Finland’s historic social and health care reform

"For Finnish society, shifting responsibility for arranging social welfare and health services from municipalities to larger regions is matter of fundamental importance and principle," says MSAH Permanent Secretary Päivi Sillanaukee.

The provision of equal and sufficient services nationwide is no longer possible for individual municipalities. People live longer and the demand for services has grown. Welfare, health, technology, medicine, and new forms of treatment have developed leading to better opportunities and bigger expectations. Larger organisational units are needed to secure and finance services.

The decision reached at the end of March on the model for the structural reform of social welfare and health services (known as SOTE) envisages service organisation in five regions in Finland. According to the model, the threshold of primary health care and specialised treatment will be lowered, as both are organised at the same source. There will also be better service coordination, as social services will be integrated into the overall structure.

Legislation will be simplified. There will be only five main players responsible for an overall entity that is very broad and very similar in terms of content.

Organisational responsibility will be arranged based on the current special responsibility areas, but even in the future municipalities too will be involved in producing services. Local services, such as health centres, home services for older people or social care services will remain close to communities.

"For a long time, no one has disputed the need for social welfare and health care reform. There has been consensus on the objectives. And now we have reached a common understanding on the model for the reform," explains Sillanaukee.

She points out that the preparation of the reform had to take account of a variety of boundary conditions: when is the Constitution an obstacle, when is it operational, the situation of personnel, management or options that have proved to be financially inferior and insufficient.

"Weighing up the different alternatives has eventually produced the world's best, most distinctive and pioneering solution. Decisions have broad support and are evidence and research based."

Sillanaukee says that a solution to the reform of social welfare and health services has now been found that can credibly reduce inequalities. It will also increase the productivity of public finances, as overlapping will be displaced by streamlining service chains and targeting measures and resources for the client at the right moment.

"In the future too, it'll be necessary to make profound solutions that are difficult, complex and include social structural criteria, and which are thought-through rigorously, taking into account all viewpoints," the Permanent Secretary stresses.

"In interactive preparations everyone learns. You also learn to recognise and respect different viewpoints."

Ensuring equality and efficiency requires strengthening national-level guidance and direction. There is a need for actors who have the possibility of viewing and managing the entirety. All international and national studies indicate that provision of treatment and assistance according to need and timeously are economically effective.

"Municipalities and hospital districts have been able to optimise resource use from their perspectives. At present, we have too many actors of very different sizes. This is not efficient when we consider the whole system, because it leads to service chain breaks and duplication," says Sillanaukee.

The future social welfare and health care system can be controlled in many ways. It can use interactive control and guidance, as with the National Development Programme for Social Welfare and Health (known as the Kaste programme) and using the data collection from the activities of the National Institute for Health and Welfare. It can also be controlled directly in terms of Euros via state subsidies, by legislation, through laws and decrees, or by the direct supervision of the National Supervisory Authority for Welfare and Health, and Regional State Administrative Agencies.

"This fundamentally alters structures and processes, which is why its implementation must be carefully planned. The MSAH and the National Institute for Welfare and Health (THL) have a crucial role to play at this stage."

Preparations for the reform are immediately underway. The change is so great that it is being carried forward by a broad framework of cooperation. The reform is being prepared mainly by officials, and a parliamentary steering committee, involving all political parties, has been created for it.

"Previously, it was thought that we would proceed by intermediate stages. From the perspectives of the well-being at work of social and health care personnel, the prolonging of working careers, and coping at work it is excellent that a clear final outcome is now known and we can plan how to proceed expeditiously," says Sillanaukee.

The aim is to have the proposal ready by the end of May and to circulate it for comment the following month. It will be submitted to Parliament in the autumn. The new regions dealing with social welfare and health services should be in operation from the beginning of 2017.

"In order for us to be able to eliminate inequality in receiving services, and to ensure efficiency, there is still a financial formula pending and its incorporation into the agreed model", says Sillanaukee.