Hostname: page-component-669899f699-tzmfd Total loading time: 0 Render date: 2025-04-29T04:03:13.279Z Has data issue: false hasContentIssue false
  • English
  • Français

Health reform in Finland: current proposals and unresolved challenges

Published online by Cambridge University Press:  11 February 2016

Richard B. Saltman  and
Juha Teperi
Richard B. Saltman*
Affiliation:
Professor of Health Policy and Management, Rollins School of Public Health, Atlanta, USA
Juha Teperi
Affiliation:
Dean, School of Health Sciences, University of Tampere, Tampere, Finland
*
*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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Type
Articles
Information
Health Economics, Policy and Law , Volume 11 , Issue 3 , July 2016 , pp. 303 - 319
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

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.Google Scholar
Bank of Finland (2014), Euro & Talous no. 5 Helsinki: Bank of Finland.Google Scholar
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].Google Scholar
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.Google Scholar
Crouch, D. (2014), ‘PM calls for “strict discipline” after Finland downgrade’. Financial Times, 11 October.Google Scholar
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.Google Scholar
Federation of Finnish Financial Services (2015), Statistical series. https://www.fkl.fi/tilastot/Tilastot/FK-Tilasto-Sairauskulutilasto2009062015.pdf [5 January 2016].Google Scholar
Haro, A. S. and Purola, T. (1972), ‘Planning and health policy in Finland’, International Journal of Health Services, 2(1): 23–34.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
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.Google Scholar
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): 3163–3169.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
Mossialos, E. A. and Thomson, S. (2004), Voluntary Health Insurance in the European Union, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Mutuals Taskforce (2014), Public Service Mutuals: The Next Steps. A Mutuals Taskforce Report, London: Cabinet Office.Google Scholar
National Institute for Health and Welfare (2015a), Health Expenditure and Financing in 2013, Helsinki: National Institute for Health and Welfare.Google Scholar
National Institute for Health and Welfare (2015b), Hospital Productivity in 2013, Helsinki: National Institute for Health and Welfare.Google Scholar
OECD (2015), How does Health Spending in Finland Compare? Paris: OECD.Google Scholar
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.Google Scholar
Pavolini, E. and Guillen, A. M. (eds) (2013), Health Care Systems in Europe under Austerity, London: Palgrave MacMillan.CrossRefGoogle Scholar
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: 147–193.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
Saltman, R. B. (1988), ‘National planning for locally controlled health systems: the finnish experience’, Journal of Health Politics Policy and Law, 13: 27–51.CrossRefGoogle ScholarPubMed
Saltman, R. B. (2008), ‘Decentralization, re-centralization and future European health policy’, European Journal of Public Health, 18(2): 104–106.CrossRefGoogle ScholarPubMed
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, 21–32.Google Scholar
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.Google Scholar
Saltman, R. B. and Bankauskaite, V. (2006), ‘Conceptualizing decentralization in European health systems: a functional perspective’, Health Economics, Policy and Law, 1(2): 127–147.CrossRefGoogle ScholarPubMed
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.Google Scholar
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: 573–578.CrossRefGoogle ScholarPubMed
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.Google Scholar
Timmans, N. (2015), ‘The bitter truth is that the NHS needs more sweeping reform’, Financial Times, 9 January.Google Scholar
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.Google Scholar
Voipio-Pulkki, L.-M. (2014), Personal communication, 15 December.Google Scholar
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.Google Scholar
WHO (1978), Declaration of Alma Ata, Geneva: WHO.Google Scholar
WHO (1991), Health for All Policy in Finland, Copenhagen: WHO Regional Office for Europe.Google Scholar
YLE (2015), http://yle.fi/uutiset/suurten_ikaluokkien_elakoityminen_on_lievittanyt_tyottomyytta/7748980 [5 January 2016].Google Scholar