Sote-uudistuksen väliraportti täsmentää hallituksen linjauksia
The preparatory committee for the act on the arranging of social welfare and health care services submitted its interim report to Minister of Health and Social Services Susanna Huovinen on 27 June. The interim report specifies the policies of the government coordination committee on social welfare and health care services in municipalities so that they can be utilised by municipalities when preparing the reports required by the act on local government structures.
The interim report defines the duties included in the responsibility of organising social welfare and health care services. It also defines the central characteristics of the model of municipalities with primary responsibility (MPRs) and arrangements between municipalities in the funding of social welfare and health care services. In addition, the interim report contains an account of the duties of specific catchment areas (SCAs) and the organisation of the administration of university hospitals. The interim report does not anticipate the number of SOTE regions or primary-level areas that could be formed in Finland.
Municipalities and other actors will have the opportunity to state their opinion concerning the interim report until 11 October. The comments can be taken into account in the final report written in the form of a government proposal to be completed at the end of the year. The proposal willbe considered by the parliament in spring 2014 and, if approved, would come into force at the start of the following year. Once the bill has been approved, municipalities will be heard regarding the formation of the regions. The aim is for social welfare and health care (SOTE) regions to begin their activities by latest at the start of 2017.
The objective of the reform is to guarantee equal social welfare and health care services to everyone. This requires changes in the municipal structure and greater regional cooperation. The population base for the arranging of the services must be expanded and the service structure and operating methods renewed. Only then is it possible to ensure high-quality local services and sufficient, competent personnel.Municipalities with primary responsibility to arrange services in regions
In the reform, the responsibility for arranging social welfare and health care services is allocated principally to social and welfare and health care (SOTE) regions and, in some aspects, to primary-level areas. The SOTE regions and primary-level areas each have a municipality with primary responsibility (MPR) that is responsible for arranging the services for the municipalities in the region. Upon specific special grounds, municipalities within a SOTE region may agree on the adoption of a joint municipal authority model.
At the moment, there are few regulations governing the MPR model. In further preparation, it is necessary to account for the boundary conditions established in the Constitution of Finland. The preparatory committee proposes certain central characteristics for the MPR (municipality with primary responsibility) model. Decisions concerning the services provided by primary-level areas would be made in a joint organ of the member municipalities. The SOTE regions, too, would have a joint organ, in which the member municipalities and the primary-level organ would be represented. The composition of the organ would also account for the power relations between the municipalities. The number of votes held by the representatives of the municipalities would be determined based on the population size of the municipalities.Cooperation between primary-level areas and SOTE regions must be ensured
SOTE regions formed by municipalities would be responsible for all statutory duties of municipalities regarding social welfare and health care services (so-called extensive primary and specialised level). Primary-level areas could be formed by municipalities with 20,000 to 50,000 residents. They would arrange primary-level services for their residents, currently provided by health centres and social services departments. Specialised services would be arranged by the SOTE region.
Municipalities with less than 20,000 residents would not arrange services themselves. Services for their residents would be organised by a SOTE region or a primary-level region. The duties of small municipalities would still include promoting the well-being and health of their residents, as this is also the duty of other sectors within municipalities.
In individual cases, the population base criteria can be overlooked if a special reason exists for this. Safeguarding the rights of language groups may constitute such a reason.
Cooperation structures between primary-level areas and SOTE regions must be implemented so that the service chains function without problems and clients do not fall through the cracks in the system. The provision of services must be equal for the residents. This means that the regional availability of the services must be ensured.
In the future, the activities of SOTE regions and primary-level areas would be coordinated by five specific catchment areas. These have been named specific catchment areas in social welfare and health care services (SOTE-SCAs) by the preparatory committee, as their duties would now also include the steering of social welfare services. A SOTE-SCA would be a body corporate and a joint municipal authority, with SOTE regions as its members.
The SOTE-SCAs would ensure equality particularly as concerns centralised services requiring cooperation between SOTE regions (e.g. emergency services, demanding social welfare services and specialised medical care). They guide purposeful use of resources in their area so that no overlaps or shortages in services are created. The specific catchment areas would also be responsible for the regional coordination of research, development and teaching.
Hospital districts will cease to exist as administrative organisations at the end of 2016. To manage the duties of SOTE regions, the staff, property and responsibilities of hospital districts would, a a general rule, be transferred to the ownership and control of the MPR or joint municipal authority of the SOTE region.Municipalities will continue to fund social welfare and heath care services
All municipalities will continue to be responsible for the funding of the services. The preparatory committee recommends that the costs of the primary-level areas and SOTE regions would be divided between municipalities using the capitation model (payment is determined based on population size of the municipality in question), in which the age structure and morbidity of the population would be weighted. This way, the payment per resident would vary based on the need for services within the population.
In the capitation model, the cost to a municipality can be anticipated and differences between municipalities are evened out over longer time periods. However, a shift to the capitation model would require a transition period of several years. Applying the model to established services may cause significant changes to current expenses in some municipalities. In most municipalities, the changes required would be small.
Primary-level areas would obtain the majority of the services required by them from the SOTE region and would pay for these services on performance basis. The capitation model would be applied to the funding of SOTE-SCAs provided by SOTE regions. Central government transfers to local government would still be paid to municipalities.
Kirsi Paasikoski, Director-General, tel. +358 (0)295 163 338