Economic Assessment of Health Promotion in Finnish Primary Health Care. Pia Hakamäki (Researcher, THL) & Timo Ståhl (Development Manager, PhD, Adjunct professor, THL)

1. Economic Assessment of Health Promotion in
Finnish Primary Health Care
25.8.2011
Pia Hakamäki (Researcher, THL) &
Timo Ståhl (Development Manager, PhD, Adjunct professor, THL) 1

2. Contents
• Issue
• Project description
– Objectives and focus
– Definition of health promotion work
– Different steps of economic assessment
• Results
– Calculating the share and costs of health promotion
• Conclusions and summary
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 2

3. Issue
1. Health promotion (HP) belongs to the work of every
administrative field
2. Lack of knowledge about the cost-effectiveness of
HP activities carried out as normal procedures of
the everyday work of organisations
3. Information is needed in each sector in order to
support planning and decision-making in
municipalities¹
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 3

4. Project description
• Started in 2008 (–2012)
• Working group co-ordinated by THL
• Five municipalities:
– Salo (population 55 235)
– Oulu (141 671)
– Kauniainen (8 689)
– Muurame (9 256) and
– Tampere (213 217)
• In co-operation with municipal experts from various
administrative sectors, the Association of Finnish Local
and Regional Authorities
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 4

5. Project objectives 2008-2012
• To outline key health promotion functions in different
municipal administrative sectors
• To calculate the resources spent on health promotion,
and to determine outputs and effects (later also cost-
effectiveness)
• To provide municipalities with a model for the economic
assessment of health promotion
• To produce comparable data
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 5

6. Project focuses
• Health promotion in the municipal service
system
• Services purchased are also included,
but separate interventions are not
• Limited to children, young people and
families with children
• ²Administrative sectors:
1. ³primary health care, social services,
education and general administration
2. culture and leisure department, sports
and youth administration, environmental
and technical administration
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 6

7. HP activities in three sectors
Promoting Daycare Child guidance
healthy growth and family
and development counselling
Special
Family
educational
mediation
support
Preventive
School welfare child
activity welfare
work
School welfare Home-help
services services
Substance
Community Health abuse prevention
actions and mental
promotion health work
School Integration
environment work
Other public Support for the
health core long-term
functions unemployed
Maternal and
Rehabilitation
child health
services
clinics
Oral School
health care General health care
practice
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 7

8. Different steps of economic
assessment of health promotion
(HP) work
6. Utilisation of comparable data to
support decision-making
5. Effects of health promotion work
4. Outputs of health promotion work
3. Cost calculation
2. Calculating the proportion of health promotion work
1. Determination of health promotion work and limitations
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 8

9. Calculating the proportion of health
promotion work
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 9

10. Primary health care
• Use of existing information systems
1. Client visits and routine classification
– Preventive/medical treatment visits, percentage
2. Number of visits
3. Procedures
4. Group activities
Extra: Appointment books
– Total hours spent on health promotion
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 10

11. Results of the proportion of health
promotion work
• Maternal and child health clinics 95–98 %
• School health care
– public health nurses 62–76%
– school doctors 91–92 %
• Oral health care
– orthodontic therapists 41–45 %
– dentists and dental nurses 2–3 %
• Rehabilitation services 7–11 %
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 11

12. Calculating costs
• Calculation model
→ takes into account personnel costs but also other
costs
→ consistent with all adminstrative sectors
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 12

13. Results of the costs of health
promotion work, 2008/2009
According to preliminary results of two municipalities:
• 11 and 17 % of the primary health care costs
• 3 and 4 % of the total health care costs
• The cost of the health promotion work was EUR 243
and 331 per 0–16-year-old child per year.
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14. Conclusions
• Defining health promotion work is a challenging but
possible
• Very difficult to get comparable data on costs
→ documentation and transparency of assessment
→ calculation is focused on personal costs
• The municipal information systems already hold large
amounts of data; the goal is to describe how to utilise
this data
• Determining comparable outputs and effects!
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15. • The big challenge …
… does the organisation provide incentives (fiscal)
that encourage cross-system working?
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16. Sources
• ¹Kiiskinen, Vehko, Matikainen, Natunen & Aromaa (2008). Terveyden
edistämisen mahdollisuudet. Vaikuttavuus ja kustannusvaikuttavuus.
Sosiaali- ja terveysministeriö Julkaisuja 2008:1.
• ²Perttilä, Hakamäki, Hujanen & Ståhl. (2009). Terveyden edistämisen
taloudellinen arviointi kunnissa. THL. Avauksia 8/2009. Available in
electronic format:
www.thl.fi/thl-client/pdfs/9c078431-6be6-4c41-ab57-16a14f74432c
• ³Hakamäki, Perttilä, Hujanen & Ståhl. 2011. Terveyden edistämisen
taloudellinen arviointi kunnissa. THL. Raportti 11/2011
http://www.thl.fi/thl-client/pdfs/f920b92c-f4e3-4b60-b3e4-69763e1acb30
• Linna 2009. Ehkäisevän terveydenhuollon osuus perusterveydenhuollon
avotoiminnan potilasepisodeista ja kokonaisvoimavarojen käytöstä.
Terveystaloustiede. THL. Avauksia 4/2009.
25.08.2011 TEVA – Economic Assessment of Health Promotion in Finnish Municipalities/Pia Hakamäki 16

17. Thank you!
Pia Hakamäki
e.mail: pia.hakamaki@thl.fi
GSM: + 358 40 5188685
Mika Vuori
e.mail: mika.vuori@thl.fi
Sanna Kilpeläinen
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