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Health reform in Finland: current proposals and unresolved challenges

  • Richard B. Saltman (a1) and Juha Teperi (a2)
Abstract

The Finnish health care system is widely respected for its pilot role in creating primary-care-led health systems. In the early 1990s, however, a severe economic downturn in Finland reduced public funding and weakened the Finnish system’s deeply decentralized model of health care administration. Recent Bank of Finland projections forecasting several decades of slow economic growth, combined with the impact of an aging population, appear to make major reform of the existing public system inevitable. Over the last several years, political attention has focused mostly on administrative consolidation inside the public sector, particularly integration of health and social services. Current proposals call for a reformed health sector governance structure based on a new meso-level configuration of public administration. In addition, Finland’s national government has proposed replacing the current multi-channel public funding structure (which includes health insurance subsidies for occupational health services) with a single-channel public funding structure. This commentary examines several key issues involved in reforming the delivery structure of the Finnish health care system. It also explores possible alternative strategies to reform current funding arrangements. The article concludes with a brief discussion of implications from this Finnish experience for the wider health reform debate.

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Corresponding author
*Correspondence to: Richard B. Saltman, Professor of Health Policy and Management, Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA 30322, USA. Email: rsaltma@emory.edu
References
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Anell, A., Glenngard, A. H. and Merkur, S. (2012), Sweden: Health System Review. Health Systems in Transition Series Volume 14 No. 5 Brussels: European Observatory on Health Systems and Policies.
Bank of Finland (2014), Euro & Talous no. 5 Helsinki: Bank of Finland.
Bank of Finland (2015), Talouden nakymista, Budjettiriihi 9.9.2015, http://www.suomenpankki.fi/fi/suomen_pankki/ajankohtaista/puheet/Documents/Budjettiriihi-syyskuu-2015-lehdistoversio.pdf [5 January 2016].
Carr, S. and Robbins, D. (2009), The Implementation of Individual Budget Schemes in Adult Social Care, Research briefing 20. London: Social Care Institute for Excellence.
Crouch, D. (2014), ‘PM calls for “strict discipline” after Finland downgrade’. Financial Times, 11 October.
Erhola, M., Vaarama, M., Pekurinen, M., Jonsson, P. M., Junnila, M., Hämäläinen, P., Nykänen, E. and Linnosmaa, I. (2014), SOTE-Uudistuksen Vaikutusten Ennakkoarviointi [A Forecast of the Effects of “SOTE” Reform. In Finnish], Helsinki: National Institute for Health and Welfare. http://urn.fi/URN:ISBN:978-952-302-176-1.
Federation of Finnish Financial Services (2015), Statistical series. https://www.fkl.fi/tilastot/Tilastot/FK-Tilasto-Sairauskulutilasto2009062015.pdf [5 January 2016].
Haro, A. S. and Purola, T. (1972), ‘Planning and health policy in Finland’, International Journal of Health Services, 2(1): 2334.
Jakobowski, E. and Saltman, R. B. (2013), The Changing National Role in Health System Governance, Observatory Studies Series 29. Brussels: European Observatory on Health Systems and Policies.
Kautto, M. (2000), Two of a kind? Economic Crisis, Policy Responses and Well-being During the 1990’s in Sweden and Finland. A Report from the Government Commission: A Balance Sheet for Welfare of the 1990’s, SOU 2000:83. Stockholm: Ministry of Health and Social Affairs.
King’s Fund (2014), A New Settlement for Health and Social Care. Final Report of the Commission on the Future of Health and Social Care in England, London: King’s Fund.
Leskelä, R.-L., Komssi, V., Sandström, A., Pikkujämsä, S., Haverinen, A., Olli, S.-L. and Ylitalo-Katajisto, K. (2013), ‘Heavy users of social and health care services in the city of Oulu’, Finnish Medical Journal, 68(48): 31633169.
Magnussen, J., Vrangback, K. and Saltman, R. B. (eds) (2009), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, London: Open University Press/McGraw-Hill Education.
Maresso, A., Mladovsky, P., Thomson, S., Sagan, A., Karanikolos, M., Richardson, E., Cylus, J., Evetovits, T., Jowett, M., Figueras, J. and Kluge, H. (eds) (2015), Economic Crisis, Health Systems, and Health in Europe: Country Experiences, Occasional Series 41. Brussels: European Observatory on Health Systems and Policies.
