Government proposes freedom of choice in health and social services
The Government proposes to increase clients’ freedom of choice as part of the regional government, health and social services reform. On 8 March the Government submitted to Parliament a proposal on the legislation on freedom of choice.
Freedom of choice means that clients have the right to choose themselves where to get health and social services. Clients would have more freedom to choose the service providers that best suit them. The purpose is to increase clients’ possibilities of influence as well as improve the availability, quality and cost-effectiveness of services.
Publicly funded health and social services would be provided by public, private and third-sector operators. The goal is to give clients faster access to care and services. Healthcare and social welfare professionals would still first assess what kinds of services each client needs.
Clients would have more freedom of choice
Freedom of choice would mean that individuals sign up as clients with the health and social services centre and dental clinic (oral health unit) of their choice. Health and social services centres would provide health services and advice and guidance on social services. They would also provide specialist services in at least two specialties, which would be decided by the county.
The unincorporated county enterprises would operate their own health and social services centres and dental clinics, and they would also provide all social services and other health services. These would include family centres’ services, school healthcare, home care, and specialised healthcare in hospitals.
The unincorporated county enterprises would be obligated by law to grant health and social services vouchers for certain services. Clients could use the services voucher to get a service from another service provider. The county enterprises should grant services vouchers for home care, housing service and medical rehabilitation, among other services. They should also grant a services voucher if they are unable to provide a service within the maximum waiting times. Counties could introduce the services voucher to a wider range of services as long as the functioning of services is not affected.
Those clients who have an extensive and long-term need for assistance could be granted a personal budget. They could use the personal budget to get services, such as a personal assistant, that best suit their individual situation.
The new freedom of choice model would be client-oriented, and services would be organised so that they respond to clients’ needs instead of organisations’ needs. The counties’ task would be to create integrated service packages for different client groups, such as those who need mental health and substance abuse services. There could be several service providers, and they would be committed to complying with the service packages and care paths defined by the county.
Clients would get more information about service quality
The act would give the counties and service providers an obligation to ensure that clients get advice and guidance. Clients would get more information about the quality of health and social services and about waiting times. Moreover, service providers operating health and social services centres and dental clinics and service providers delivering services against health and social services vouchers would be obligated to issue annual reports on revenue, taxes paid and place of taxation, profit and loss, management salaries and bonuses as well as on corporate social responsibility, among others.
Compensation to providers would take into account different kinds of clients
The counties would receive their funding from the state. The counties would be responsible for ensuring that their residents get the services they need. They would pay the service providers compensation for the clients treated.
The compensation to service providers would take into account factors, such as age and morbidity, which affect clients’ need for services. This means that the counties would pay a higher compensation for clients who are older or more ill. The counties could pay additional compensation to service providers operating in remote areas and offer incentives based on care and service outcomes.
Health and social services centres and unincorporated county enterprises could supplement their own service provision by purchasing services from private and third-sector operators. Small enterprises, too, would have good chances of becoming service providers that deliver services against health and social services vouchers and personal budgets.
It is estimated that the services organised within the scope of freedom of choice would account for some 29 per cent of the health and social services organised by the counties. This would mean that the funding for freedom of choice would be around EUR 5.3 billion at the 2016 prices, while the funding for all public health and social services would be EUR 18.6 billion.
Freedom of choice would be extended in stages
Parliament will decide in June 2018 whether to accept the proposed Freedom of Choice Act. The objective is that the counties would start organising public health and social services at the start of 2020. As of autumn 2019 clients would be able to choose the unincorporated county enterprise, and thereby the county, which they want to use to get the services they need. The counties would introduce the health and social services voucher and personal budget by 1 July 2020 at the latest. Health and social services centres would start operating by 1 January 2021 and dental clinics by 1 January 2022.
Since the preparations are progressing at different paces in different counties, some counties will have a wider freedom of choice already in 2018–2021 through pilot projects involving health and social services centres and oral health units. Pilot projects involving health and social services vouchers and personal budgeting will be carried out in 2018–2019.
Wide-ranging impact assessment of the legislative proposal
Impact assessment has been revised based on the consultation round and the proposals of the Finnish Council of Regulatory Impact Analysis. The impact assessment shows that the freedom of choice model will improve access to basic-level services and people’s possibilities to get services on an equal footing. It also indicates that the legislative proposal will both increase and curb public spending. The way the reform is implemented in different counties determines the impacts of the freedom of choice model.
Kirsi Varhila, Director-General, Ministry of Social Affairs and Health, tel. +358 295 163 338
Hanna-Maija Krause, Special Adviser to Minister Saarikko, tel. +358 295 163 109