Health, social services and regional government reform In accordance with the government proposal on the health, social services and regional government reform and on the draft legislation on the freedom of choice for clients
One operator 2 9.5.2017
Cornerstones of the new health and social services 1. Strong organiser 18 counties 2. Services integration service packages adjusted to residents needs right and timely care and services given by skilled personnel smooth service chain in line with population s and clients needs 3. Freedom of choice supports clientoriented approach, selfdetermination and utilisation of competition 4. Curbing the increase of costs costs reduced by EUR 3 billion by the end of 2029 timely services best practices and most effective services and treatments 5. Digitalisation everyday life is digitalised information flows well and data systems are compatible data is used for management 3 9.5.2017
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Why is the reform needed? The growing need for services especially among the ageing population. Access to services varies in different parts of the country. Rising costs and slow economic growth. 5 9.5.2017
Current Situation: Organising Social and Health Services in Mainland Finland Health services Municipalities (local authorities, 295 in mainland Finland) are responsible for arranging health services Hospital districts (20 in total) are responsible for specialised medical care. A municipality has to be part of a hospital district to arrange specialised medical care. 5 specific catchment areas are responsible for arranging highlyspecialised medical care Social services Municipalities (local authorities) are responsible for arranging social services Municipalities are members in joint municipal authorities of special welfare districts (15+1 in total) that arrange services for people with developmental disabilities.
The Health and Social Services Reform 18 counties will be established. Counties will have responsibility for social and health services Also some other duties will be under the responsibility of the counties 5 cooperative areas based on existing specific catchment areas Counties will be managed by elected councils Central government funding More freedom of choice for customers
Aims of the reform Equal access to services Integration between health and social services, and primary and specialised level services Cutting the growth of costs in a long term (from 2019 to 2029) from estimated 2,4 % to 0,9 %, which would lead to 3 billion euros cost cut 8 9.5.2017
New structure of health and social services 9 9.5.2017
What is important to residents? Health and social services will be reformed: Your will always get a response. You will have faster access to doctors and social workers. Emergency number 112 and emergency care services continue to operate. You ll have more freedom to choose services. Electronic services make things easier for you. 10 9.5.2017
Local services will be more versatile New kinds of local health and social services will be offered at different units: A wider range of digital services and guidance available to support your wellbeing Home services: family workers at child health clinics services for the elderly prehospital emergency medical services Mobile services, such as mobile dental clinic 11 9.5.2017
Promotion of wellbeing a collective responsibility A shared duty of municipalities and counties Counties will receive financing Counties will offer expertise to municipalities Organisations involved as cooperation partners 12 9.5.2017
Public health work and structural social work into focus again Emphasis on a stronger primary level instead of focusing on hospitals Primary services given at health and social services centres supplemented by demanding consultation services (by medical specialists and social work professionals) The model of financing will change significantly: it will be based on residents needs New, personalised service model and assessment of service needs combined with the promotion of health and wellbeing of the whole population 13 9.5.2017
Financing and property 14 9.5.2017
Financing of the counties 1 15 9.5.2017
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Health and Social Services 17 9.5.2017
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Updated work division between hospitals Certain specialities will be centralised on the basis of researched information. The current hospital network is based on service dimensioning from 30 40 years ago. Clinical practices have developed and hospital visits shortened. Large enough number of patients secures highlevel professional skills and highquality treatment. 20 9.5.2017
Freedom of choice for clients 21 9.5.2017
Freedom of choice briefly Clients freedom of choice in health and social services is wider than at present. The goal is that freedom of choice will give people faster access to health and social services and increase their chances to influence their services. In the future, you will have more freedom to choose the provider of your health and social services. You can choose a health and social services centre and a dental clinic from public or private operators. They provide services that are funded publicly. Client fees are the same for the same service, irrespective of service provider. In emergencies you can call 112 or go to the nearest urgent and emergency care services, just as before. The wider freedom of choice is part of the health and social services reform. 22 9.5.2017
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Health and social services centres and dental clinics Clients can choose a health and social services centre and a dental clinic where they will be clients at least a year. In a health and social services centre clients can get nurses and GPs services, guidance and advice by social welfare professionals, and shortterm social services. Counties can decide that health and social services centres provide even maternity and child health clinic services. Clients can get a health and social services voucher from a health and social services centre or dental clinic for buying a particular service (such as physiotherapy or orthodontic care) from other private providers. 24 9.5.2017
