Suomen sote-uudistuksella tavoitellaan hyvinvointi- ja terveyserojen kaventamista, palvelujen yhdenvertaisuuden ja saatavuuden parantamista sekä terveydenhoitokustannusten hillitsemistä. Miten valinnanvapaus ja kilpailu tullaan toteuttamaan Suomen sote-uudistuksessa? Alivaltiosihteeri Tuomas Pöysti puhui aiheesta VATT-paivassa Säätytalolla 1.11.2016.

1. -2.11.2016 Under-Secretary of State, Dr. Tuomas Pöysti1
Freedom of Choice
and Competition -
How Finland will use
it?

2. -
Finnish social and health services reforms
• Ambitious social and health services reform together with a reform of
regional administration
• concerns 50 % of the public sector employees
• establishment of autonomous counties with directly elected councils
• Widening of the freedom of choice
• Use of multiple producers => modern service ecosystem based on
platform economics
• Use of competition and markets in the production of services =>
enhancement of effectiveness
• http://alueuudistus.fi/frontpage

3. -
Objectives of the Finland’s social and health services reform?
Renewal of services
More expedient
administration
Better and more fluid
functioning of services
Citizen participation
Enhancement of
economic growth
Cost-effectiveness
to promote and
enhance the
activities of citizens
and enterprises
Administration
as a service
Openness.
Customer-focus.
Inter-action and dialogue
Diminuation of
differences in health and
social wellbeing
Improved equality in
services, efficiency of
fundamental rights
Slowing of the
expenditure growth
(1.5 % to GDP)

4. -
Bridging the Sustainability Gap in the Public Finances
The savings target for the health and social services reform package is EUR 3
billion, approx. 1,5 % of the GDP
The expected annual growth of healthcare and social welfare costs must be cut
from 2.4% to 0.9% between 2019 and 2029
Functional and performance gains trough digitalisation
Competition => wise use of resources

5. -
New functions of the counties as of 1 January 2019
Government
Decisions on health and social services: nationwide work division, division of
duties over county borders, policies for service provision, broad-based
investments, other measures needed to safeguard availability of services, steering
of information management and ICT
18 counties
- Responsibility for
organising services
- Responsibility for
financial resources
- Determines service level
and contract for
arranging services
Municipalities
5 collaborative
catchment areas
Counties
• Healthcare and social welfare
• Rescue services
• Duties of the regional councils
• Regional development duties and tasks related to the promotion of
business enterprise
• Environmental healthcare
• Planning and steering of use of regions
• Promotion of regional culture and identity
• Other statutory services organised on a scale that is larger than a
municipality that require deliberation
Collaborative catchment areas
• Centralised duties in most demanding services
• Streamlining of service structure, investments and services
• Development and centres of excellence
• Emergency medical service unit
• Collaborative tasks and forum
• Cooperation agreement
Service
providers
• Public, private
and third sector
service
providers
Municipalities
• Promotion of health and wellbeing
• Local democracy and dynamism
• Statutory duties – local tasks
• General mandate
Regionalstateauthoritywithnationwideresponsibilities
JointICTservices,otherjoint
supportservices
12 units with extensive
service around the clock
(incl. 5 university hospitals

6. -
The Finnish model for organising health and social services and county
government in the future:
Healthy people, fluent services and strong economy
Health and social services and county government reform legislation creates
possibilities
-
Promoting
health and well-
being in
municipalities
and counties
Strengthening the self-
determination and
responsibility of
customer
Information, digitalisation and skillful personnel enablers
Citizen
Functional democracy and
participation
The usa of information -
Integration og information
The Act on
Financing of the
Counties -
Criteria for the
service needs
and cost
containment
Economic growth
Taxpayer
cost-
effectiveness,
effectiveness
Public, private and third sector
providers
Promoting health and
well-being in all
policies
Effective
organising,
producing and
management
Multiple producers
model -
Same principles for
public, private and third
sector providers
New County
Responsibility to organise duties
Financing responsibility
Responsibility on integrated services and
functioning service chains
Alignment for
preparation of the
legislation for wider
freedom of choice
Measurements
supporting and required
by renewal
- Entrepreneurship
Multisectoral
counties with
distinct distripution
of work
Municipalities as
local vital societies
Democracy in the
Counties: county council
User
- possibility to choose
- possibility to
influence
Workforce transfers employees
maintain their current terms of
employment
Incorporation has transition
period

7. -
Issues to be addressed
• Freedom of choice in health care
• Competition policy, social and health policy or both?
• Will it function?
• Is health care exceptional?
• Is freedom of choice alien to the social services?
• Under which institutions and rules will competition and freedom of choice
work?

8. -
Freedom of choice: cost-effectiveness trought shared
decision-making and customer-centred service
Government’s guidelines on the
reform 29.6. 2016
Main rule in the primary and community services
Modified principle in secondary and tertiary care
User may choose between public, private or third sector provider
Finnish freedom of choise model. supports
user-centred service integration
4 different tools
- right to choose primary service provider
- client vouchers
- personal budget
- right to choose among public producers.
The possibilities for producers of different sizes
to operate in the market will be secured

9. -
Theory
• Competition good to allocate scarce resources
• Freedom of choice with shared decision-making creates incentives for
customer-cenred approach
• Freedom of choice balances asymmetries of information and power
• Health and social services are trust commodities
• big information problems
• trust to service provider is a key decision-criteria
• A good case for public sector financing for universal health services and
social services
• There is a case for multiple producers in the productions and utilisation of
market mechanisms

10. -
Practise
• Conflicting goals in the market and freedom of choice models
• Challenge of persons with multiple service needs
• Commissioning - provision -distinction in practise
• Trust commodity
• conditions for trust
• Few persons actively change producers
• Different levels of complexity and different business logics in the social and
health services commodities
• Information conditions vital for the market
• A natural tendency for big producers and concentration of the markets
• incentive structures in the market
• risks to be allocated by the market
• producer payment systems decisive
• Listing of clients to producers in the opening of the markets is a decisive act
• Dependent on the regulation and institutions of the markets

11. -11
Primary
services
producer
Producer selected
by the used to
which the user
lists
himsels/hersselg
Public service
institutions of
the County
Services outside
the freedom of
choice
Assessment
of service
needs
(gatekeeper)
Producers of
services on the
bases of
vouchers and
personal
budgets
Finnish freedom of choice model

12. -2.11.2016 Alivaltiosihteeri Tuomas Pöysti12
Will it work?
Updates?
alueuudistus.fi
#sote #maakunta2019 #maakuntauudistus
@thpoysti