Authority. In 2018, cash flow forecasts for the technical provisions estimated by PVK required by Solvency II reporting were sent to the member companies on a quarterly basis 

Financial and personnel administration

The Patient Insurance Centre has shared financial and personnel administration with the other organisations within the Insurance Centre Group (the Finnish Motor Insurers’ Centre (LVK), the Finnish Environmental Insurance Centre (YVK) and the Finnish Pharmaceutical Insurance Pool (LVP)). The jointly manages services include financial, personnel and information management and internal services.

The Patient Insurance Centre’s public-sector insurance premium income totalled EUR 58.6 (43.1) million, and private-sector premium income EUR 20.6 (16.7) million.

PVK handles the compensation procedures pursuant to the Patient Injuries Act on a centralised basis in Finland. PVK paid out a total of EUR 31.7 million in compensation, and the claims reserve as of 31 December 2018 totalled EUR 575.7 million. PVK’s operating costs totalled EUR 9.3 million, of which claims handling costs accounted for EUR 7.5 million. The Patient Injuries Board’s expenses during the reporting period were EUR 1.5 (1.5) million.

A total of around 98 person-years were used in PVK’s operations (excluding medical experts).

Assessment of likely future development

No phenomena with material impact on future development can be seen in the operating environment after the end of the financial year, so operations are expected to remain at their current extent. No special research and development investments were made.

Bodies in 2018

Board of Directors of the Patient Insurance Centre

  • Markus Munter, LocalTapiola, Chair
  • Christina Branders, Folksam
  • Nisse Heikkinen, Fennia
  • Hannu Leskinen, Northern Ostrobothnia Hospital District
  • Tuomas Seppänen, OP, Vice-Chair
  • Tapio Valtonen, If

Executive management of the Patient Insurance Centre in the Insurance Centre Group

  • Ulla Niku-Koskinen, Managing Director
  • Jari-Matti Lifländer, Director of Administration
  • Minna Plit-Turunen, Unit Director
  • Ville Lilja, Director of Actuarial Affairs
  • Sari-Leena Lund, Communications Manager starting from 1 September 2018, Leena-Mari Tanskanen until 10 August 2019
  • Asko Nio, Director of Legislation
  • Janne Jumppanen, Director of Motor Insurance Unit (Debt Collection)

Auditors

Oy Tuokko Ltd

  • Terhi Latvala, APA (controlling auditor)
  • Janne Elo, APA