Services of unincorporated county enterprises Unincorporated county enterprises provide services that are not available in health and social services centres or dental clinics (emergency services, most of specialised medical care and social services). Clients can choose a unit, such as a hospital or social services clinic, from anywhere in Finland. Unincorporated county enterprises also assess, when necessary, the client s need for services and draw up a client care plan. Clients can be granted a health and social services voucher or a personal budget for getting the services they need. 25 9.5.2017
What is a health and social services voucher? Health and social services centres, dental clinics or unincorporated county enterprises can grant their clients health and social services vouchers. Clients can use the voucher to buy a particular service, or a set of services up to a certain amount, from private providers. Clients can be get a services voucher for buying a particular service from some other service provider even when the service is available at the health and social services centre or dental clinic. Clients can also get a services voucher from their unincorporated county enterprise for a particular service or to get services recorded in their client care plan when the county has introduced the voucher in those services. Clients can choose a registered service provider, approved by one of the counties, from anywhere in Finland. The client fee is the same for the same service. Responsibility for clients services as a whole and for service quality and costs remains with the health and social services centre, dental clinic or unincorporated county enterprise even when clients are using vouchers. The county decides the services where services vouchers can be used. 26 9.5.2017
Individual services with a personal budget Clients can decide themselves where to get the services recorded in their client care plan and what kind of assistance or support would best suit them. Counties are obliged to grant a personal budget for clients receiving services for older people and people with disabilities when they need extensive assistance on a longterm basis and are able to plan their services by themselves or assisted. With the personal budget clients can choose services provided by third and privatesector operators. The service providers receive compensation from the counties for services delivered against personal budgets. Clients do not get money from the counties. 27 9.5.2017
Clients can ask for a particular care provider Clients can ask for a particular care provider or a multiprofessional group of care providers when they need nonurgent services. Clients wishes are followed as far as possible. The goal is a continuity of services: a client could always meet the same care provider when dealing with same issue. The continuity of care relationships is particularly important for those clients who need care or services on a longterm basis. Waiting times could be longer for the care provider a client have asked for. 28 9.5.2017
Clients get information about services The counties are responsible for ensuring that residents have sufficient information for making choices. The counties maintain online information about service providers and the quality and availability of services. Information about services, client numbers and waiting times are published online by health and social services centres, dental clinics, and service providers delivering services against health and social services vouchers and personal budgets. Service providers must issue reports on revenue, taxes, profit, loss, management salaries and corporate social responsibility, etc. The Act on the Openness of Government Activities applies to all service providers. 29 9.5.2017
Clients right to choose 30 9.5.2017
Freedom of choice from the counties perspective Counties are responsible for organising publicly funded health and social services in their area. Counties are responsible for ensuring that all residents get the services they need and that different providers services form a wellfunctioning system. Counties ensure that there is freedom of choice. Counties decide which specialised and demanding services can be delivered against health and social services vouchers. Counties can decide to introduce personal budgets in more services than required by law. Counties decide on the details of compensation to service providers. There is no competitive tendering for services within the scope of freedom of choice. All operators meeting the requirements can provide the services. 31 9.5.2017
Counties as service providers Counties must divide their service provision between an unincorporated county enterprise and one or more county companies: Unincorporated county enterprises can provide services by themselves, open them up to competition and buy services for their clients Unincorporated county enterprises grant clients health and social services vouchers or personal budgets in services decided by the county and leave the choice of service provider for the client. Counties must corporatise the services available on the market (health and social services centres, dental clinics and services delivered against health and social services vouchers. 32 9.5.2017
Providers of health and social services centres and oral health services units The providers must: be registered meet the requirements set in the legislation and the conditions set by the county and make an agreement with the county publish all required information online and accept all clients unless their client list is full take responsibility for the client s services as a whole guide the client, when necessary, to the unincorporated county enterprise for an assessment of need for services Service providers receive compensation from the county. 33 9.5.2017
Providers delivering services against health and social services vouchers and personal budgets Any provider registered with the national supervisory authority can deliver services against health and social services vouchers and personal budgets. Providers delivering services against health and social services vouchers must also be approved by one of the counties. The service providers must publish all required information in a national online service All providers delivering services against health and social services vouchers receive the same compensation for the same service. The level of compensations may, however, vary by county. 34 9.5.2017
