Senior Medical Adviser
Association of Finnish Local and Regional Authorities
Finland is a large country with an area of approximately 330,000 sqkm – in fact, the sixth-largest in Europe – yet it is scarcely populated (on average, 15.5 persons per sqkm). Indeed, most municipalities have few residents: there are 81 local authorities with fewer than 2,000 inhabitants, and 173 with 2,000–6,000. Municipalities are responsible for organising and running primary healthcare centres, which also provide maternity and child welfare clinics, school healthcare, medical rehabilitation and dental care. To date, the 400 municipalities have formed over 250 primary healthcare centres, which provide services to the 5.3 million total population. There are considerable demographic as well as financial differences between municipalities. The local authorities also make up 20 regional hospital districts which provide specialised care; five of the central hospitals serve as academic teaching hospitals. Until now, primary and specialised healthcare have operated under separate legislations.
Since the introduction of the so-called Care Guarantee Laws in 2005, surgical waiting lists have virtually disappeared, but access to primary care has become more difficult, particularly in rural areas. Although much has been done to improve phone and internet services as well as to promote nurse-led services, a shortage of general practitioners is halting service expansion in many healthcare centres, not only in remote locations but also in some urban areas. In order to reduce the vulnerability of the smallest primary healthcare centres and to take into consideration the changing needs of the population – in particular families and elderly people – the Finnish parliament recently set a minimum population figure of 20,000 for municipalities or municipal partnerships that organise primary healthcare and associated social services.
This reform is part of a national project launched in 2005 to restructure municipalities and services. Its goal is to create a system that ensures high-quality public services for all and is still viable in 2020. It focuses on the potential for local authorities to provide the structural and financial foundations for the national welfare system. The Framework Act that guides the reform will be in operation until 2011; assessments of the implementation process will be carried out in 2009 and 2012.
The service structure reform will be supported by several reforms affecting healthcare per se. The most important projects include adoption of a uniform electronic healthcare record and archiving system between now and 2011, and health promotion programmes, including ones promoting the wellbeing of children, young people and families. Special attention will also be paid to reducing socioeconomic health inequalities, to the development of a national patient safety network, and to the implementation of a new directive on screening. The impact of the new Public Procurement Act, passed this year, which affects the acquisition of services by local authorities, has yet to be gauged. Finally, revision of public healthcare and specialised hospital care legislation will be debated in 2008.