The Healthcare System in the Åland Islands: the ÅHS, Health Centres, Emergencies and Access to Care

The Åland Act on the Autonomy gives health to the archipelago (section 18, point 12), subject to the exceptions of section 27; social insurance and pensions come under the State (section 29). The organisation therefore differs from that of mainland Finland: it is Ålands hälso- och sjukvård (ÅHS) that is responsible for all public health, from maternity to specialist care and end-of-life care. Most services are at Mariehamn hospital; the ÅHS also runs a health centre in Godby, health and care clinics in most municipalities and dental care in Mariehamn and Godby. For specialist care, it cooperates with hospitals in Helsinki, Turku and Uppsala.

The private sector exists: Åland Living, the site of the AMS (regional labour market and study authority), mentions private medical practices, physiotherapists and chiropractors, and indicates that adults use private dentists. Private provision of care requires authorisation from the Government of Åland. How the system works in detail for a French national who has settled is described in the page healthcare reimbursement in the Åland Islands.

Åland is an autonomous region whose social legislation differs in part from that of the mainland (Kela). ÅHS patients’ fees rest on Åland legislation: the ÅHS site cites the regional act on the bases of fees and two texts of 2007, and refers to the patient fee manual, as well as to a document on the right to protection against high costs (“högkostnadsskydd”). The amounts in these documents could not be read in the sources consulted: the ÅHS cashier service (018-535 163) provides them.

The split of benefits between bodies is precise, according to Kela:

• Kela: general housing allowance, family allowance, study grant at the choice of the resident student, reimbursement of travel costs to a care provider in Åland;
• KST (the municipalities’ social services): social assistance, birth and adoption allowance;
• AMS: general social benefit, study and student housing grants;
• ÅHS: travel voucher for treatment on mainland Finland or in Sweden, without which the journey is not reimbursed.

CLEISS (the French centre for European and international social security liaison) specifies that Kela does not reimburse public sector care and reimburses part of private care and medicines. Kela’s pages on these reimbursements do not mention Åland: their application in the archipelago should be confirmed with Kela and the ÅHS.

The ÅHS sets a common rule: everyone is entitled to urgent public care, whatever their country of origin and citizenship, and must present photo identification. The rate then depends on the situation.

• Residents of the EU, the EEA, the United Kingdom and Switzerland: urgent care at the normal rate on presentation of the European Health Insurance Card (EHIC), valid identification and the home address; without the EHIC or another document proving entitlement to care, the patient pays the full cost. A person insured in another EU state can use planned care under the Cross-Border Healthcare Act, without a particular certificate, but without an S2 certificate they bear the cost.
• Residents of the Nordic countries: necessary care at the normal rate on presentation of identification and the address.
• Residents of mainland Finland: urgent care at the normal rate; for planned care, a payment commitment from their wellbeing services county is necessary, and they do not choose their health centre in Åland.
• Residents of other countries: entitled to urgent care, at the full cost.

The ÅHS has a coordinator for cross-border care matters (kund.ekonomi@ahs.ax). The pages consulted do not detail the treatment of an employee or retiree who has settled without a municipality of residence: this case should be confirmed with the ÅHS and Kela. France Diplomatie (the French foreign ministry) reminds readers that it is essential to hold an assistance contract or insurance covering medical costs, hospitalisation and repatriation.

For an illness that is neither urgent nor life-threatening, the entry point is the health centre in Mariehamn (018-538 500) or Godby (018-535 819); residents of the archipelago turn to their municipality’s health clinic. The health centres see children and adults, with nurses and general practitioners who refer to specialists; no referral letter is required to go there. Appointments are made online in the “Mitt ÅHS” patient area or by telephone.

• Nurse advice: the ÅHS Sjukvårdsupplysning line (018-535 117) answers every day from 8 a.m. to 8 p.m. for minor injuries and illnesses.
• Screening and vaccines: the ÅHS runs screening and vaccination programmes, detailed in the last section.
• Waiting times: the ÅHS publishes the assessment times for non-urgent care requests.

