Health and social services reform
In Finland, as in the rest of Europe, the population is declining and its average age is increasing. Demographic changes have considerable impacts on macroeconomic indicators such as economic growth and investment. The change in the age ratio weakens public finances and poses challenges to the financing and organisation of public services.
Throughout the 2000s, Finland has sought to reform social welfare and healthcare in an attempt to address the following challenges:
- First, a rise in health and wellbeing inequalities — there are considerable differences for example in the mortality rates among population groups. Inequality is specifically related to educational background and professional status.
- Second, challenges in the availability of services. There have been specific problems in accessing non-urgent care in health centres, but also in specialised care, where patients wait for months to access non-urgent care in some special fields.
- Third, problems with the availability of personnel. There is a lack of educated and competent workforce: physicians, social workers, psychologists, and practical nurses working in the primary level especially in the services for older people.
- Fourth, access to services — the challenges include long distances and difficulties in organising local services in sparsely populated areas. Services that require high-level skills have been consolidated into the central hospitals of regional centres. Particularly demanding specialised care services are offered in five catchment areas. Services for people with a rare disease have been centralised into even fewer areas.
- Fifth, a growing demand for services — this is, above all, caused by the ageing of the population and by general expectations for the availability and quality of services
- And finally, rising costs — social welfare and healthcare costs have increased from close to 10 billion euros in 2000 to 21.7 billion euros in 2018. The reforms aim to curb the rise in costs.
The Government has started preparations for the health and social services reform according to the Programme of Prime Minister Sanna Marin's Government.
The reform would shift the focus of the healthcare and social welfare system towards basic-level services and prevention. The aim is that services will be integrated, care chains will run smoothly and people will get sufficient and effective services when they need them.
After the reform, the regions will produce services mainly as public services. The private and third sectors will supplement the service production. The health and social services reform will transfer the responsibility for organising health and social services to a new regional tier of administration, to the ‘wellbeing services counties’, which will be larger than municipalities. The responsibility for organising rescue services will also be transferred to the new counties.
There will be 22 wellbeing services counties and the city of Helsinki, which will organise health and social services itself. Separate legislation will be enacted on the functioning, finances and governance of the counties. Decision-making power in the counties will rest with directly elected councillors.
The new counties will receive most of their funding from the central government. The system for financing health and social services will be reformed so that it is structured on needs-based criteria. The Government has started parliamentary preparations to introduce county taxation. On their entry into force, the changes to the tax structure must not result in tax increases. The counties will be able to collect client fees laid down in legislation.
For more information, visit the Health and social services reform website maintained by the Ministry of Social Affairs and Health.