Eeva Nykänen: Social and health care reform in Finland
WHY THE REFORM?
The population is ageing rapidly and there is a growing need for services but less
money to finance them.
Although the quality of care is regarded generally good, there are regional disparities
in access to and availability and quality of services.
Socioeconomic inequalities persist in Finland.
At present the responsibility to organize health and social services belongs to
municipalities (local authorities, 295 in mainland Finland), many of which are too
small and financially too weak to carry this responsibility.
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AIMS OF THE REFORM
Narrowing down the differences in people's health and wellbeing.
Enhancing equality and accessibility of health and social services.
Curbing costs: savings of EUR 3 billion by year 2030
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KEY POINTS OF THE REFORM
Establishment of counties – a new level of governance – and responsibility to organize services
from municipalities to counties
Responsibility of financing, steering and monitoring the counties to central government
Integration of social and health services
Freedom of patient choice
Public, private and third party providers of services
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Responsibility to organize social and health services will be shifted from 295 municipalities to 18 counties.
The counties will have also other duties, such as rescues services, environmental healthcare, regional
The counties will constitute a new democratic and autonomous level of governance.
Autonomy of the counties will be limited – no right to levy taxes, strong state regulation.
In the organization of the county, the organizer-producer model will be applied: a service utility for the production
5 collaborative catchment areas
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State will finance the public health and social services as well as the other functions of the
The financing will flow through the counties to the service providers
State will steer the counties (functioning, investments, service structure).
State will monitor, evaluate and supervise the counties. If a county ‘fails’ it will be incorporated
into another county.
Compared with the current situation, the role of the central government will be stronger.
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INTEGRATION OF SOCIAL AND HEALTH CARE
Integration of social and health care is seen as a central tool for reaching
the aims of the reform:
– 10 % of population uses 80 % of social and health care costs, 5 % of
population who uses social and health care services uses 57 % of social
and health care costs
– integration of services would serve the needs of these population groups
Integration at the level of financing, organizing and producing the services
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FREEDOM OF PATIENT CHOICE
Right to choose a public, private or third sector social and health centre for primary health care
Right to choose the provider of services by a voucher issued by the county
Right to choose the provider of services by a personal budget in the services for ageing and disabled people
The county may set conditions for service providers
All providers which meet the conditions set in law and defined by the county must be approved (s&h centres and
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PUBLIC, PRIVATE AND THIRD PARTY PROVIDERS
Services within the scope of the Act on Freedom of Patient Choice
will be provided by public, private and third-sector operators.
There must always be public production available (19 §+124 § of
The counties are responsible for making sure that public, private
and third-sector services work seamlessly together, that information
flows smoothly and that the services meet quality criteria.
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CURRENT STATE OF THE REFORM
The legislative package which comprised of more than 40 laws is being
processed by the Parliament.
The recast version of the Act on Freedom of Choice is being discussed by
the Constitutional Law Committee
The legislative package should enter into force on 1.7.2018, the
responsibility for services will be shifted to counties on 1.1.2020.
But… will the Parliament approve the package?
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Finland’s forthcoming health and social services reform is
revolutionary in its scope and impact, even in the international
context. Implementation of the reform is a challenging task.
The increased size of the organizers and the strengthening of their
economic capacity may lead to reduced inequalities in health and
wellbeing. But will they be strong enough?
Managing the system of freedom of choice will require strong
resources which some of the counties will not necessarily have.
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Plans to slow the rate of expenditure growth are ambitious. Is there
a risk of underfunding the health and social care system? How to
Are there sufficient tools to prevent disruption of integration?
The time frame for implementing the reform?
Yet, the reform is necessary…
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Integration of health and social care – predicting the quality, costs and consequences 17.4.2018.