Joint responsibility and central government steering must be strengthened in healthcare and social welfare
Clearer central government steering and, most importantly, joint responsibility are necessary to carry out the healthcare and social welfare reform successfully. This is the opinion of the Rapporteurs appointed by the Ministry of Social Affairs and Health. People's wellbeing and health shall be promoted but simultaneously the limited nature of public funding needs to be understood.
The Rapporteurs' task was to consider different ways to reform the steering of healthcare and social welfare services in order to make it more effective.
The funding and strategic steering of healthcare and social welfare services need to be coordinated in a way that reduces differences in people's wellbeing and health. This means that central government will steer the autonomous regions to take into use new, uniform practices for providing services that are more effective than today but produced with the same amount of money than today. The aim is to strengthen central government steering when the new autonomous regions start to provide healthcare and social welfare services in 2019.
Managing the healthcare and social welfare reform requires a comprehensive approach where joint responsibility for carrying out effective actions applies to all levels of healthcare and social welfare. The effectiveness of services depends both on central government steering and encounters between individual healthcare and social welfare professionals and their customers.
The Rapporteurs suggest a simple management model, and the model should be the same at all levels of healthcare and social welfare services. The model takes into account which services will be provided, which resources will be used and how the effects of services in promoting wellbeing will be measured. National procedures need to be determined to ensure keeping to the budget and to provide equal and fair services. It is important to prepare the service policies in open interaction with all parties of society, citizens included.
The report suggests that a national strategic healthcare and social welfare unit should be established under the Ministry of Social Affairs and Health. In cooperation with other parties, the unit should define adequate and equal healthcare and social welfare services and promote cost-effective practices. The unit would be responsible for the grounds for resource division and for allocating resources in a way that best promotes wellbeing. The unit would also be responsible for national assessment of healthcare and social welfare services.
Regionally, corresponding strategic healthcare and social welfare units would be established in the autonomous regions. Similar strategic organisation would be required of service providers. Additionally, five joint research and development units would be established in the autonomous regions to support the activities.
The Rapporteurs also suggest that the Social Insurance Institution of Finland Kela and the occupational health care service providers should be included in the healthcare and social welfare reform. For example Kela's medicine costs should be included in the autonomous region's budgets. This would encourage healthcare service providers to use non-pharmacological treatment when possible. Cost-effectiveness should also be included as an educational subject in educational programmes for healthcare and social welfare. The costs largely depend on decisions made by healthcare and social welfare professionals.
The report of the Rapporteurs will be used in connection with drafting the act on organising healthcare and social welfare services and preparing legislation relating to counties.
- Cost-effective steering of healthcare and social welfare services, report of the Ministry of Social Affairs and Health 5:2016, available in Finnish)
- Why should central government steering be strengthened in healthcare and social welfare services? Video interview of Project Manager Tuomas Pöysti (in Finnish)
Project Manager Tuomas Pöysti, Permanent State Under-Secretary, tel. +358 2951 63012
Director Tarja Kauppila, tel. +358 44 754 3333
Professor Anja Tuulonen, tel. +358 40 779 6278
Director Päivi Voutilainen, tel. +358 2951 63403