Palko (Finland)
Palko (Palveluvalikoimaneuvosto, known in English as COHERE Finland) is the Finnish council that makes recommendations on which treatments should be included in the publicly funded healthcare package. The council operates in conjunction with the Finnish Ministry of Social Affairs and Health.
The main article on this subject is Gender Care in Finland.
What you can find
The website publishes recommendations, criteria and statements, some of them also in English. On 11 June 2020, it published three recommendations on gender dysphoria: one for minors, one for adults with a transgender identity and one for adults with a non-binary identity.
Why it is on this list
The recommendation for minors states that psychosocial support should be the first step, supplemented where necessary with psychotherapy and treatment for co-occurring mental health problems. According to the council, hormonal treatment can be considered only after careful individual assessment. Finland was therefore one of the first countries to take a more cautious approach to what is known as the Dutch Protocol. See also policy by country.
The council’s position and role
According to its own website, Palko is a permanent body appointed by the Finnish government. The council recommends which examinations, treatments and rehabilitation methods should be included in the public healthcare package and which should not. It also monitors and assesses the scope of that package, gives opinions on applications upon request, participates in public discussion about the healthcare package and follows developments abroad. The council has sections and a secretariat, and works with a handbook describing the criteria and the process for selecting topics. A recommendation is first published as a draft and then adopted.
A closer look at the 2020 recommendations
The three recommendations concern medical treatment methods for dysphoria. The full texts are in Finnish; an English summary is available for each one. An unofficial English translation of the recommendation for minors was published by SEGM. According to that version, Finland assesses on a case-by-case basis whether a minor is eligible for medical treatment, at two specialist centres, and does not offer surgery to minors. How this compares with neighbouring countries is set out in the overview of gender dysphoria surgery in five Nordic countries. The council also concludes that there is no medical treatment for minors that can be considered evidence-based.
How to use this source
The recommendations are a primary government source and are therefore more authoritative than third-party summaries. Many English-language descriptions of Finnish policy come from organisations with their own position. It is therefore best to compare such accounts with the summaries on Palko’s own website. Also pay attention to the date: the recommendations date from June 2020 and describe the state of the research at that time. Those wishing to compare the Finnish approach with that of other countries can consult Socialstyrelsen in Sweden and the British Cass Review.