Maximum user charges
There are no rules in Denmark for maximum user charges, except for pharmaceutical products and dental treatment (cf. the section on reimbursement for dental treatment).
For subsidized medicine, there is a maximum user charge of DKK 2 076 annually (no charges for children under 18 years and DKK 1 328 for pensioners). There is no maximum user charge for dental treatment. Apart from pharmaceutical products and dental care, there are no user charges in the Faroe Islands (cf. the sections on reimbursement for pharmaceutical products and reimbursement for dental treatment).
There are no user charges in Greenland except for non-prescription medicines and some types of dental treatment. There are no maximum user charges.
If the total cost of pharmaceutical products exceeds EUR 605.13 per year, or if travelling costs for treatment exceed EUR 300 per year, the Social Insurance Institution reimburses the excess costs.
If a person's ability to pay taxes is reduced because of sickness, a special tax relief may be granted. The amount of the tax relief is calculated on the basis of the person's and his/her family's ability to pay taxes.
User charges for a long-term stay in an institution or a hospital cannot exceed 85 per cent of a patient’s/resident's net income per month. If the spouse with the highest income is hospitalized, the user charge for the hospitalization cannot exceed 42.5 per cent of the spouse’s joint net income per month. A patient must have at least EUR 107 per month for personal necessities. The same user charge is payable in all kinds of institutions within the social and health care sectors.
A user charge ceiling of EUR 691 is applied by the municipal social and welfare sectors. Once the ceiling for the present calendar year is exceeded, the user may generally utilize services free of charge. The ceiling applies to physician services in the primary health care sector, physiotherapy, out-patient treatment, day surgery and short-term stays in institutions in the social and health sectors. Dental care, patient transport, certificates, laboratory tests and radiological examinations requisitioned by private physicians must still be paid for. Income-regulated payments are not included in the maximum amount.
User charges for children under 18 years of age are added to the amount paid by the person who has paid the user charges.
The rules for maximum user charges for pharmaceutical products and transport to and from treatment are the same as in Finland.
The maximum user charge for health care and out-patient treatment is EUR 475 within one calendar year, after which there is no charge for the remainder of the year, with the exception of short-term stays in institutions/hospitals, where the charge is reduced from EUR 33 per day to EUR 15 per day.
For children and young people under the age of 20 and people over the age of 65, the maximum amount for user charges is EUR 100 per calendar year. After this amount has been reached, all treatment for children and young people is free. The user charge per day for a hospital stay for persons aged 65 years and older is reduced from EUR 33 to EUR 15.
As part of the maximum user charge, payment for out-patient treatment and services received outside the county are also included. Dental treatment and x-ray and laboratory examinations are not included. User charges may be deducted from municipal tax.
User fee, or payment participation, for people aged 18–66 years old never exceeds ISK 27 475 for one month. If that ceiling is reached, access to health care is free of charge for the rest of the month. The following months the user fee gradually decreases but can go up to ISK 4 579 for one month. The maximum user fee for one year (12 months) can be as much as ISK 79 844. The same applies to children under the age of 18, pensioners and people with disabilities, if the payment participation exceeds ISK 18.317 for one month the service is free of charge for the rest of the month. The maximum payment for one year does not exceed ISK 51 900.
For children, all primary health care is free of charge and secondary health care if they have a referral from their general practitioner.
If there are two or more children under the age of 18 in one family, they count as one person in relation to the payment participation system.
The payment participation system covers the following services: GP or specialist consultation, home visit by a physician, outpatient treatment in a hospital or an emergency department, and laboratory and X-ray examinations. The payment participation system also covers physiotherapy and occupational therapy, speech therapy and psychological services for children with special referrals. The system does not cover treatment for in vitro fertilization nor pharmaceutical products.
When the ceiling for user charges is reached, patients are eligible for an exemption card (frikort for helsetjenester) valid for the rest of the calendar year. The ceiling or the upper limit is set annually by the Norwegian Parliament. From January 2021, there is one single exemption card scheme in Norway, instead of two schemes, as before. This means that patients can use the same exemption card for all the health services that are currently covered by the two different exemption cards. The new user fee ceiling is NOK 2 460 (2021). The user fees are registered automatically.
Patients must pay any expense that are not approved user fees. These expenses do not count towards your exemption card for health services. This could be fees for bandages and equipment which is necessary for treatment.
Some groups are exempt from paying user fees for examination and treatment by a doctor. For example this applies to: children under the age 16, children and adolescents under the age of 18 who receive psychotherapeutic treatment, patients who have received a decision concerning an occupational injury, soldiers serving compulsory military service (førstegangstjeneste), pregnant women attending antenatal checkups, patients suffering from an infectious disease which constitutes a risk to public safety, such as the coronavirus (coronavirus, 2019-nCoV/SARS-CoV-2), chlamydia and gonorrhoea, and persons suspected of having such a disease and initial medical examination for individuals seeking emergency care after being subjected to violence in close relationships and/or sexual abuse.
The maximum user charge over a twelve-month period is 1 150 SEK for outpatient care (2021). This also applies to children up to 18 years. When the maximum payment has been reached, patients can receive health carefree of charge in any region for twelve months.
The general high-cost protection scheme applies to Swedish citizens and covers patient fees for consultations in outpatient care, incontinence aids, some types of laboratory tests and x-ray, certain dental care procedures, and acute care provided in other EU/EES countries. The general regulations apply to both public and private health care providers contracted by the regional authorities.
Individuals who are non-residents and registered as asylum seekers have reduced patient fees and are entitled to apply for a special high-cost protection scheme that covers health care and medicines above 400 SEK over a six-month period. Preventive care among children and mothers is free of charge.
The regional health authorities decide on user charges for different types of services available in their geographical area. The Swedish Association of Local Authorities and Regions (SKR) publishes annual overviews of both the general rules and the fees applied by regional authorities, as well as conditions that apply regionally.
The Act on pharmaceutical products benefits regulates high-cost protection and allowances. The Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket, TLV) decides which pharmaceutical products, medical devices and dental care procedures should be subsidized by the government.