Ministry of Social Affairs and Health (2015), Reports of the Ministry of Social Affairs and Health 19: A Report on Alternative Ways to Dismantle the Multi-Channel Funding System. Helsinki: Ministry of Social Affairs and Health. ISBN:978-952-00-3579-2.
Mossialos, E. A. and Thomson, S. (2004), Voluntary Health Insurance in the European Union, Brussels: European Observatory on Health Systems and Policies.
Mutuals Taskforce (2014), Public Service Mutuals: The Next Steps. A Mutuals Taskforce Report, London: Cabinet Office.
National Institute for Health and Welfare (2015a), Health Expenditure and Financing in 2013, Helsinki: National Institute for Health and Welfare.
National Institute for Health and Welfare (2015b), Hospital Productivity in 2013, Helsinki: National Institute for Health and Welfare.
OECD (2015), How does Health Spending in Finland Compare? Paris: OECD.
Olejaz, M., Nielsen, A. J., Rudkobing, A., Birk, H. O., Krasnik, A. and Hernandez-Quevado, C. (2012), Denmark: Health System Review. Health Systems in Transition Series, Brussels: European Observatory on Health Systems and Policies.
Pavolini, E. and Guillen, A. M. (eds) (2013), Health Care Systems in Europe under Austerity, London: Palgrave MacMillan.
Puska, P., Nissinen, A., Tuomilehto, J., Salonen, J. T., Koskela, K., McAlister, A., Kottke, T. E., Maccoby, N. and Farquhar, J. W. (1985), ‘The community-based strategy to prevent coronary heart disease: conclusions from the ten years of the North Karelia project’, Annual Review of Public Health, 6: 147193.
Raivio, R., Jaaskelainen, J., Holmberg-Martilla, D. and Mattila, K. J. (2014), ‘Decreasing trends in patient satisfaction, accessibility and continuity of care in Finnish primary health care – a 14-year follow-up questionnaire study’, BMC Family Practice, 15(1): 98.
Ringard, A., Sagan, A., Saunes, I. S. and Lindahl, A. K. (2013), Norway: Health System Review. Health Systems in Transition Series, Volume 15 No. 8. Brussels: European Observatory on Health Systems and Policies.
Saltman, R. B. (1988), ‘National planning for locally controlled health systems: the finnish experience’, Journal of Health Politics Policy and Law, 13: 2751.
Saltman, R. B. (2008), ‘Decentralization, re-centralization and future European health policy’, European Journal of Public Health, 18(2): 104106.
Saltman, R. B. and DuBois, H. F. W. (2004), ‘The Historical and Social Base of Social Health Insurance Systems’, in R. B. Saltman, R. Busse and J. Figueras (eds), Social Health Insurance Systems in Western Europe, European Observatory on Health Care Systems Series. London: Open University Press, McGraw-Hill Education, 2132.
Saltman, R. B., Busse, R. and Figueras, J. (eds) (2004), Social Health Insurance Systems in Western Europe, European Observatory on Health Care Systems Series. London: Open University Press, McGraw-Hill Education.
Saltman, R. B. and Bankauskaite, V. (2006), ‘Conceptualizing decentralization in European health systems: a functional perspective’, Health Economics, Policy and Law, 1(2): 127147.
Saltman, R. B., Duran, A. and Dubois, H. W. F. (eds) (2011), Governing Public Hospitals: Recent Strategies and the Movement Toward Institutional Autonomy, Brussels: European Observatory on Health Systems and Policies.
Tarkiainen, L., Martikainen, P., Laaksonen, M. and Valkonen, T. (2012), ‘Trends in life expectancy by income from 1988 to 2007: decomposition by age and cause of death’, Journal of Epidemiology and Community Health, 66: 573578.
Thomson, S., Figueras, J., Evetovits, T., Jowett, M., Mladovsky, P., Maresso, A., Cylus, J., Karanikolos, M. and Kluge, H. (2014), Economic Crisis, Health Systems, and Health in Europe: Impact and Implications for Policy, Brussels: European Observatory on Health Systems and Policies.
Timmans, N. (2015), ‘The bitter truth is that the NHS needs more sweeping reform’, Financial Times, 9 January.
van Doorslaer, E. and Masseria, C., OECD Health Equity Research Group (2004), ‘Income-related inequality in the use of medical care in 21 OECD countriess’, in OECD (ed.), The OECD Health Project. Towards High-Performing Health Systems, Paris: OECD, 109--140.
Voipio-Pulkki, L.-M. (2014), Personal communication, 15 December.
Vuorenkoski, L., Mladovsky, P. and Mossialos, E. A. (2008), Finland: Health System Review, Health Systems in Transition Series, Volume 10 No. 4. Brussels: European Observatory on Health Systems and Policies.
WHO (1978), Declaration of Alma Ata, Geneva: WHO.
WHO (1991), Health for All Policy in Finland, Copenhagen: WHO Regional Office for Europe.
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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
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