Inequality in Finnish health care since the 1990s

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Inequality and the Nordic Welfare Model Seminar 7th November 2011, THL
Inequality in Finnish health care since the 1990s
Ilmo Keskimäki
Inequality and the Nordic welfare model
Helsinki, November 7, 2011

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Inequality in Finnish health care since the 1990s

  1. 1. Inequality in Finnish health care since the 1990s Ilmo Keskimäki Inequality and the Nordic welfare model Helsinki, November 7, 2011
  2. 2. Equity objectives in Finnish healthpolicy• Equitable distribution of health• Diminishing socioeconomic and other health differences between population groups• Levelling the financial burden of disease• Equal access to health care• Use of services according to need• High quality services for all residents Inequality in Finnish health care / Keskimäki 7.11.2011
  3. 3. Structural features supporting equityobjectives in the Finnish system• Universal coverage of the health care system, mandatory health insurance• Levelling the resources in health care between municipalities• Levelling the financing of health care – health services mainly funded by tax revenues (90%) – most user fees are small and some non-existent Inequality in Finnish health care / Keskimäki 7.11.2011
  4. 4. Structural features undermining equity inthe Finnish health care• High share of out of pocket payments in health care financing• High impact of the private services in outpatient care – about 20% of all visits to doctors – in some specialities even larger share – despite NHI support, patients still pay a large part of the costs• Occupational health care – about 18% of all visits to the doctor among adult population – services best among those with good positions in the labour market• Hospital care – referral pressure from private outpatient care – poor supply of public specialist outpatient services – private hospitals Inequality in Finnish health care / Keskimäki 7.11.2011
  5. 5. Progressivity of total health care financing and out-of-pocket payments in 1990-2006 Klavus 20108.11.2011 5
  6. 6. Inequity indices (95% confidence intervals) forvisits to a doctor by sector in Finland in 1987-2009 All visits Health centres Occupational health care Hospital outpatient Private services Häkkinen and Nguyen 2010 Inequality in Finnish health care / Keskimäki 7.11.2011
  7. 7. Visits to a doctor by income in OECD countriesmeasured by inequity indices OECD 2004 Inequality in Finnish health care / Keskimäki 7.11.2011
  8. 8. Income group, coronary procedures (PTCA or CABG) and coronary mortality in 2003 in Finland 25-84 -year old men and women /100 000 Men Women Unpublished results from the Finnish Care Register8 Inequality in Finnish health care / Keskimäki 7.11.2011
  9. 9. Unpublished preliminary material; Please, do not quote without the authors’ consent!Inequity indicies (95% confidence intervals) for mortality amenable to health careinterventions (All, primary (PHC), specialized (SHC) health care) in 1992-2008,women and men aged 25-74 Lumme et al. 2011 Inequality in Finnish health care / Keskimäki 7.11.2011
  10. 10. Summary10 • The funding of health care has become regressive • Clear socioeconomic differences in access and use of health services have remained – Differences in almost all parts of the service chain – Differences in visits to medical doctors are large compared to other Western European countries • Findings on amenable mortality suggest that socioeconomic inequalities in effectiveness of health care have increased Inequality in Finnish health care / Keskimäki 7.11.2011
  11. 11. Inequality in Finnish health care / Keskimäki 7.11.2011

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