Finland’s complex overhaul of healthcare promises more choice for patients

An ambitious and complex plan to overhaul healthcare in Finland will leave patients with better and cheaper care, according to Pirkko Mattila, the country’s minister of social affairs and health.

Starting from 2019, the reform moves responsibility for the provision of health from more than 300 local authorities to 18 new care regions.

The shake-up, partially motivated by depleted state coffers, has been designed to grant more freedom for patients to choose their care provider and save money. The idea is to open the health market for private health-care companies, which say the government says can treat patients much more cheaply and efficiently, compared with the currently publicly provided services.

“The reform is the biggest ever in Finnish healthcare,” said Mattila, speaking on Tuesday at a Science|Business conference on digital health in Espoo. “The objective is to reduce inequities in well being and health between people, and to manage costs.”

Sweden, which implemented a patient-choice reform in primary care in 2010, was a model for the Finnish government.

“We are going more and more towards a situation where the patient is not the target of healthcare operations but one of the most active players and participants in health processes,” said the minister, who worked as an anaesthetist before she joined the Eurosceptic Finns Party.

The strong digital backbone in the country, and a good record of embracing digital health innovation, will make the re-organisation easier and more successful, Mattila said.

“We have a long tradition and extremely good coverage of electronic health records. Our national infrastructure gives us the very good possibility to collect and share information among all social and health providers,” said Mattila.

Steering the reform, which has been in the works for years, has been a complex affair, and almost led to one of the three coalition parties quitting the government in 2015.

The overhaul presents opportunities but also risks, said Ilkka Niemelä, provost of Aalto University, the country’s second largest university.

“One of the big risks is the schedule – it would have been nice to leave time for some more experimentation through pilots. There’s a danger that, with the new system already happening in 2019, we are left with conservative approaches,” Niemelä said.

According to some economists, there is also the risk that the reform will benefit a pool of multinational corporations, at the expense of smaller Finnish providers.

And while the new system is supposed to erase inequalities, such as differences in waiting times in clinics and differences in the quality of care across the country, Mattila recognises that ensuring a uniform level of healthcare delivery across the 18 regions will remain hugely challenging.

“Our regions are all very different. Compare Helsinki with the sparsely-populated regions in Northern Finland,” she said.

Healthcare reform has been on the agenda of previous Finnish governments facing a rapidly ageing population. “Our demographic development increases the need for services – and decreases the staff able to provide them,” Mattila said. The government claims that over the long term the changes will help save €3 billion annually.

According to the Organisation for Economic Cooperation and Development, Finland’s health system is already in the "high performing” bracket. But Finns are being forced to confront the cost of top quality care.

Healthcare spending in the country increased from 6.9 per cent of gross domestic product in 2000 to 9.6 per cent in 2015. The same period saw a long recession, following the decline of Finland’s most successful company, Nokia. A slump in Finland’s paper industry, with jobs moving to the Southern hemisphere, and falling demand from Russia, further stunted the export-driven economy.