The emergency department (akuten) is at Doktorsvägen 1 A in Mariehamn, with an entrance of its own to the left of the main entrance, near the heliport. It is staffed at all times: two emergency doctors during the day, then a doctor on call, often a junior doctor, at other times. For a life-threatening emergency, call 112; for an urgent psychiatric need, the psychiatry department answers on 018-535 030, and the emergency direct line is 018-5355.

• Ambulance: 112 leads to the regional alarm centre, which sends an ambulance according to the urgency; the service is provided by the Räddningsverket in Mariehamn on behalf of the ÅHS, with about 3,100 call-outs a year, two ambulances ready to leave within one minute and a third within fifteen minutes.
• Helicopter: the ambulance helicopter operates in the archipelago and in rural areas.
• First responders: groups of trained volunteers can be alerted in parallel for life-threatening emergencies such as cardiac arrest.
• Journeys to the mainland: Kela reimburses travel costs to a care provider in Åland; for treatment on mainland Finland or in Sweden, only with a voucher from the ÅHS.

Medicines: Kela reimburses medicines prescribed to treat an illness; the annual deductible and the annual ceiling on the patient’s share are revised every year. These national amounts are given by Kela, whose page does not mention Åland: their application to the archipelago should be confirmed with Kela. The pages consulted do not detail Åland’s pharmacies.

Dental: the ÅHS offers public dental care to children and young people up to age 28 and to priority groups for medical or social reasons; adults outside these groups first turn to their usual dentist for urgent problems. Visitors and temporary residents are entitled to emergency dental care (telephone 018-538 524, Monday to Friday from 8 a.m. to 2 p.m., weekends and public holidays from 9:30 a.m. to 11:30 a.m.). A weekend, public holiday or on-call visit costs €50 more than the rate for the care.

Maternity: the ÅHS has an advice service for pregnant women (foetal screening, gestational diabetes, birth preparation) and a maternity and delivery service. The maternity and adoption allowance is paid by the KST, according to Kela, and CLEISS indicates that Åland residents turn to their municipality’s social services for the birth benefit. See also the page healthcare reimbursement.

France Diplomatie recommends checking that routine vaccines (diphtheria, tetanus, poliomyelitis, whooping cough, measles) are up to date and mentions as the only additional vaccine the one against tick-borne encephalitis (TBE). This infection is transmitted by tick bite, mainly in spring and summer, with no treatment; prevention relies on protection against ticks and on vaccination for a stay in rural or wooded areas. The ÅHS indicates that it is in general only needed for at least four weeks spent in the countryside in summer.

• Basic series: three free doses for people aged 3 and over with a municipality of residence in Finland and living in Åland or owning a leisure residence there; free vaccination began in 2006. Schedule: second dose 1 to 3 months after the first (two weeks if rapid protection is needed), third dose 9 to 12 months after the second, first booster recommended after three years.
• Boosters: at the patient’s expense, on a prescription from the health centre, the vaccine being collected from a pharmacy; the visit to the nurse is free. Frequency indicated by the ÅHS: every 10 years if the previous booster was before age 50, every 5 years between 50 and 60, every 3 years from age 60.
• With no municipality of residence in Finland: the ÅHS refers people to the private sector for tick-borne encephalitis vaccination.
• Adult vaccination programme: diphtheria-tetanus-whooping cough booster at 25 and 45, diphtheria-tetanus at 45 and 65 then every 10 years, flu every year from age 65 and for risk groups, Covid-19 from age 75 and for risk groups.

The ÅHS recalls the rights arising from the Act on the Status and Rights of Patients: complaints about care, requests for copies of the medical record (processing of at least five working days), correction of inaccurate data within one month, consultation of the record's access history, professional secrecy of all carers. It refers people to the patient ombudsman for advice and to the Patient Insurance Centre for compensation for damage related to care. It also recalls that citizens of the EU, the EEA and Switzerland can be treated in another state, unforeseen care while travelling as well as planned care abroad.

To choose between EHIC, S1, A1 or international insurance, the guide expat health insurance gives benchmarks, and the pages living and retiring in the Åland Islands detail the cases of each profile.