New health care act will not compromise on service availability

"The aim of the equal availability of health care services required by the Constitution will not be bargained with by the new health care act", says Jukka Mattila, Ministerial Counsellor for Health Affairs. The point of departure of the new law concerns the situation of clients and patients and improving treatment. The aim is to ensure this through the equal availability of services, giving clients the opportunity to choose where they are treated and by improving the quality of treatment and patient safety.

"The equal availability of services does not mean the uniform availability of services. Everyone must be able to receive the treatment they need, but this may be available in different ways", explains Mattila.

"Services may be applied according to conditions and distances. For instance, specialised medical services can be organised in smaller units in more sparsely populated areas, so that clients do not have to make lengthy trips."

The equal availability of services also includes the times at which services are obtainable. The new health care act intends to give greater clarity to existing health care guarantees concerning access to specialised treatment. As before, the deadline for a referral for non-urgent treatment is three weeks from the time of the receipt of referral by the treatment unit, and an assessment of the treatment and its associated tests needed must be started within this time. The decision on the course of treatment must be made within three months of the referral, and treatment, such as an operation, must be provided within six months of this decision.

Children and young clients have to be able to receive psychiatric treatment within a three-month waiting period. Under the new health care act the upper age limit of clients receiving such treatment will be 22 years. Current legislation does not set an age limit. In practice it is 18 years but some hospital districts use a higher age limit.

In addition to improving the availability of services, the situation of clients will be improved by enabling them to choose where they are treated. This freedom of choice will be made possible in two phases.

In the first, clients will be able to choose where they receive primary health care, whether from their own municipality or a health centre in an area of joint municipal organisation. Clients will be able to choose where they receive specialised medical treatment from within their regional grouping of hospital districts. In Finland hospital districts belong to one of five regional groupings providing specialised medical treatment.

Mattila points out that clients will not always be able to choose which doctor they see, only which health centre or treatment unit they attend. But treatment units will where possible have to take into account their clients' preferences concerning the health care professional treating them, as is now the case.

The second phase of improving clients' options in access to health care will extend their freedom of choice to health centres and specialised medical treatment units throughout the whole of Finland.

The first phase will be carried out in 2011 when the new health care act becomes law. The second phase is expected to come about in 2014.

"In the first phase we'll amass information on clients' health care choices. The second phase requires that there is a functioning and supportive cost reimbursement mechanism between the municipalities, which we do not yet have in primary health care. Its creation requires the commodification of services", says Mattila.

But in Mattila's view realising client freedom of choice does not necessarily require the existence of a nationwide electronic patient record registry. Relevant files and referrals can be sent electronically or by hard copy. A comprehensive electronic registry would, however, improve patient safety, and does currently operate at the level of hospital districts.

Improving choice also involves access to non-emergency health services in the municipal area in which clients are staying. Municipalities have to draw up health care treatment plans for each of their residents. Any treatment procedures or laboratory tests that clients require will be able to be arranged at the health centres or hospitals in the municipalities in which they are staying, as long as they are arranged in advance.

"Until now, clients requiring health care services have been able to get promissory notes for the use of the services of another municipality, but municipalities have granted them scantily. The new health care act will be on the clients' side and will oblige municipalities to arrange treatment in the way that the client wants, as long as it is practicable."

But Mattila stresses that freedom of choice concerning where one is treated does not mean that clients will be able to shop around for different treatment units on a daily or monthly basis. One will be able to change one's place of treatment once a year, and despite the opportunities for choice that will exist the aim is to ensure that lasting treatment relations and attentive responsibility for one's health care are nurtured.

He says that choosing one's place of treatment is important in terms of one's attitude. It is one thing to receive treatment in a place to which one has been sent, and quite another to go for treatment at a place of one's own choosing.

"When clients choose which health centre they go to they are responsible for their choice and therefore for their treatment. They take responsibility for it because they are confident in their choice of health centre, from which they receive guidance concerning their treatment. And this creates the conditions for better treatment."

"Quality and patient safety are crucial to good treatment. They affect the plans carried out in all treatment facilities, but there is room for improvement in making them dynamic", says Mattila.
"In promoting clients' freedom of choice in health centres more attention will be given to the quality of professional treatment as well as to the quality of clients' experience of the treatment they receive. Clients bring in cash. If they dwindle, then the treatment unit will decline."

Merja Moilanen