HealthManagement, Volume 9 - Issue 5, 2009
Finnish healthcare is divided into the public and private sectors. The public sector is significantly larger than the private sector in Finland. The private sector consists of small health centres and some specialised hospitals (e.g. for heart surgery, orthopaedics, ophthalmology, etc.) mainly concentrated in cities. Citizens can choose freely between the private and the public sector. While the private sector is primarily more expensive, the patient is reimbursed up to 40% of the costs from public health insurance (financed by government taxes). Finland has about 330 municipalities that collect taxes and get additional financial support from the government (Ministry of Finance) in accordance with the status of municipality. Status parameters include size and age distribution of the population, location of the municipality, industry, agriculture, etc. Every employed individual pays taxes to municipalities and the government.
Access and Prevention
Everyone residing in Finland is entitled to receive good quality healthcare within set timeframes. The primary goal of Finnish health policy is disease prevention. Preventive services are provided by health centres, child health clinics, school healthcare, student healthcare and occupational healthcare. A prime aim of the Finnish Ministry of Social Affairs and Health (MSAH) is to narrow the appreciable health inequalities between different sections of the population in different parts of Finland. The MSAH “Action Plan to Reduce Health Inequalities: 2008 – 2011” outlines proposals for strategic policy definitions and the most important measures to reduce socioeconomic health inequalities in Finland.
Primary & Specialised Healthcare
Municipal health centre services include physical examinations, oral health, medical care, ambulance services, maternity and child health clinics, school and student healthcare and other basic services. Specialised outpatient and institutional treatment is provided by hospital districts. Diseases requiring highly demanding treatment are handled by regional arrangements or centrally, according to a specific decree. Each hospital district contains a central hospital and other specialised units. There are five university hospitals in Finland.
Healthcare Reform and Development
The Ministry of Social Affairs and Health defines the course of social and health policy in Finland in its strategy and it implements these policy lines by legislation, quality recommendations, programmes and projects. Every four years, the Ministry compiles a development programme for social and healthcare, which sets out the main points of emphasis of policy aims, activity and oversight, as well as reforms and legislative programmes, guidelines and necessary recommendations to support their implementation.
Financing and Expenditure
Social and healthcare in Finland is mainly financed by taxation. The state pays social and healthcare subsidies to municipalities. The size of the subsidies depends on the size of the populations of the municipalities, and on their age structure, unemployment rate and other factors. Municipal, social and health expenditure was 16.1 billion euros in 2007, or 53.4% of total municipal spending.
The main outlays were for:
• Specialised medical care - 4.5 billion euros
• Primary healthcare - 3.3 billion euros
• Services for older people and people with disabilities
- 2.7 billion euros
• Child day-care and care allowance - 2.3 billion euros
State subsidies for operating costs in 2007 absorbed about 34% of statutory municipal spending. Client fees covered about 7% of expenditure. The remainder was paid for by the municipalities themselves. Healthcare expenditure for 2006 was about 13.6 billion euros, or 8.2% of GDP. This has remained below the OECD average.
The main expenditures were for:
• Specialised medical care: 34%
• Primary healthcare: 19%
• Dental care: 5%
• Occupational and student healthcare: 4%
• Pharmaceuticals: 15%
• Health insurance reimbursements for private healthcare: 6%
• Institutional care for older people: 5%
• Investments: 5%
• Other: 7%
Health Promotion
The Finnish government sets a targeted appropriation for measures aimed at health promotion. The MSAH is responsible for the use of the appropriation. The government’s “Resolution on the Health 2015” public health programme outlines the targets for Finland’s national health policy for the next fifteen years. The main focus of the strategy is on health promotion, rather than on developing the health service system. The foundation for the strategy is provided by the “Health for All” programme organised by the World Health Organisation (WHO).
The Health 2015 Project
Health 2015 is a cooperation programme that provides a broad framework for health promotion in various component areas of society. It reaches across different sectors of administration, since public health is largely determined by factors outside healthcare, such as lifestyles, living environment, quality of products, factors promoting and factors endangering community health. The concepts ‘settings of everyday life’ and ‘course of life’ play a key role in the programme. The strategy presents eight targets for public health, which focus on important problems requiring concerted action by various bodies. They indicate the outcome aimed at in different phases of life. In addition, there are 36 statements concerning the lines of action underlined by the Government, incorporating challenges and guidelines related to citizens’ everyday environments and various actors in society.