Small, mediumsized and micro enterprises as service providers SMEs and micro enterprises have good chances of becoming service providers that deliver services against health and social services vouchers and personal budgets. Moreover, health and social services centres can supplement their own service provision by purchasing services from SMEs and micro enterprises either through competitive procurement or direct procurement. Unincorporated county enterprises can also purchase services from SMEs and micro enterprises through competitive procurement or direct procurement. SMEs and micro enterprises can even in future provide support services (e.g. cleaning, catering) to service providers in the county. SMEs and micro enterprises can operate as health and social services centres by means of cooperation agreements or joint enterprises (e.g. cooperative), while mediumsized enterprises can operate as centres independently. 35 9.5.2017
Legislation By 2019 there would be the following main acts concerning health and social services provided by public and private operators: Structures: act on organising health and social services Providers: act on the operating conditions, registration and supervision of health and social services providers Service content: healthcare act, social welfare act and other relevant legislation Clients freedom of choice: act on clients freedom of choice in health and social services Clients rights and obligations: acts on the status and rights of clients in health and social services, act on the right of selfdetermination, act on client fees in health and social services Personnel: acts on qualification requirements for healthcare and social welfare professionals 36 9.5.2017
Act on the Provision of Health and Social Services The Service Provision Act would prescribe for the right to provide health and social services that are the counties responsibility to organise as well as (fully) private health and social services. The Act will seek to ensure the safety of the client and patient as well as good, highquality services. The aim is to promote cooperation between service providers and the authorities by reducing the administrative burden on entrepreneurs, among other things. 37 9.5.2017
Requirements for service providers All providers of health and social services must meet the basic requirements before they can become registered service providers (Service Provision Act). The counties can make additional demands on the service providers (Freedom of Choice Act). The authorities must inspect beforehand hospitals and units providing demanding social welfare services. Prior inspection will not be necessary if the provider has in place a certified quality management system (Service Provision Act). 38 9.5.2017
Client in the jungle of freedom of choice? One party always bears the responsibility for a person s treatment and care Clear and understandable information available for making comparisons Support available for making choices Client care plan 60% of residents: occasional need for services 40% of residents: wider need for services 39 9.5.2017
Residents with many illnesses desired clients? Clients predicted needs for services affect the financing to service providers Providers incentives will be based on care results Overtreatment and undertreatment will be prevented Sanctions 40 9.5.2017
County s own service provision County also need to provide services which are not offered by the health and social services centre, for example social services, 24hour services and specialised medical care. The client can choose a public sector service unit amongst all public units in the country. The public care facility for specialised medical care will be chosen together with the referring GP 41 9.5.2017
Counties will have responsibility for services. The health and social services centre and the unit for dental services are responsible for all services assigned to them. 42 9.5.2017
Freedom of choice will be extended in stages In some counties wider freedom of choice can be introduced already this year through pilots experimenting with health and social services centres and personal budgets. The Freedom of Choice Act is due to come into force on 1 January 2019. From that date onwards clients could choose their dental clinic and start using health and social services vouchers and personal budgets. 2017 2019 Other counties not participating in the pilots would establish their health and social services centres by 1 July 2019. By special permit counties could postpone the establishment of their health and social services centres until the beginning of 2021. The new types of health and social services centres with a full range of services would be in place in all counties by 1 January 2023. 2023 43 9.5.2017
Service provision 44 9.5.2017
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How to curb cost increase? The level of central government financing will be determined on the basis of population figure and service needs. Better productivity and better effects; practices need to be changed: timely help early support for families new kinds of health and social services centres maintaining the functional capacity of the elderly fewer people in need of inpatient care new division of duties between hospitals service coordinators help clients that need a lot of support digital services 47 9.5.2017
Do we know how tax money is used? Central government steering will be strengthened. Creamskimming by private businesses will be restricted: Counties decide on financing Financing to service providers based on capitation and performance Clients able to vote with their feet Corporate social responsibility included in law: taxrelated information must be published Incentives and sanctions 48 9.5.2017
Digitalisation 49 9.5.2017
Digitalisation: new kinds of services Through digitalisation, services can be provided in completely new ways, and processes enhanced. Electronic services also encourage residents to independently maintain their functional capacity and health. Basic principle of ICT solutions: client information can be used across the boundaries of organisations and regions. 50 9.5.2017
regionalreform.fi MINISTRY OF SOCIAL AFFAIRS AND HEALTH MINISTRY OF FINANCE 51 9.5.2017