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Structures and reforms in Finnish health care system

Assistant Director General Marina Erhola

Marina Erhola / THL

Public health services in Finland• Municipalities have legislative responsibility to arrange health

care services for their residents– in addition to basic education and social services

• 336 municipalities in 2011 (415 in 2008)• Population varies from 800 inhabitants to 560 000

– the median being about 5 800• Municipalities can decide rather independently how services

are provided and their scope– legislation gives only general outlines

• Services are divided to primary health care and specialized health care– municipal specialized services are

provided mainly by 20 municipal federations (Hospital Districts)

13.5.2011 2Marina Erhola / THL

Finland is different EU country

13.5.2011 3Marina Erhola / THL

Historical perspective• Long tradition of strong municipal autonomy• Intense development of hospital sector in 1950s• Health centre –organisation developed in 1970s• National level steering of municipalities:

– Before 1993: steering by funding and guidelines– After 1993: ”information steering” – Early 2000s trend of increasing ”programme

steering”– Mid 2000s onwards: increasing steering by legislation

and ”stick”

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Challenges in terms of the service delivery system• The service delivery system in social and health

care has the support and appreciation of the public. • Challenges include:

– to control the growing costs– to meet the increasing public

demand for services– to ensure the supply of trained

professionals– to efficiently steer and manage the service system– Increasing inequalities in health and inequalities in

access to services.

Marina Erhola / THL

13.5.2011 6Marina Erhola / THL

Parliament elections 17.4.2011• Current government headed by Centre party in coalition

with National coalition party, Green Party and Swedish peoples party

• Parliament seats for four largest parties:– National coalition party 50 44– Social democratic party 45 42– True Finns party 539– Centre party 5135

• Result leads to major change in government– Implies change for example to EU policy and tax policy– Implications to health care system?

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Conclusions• Finnish health and social service system is under a

phase of intense reform– Larger shoulders for organizational responsibility– Integration of social services and health

services– Integration of primary care and specialised

care– Increasing co-operation between municipal

and private sector– Streamlining of financing system for health services

• THL is central actor in this process– research, information steering, evaluation and implementation

support

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13.5.2011 Marina Erhola / THL 9