Health and social care reform in Finland Anneli Milen Associate Professor, National Institute for Health and Welfare (THL), Finland esn-eu.org
Health and Social Care Reform in Finland Chief Expert Anneli Milen 100
A highly decentralised system 300 municipalities Average size of 5,000 inhabitants Local authorities are self-governing entities Right to collect taxes Local authorities are responsible for: Supporting health and wellbeing of inhabitants Organise and finance universal (not integrated) primary health care, primary social welfare and, specialised medical care = 50% of municipal budget + education, culture, environment & technical infrastructures 101
Health and social care: many structures Municipalities have to form joint areas to provide: Specialised medical care (20 areas) Highly- specialised medical care (5) Specialised social services (15) Municipalities Some municipalities joined each other to provide primary health and social services 102
What triggered the need to reform 1/3 Expansion of hospitals out- and inpatient care more funds attracts physicians financially too heavy for small municipalities Expansion of Occupational Health Care (tripartite funding) beyond prevention, mainly provided by private (big) providers attracts physicians parallel system to public health care Public primary level health care deteriorating due to less funding shortage of physicians long waiting times to general practitioner 103
What triggered the need to reform 2/3 Separate funding streams for health National steering of 300 actors difficult Ageing population Institutional care: extensive and expensive Finland: empty rural areas, urban centres, dense South Increasing inequalities Increased demand for services New technology for home-based care 104
What triggered the need to reform 3/3 Accumulation of social and health problems focus on patient/client need for integrated services Also ideologies not in strong support of traditional welfare state: - efficiency through full liberalisation - freedom of choice - economies of scale - production of services rather than population health - financial crisis austerity measures 105
Attempts to increase the areas for social and health care 2007- Voluntary merging of municipalities 2011- New government: tried to force merging of municipalities Draft Act: municipalities to form five areas rejected 2015- New government - new approach 106
Social and health care reform PLANS Government programme May 2015, no decisions made! Proceeds in phases Objectives (political) Reduction of health inequalities Reduction of costs Economies of scale Full integration Freedom of choice (to be decided, tbd) Tendering- competition (tbd) One channel of financing (tbd) 107
New regional governance structures Number to be decided (highly political): 5-19 Self-governance; council through general elections Right to collect taxes? Responsibility for all health and social services Promotion of health and wellbeing to remain with municipalities Gradually other responsibilities (sectors) added 10/11/2015 Anneli Milen/ THL 108
Provision and purchasing of services: Provides social and health services itself or Purchases from a municipality/-ties if it has a company or Private sector or Other non-state organizations Transfer of social and health care property from municipalities to regions? 109
Financing social welfare and health services Funded by state, later right to collect taxes? Proceeding via a single funding stream? Budgetary framework not to be exceeded to ensure effective governance 110
Concerns 1/2 Major changes Objectives sufficient? - reduction of health inequalities - cost-efficiency Effective strategies to achieve the objectives? - extensive horizontal and vertical integration - strengthening the economical carrying capacity of the areas Linkage between promotion of health & welfare and the services? 111
Concerns 2/2 Focus is strongly on structures The reform is so far health-driven, what about social welfare and social services? Integration with other services, for instance employment? Timetable is (too?) tight Expectations are high and numerous 112
Conclusions Finnish health and social care system is embarking upon an intense reform Larger areas: more finances and other resources Integration of social and health services Integration of primary care and specialised care incl. hospitals Private sector is increasing its involvement (freedom of choice) Streamlining of financing system for health services THL is a central actor in this process research, information steering, evaluation and implementation support 113
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