Pasi Pohjola (Ministry of Social Affairs and Health) & Pekka Rissanen (Finnish Institute for Health and Welfare)
The world is changing — the health and social services system must change with it

The main reasons for the health and social services reform have remained the same over several government terms now — the population is aging and it needs more services than before, services are scattered, and people are, in some cases, treated in the wrong place at the wrong time.

The current Government Programme includes a set of measures aimed at reforming the health and social services system. Basic public services will be strengthened, for example, as part of the Future Health and Social Services Centres programme. 

One of the objectives is also to transfer the responsibility for the organisation of health and social services to counties, and in that connection, to modify the funding of these services.

Evidence-based information needed to support the reform

To meet the general objectives of the health and social services reform, it is necessary to make assessments and gain information regarding the functioning and effectiveness of health and social services and the challenges facing these services across the country.

The Finnish Institute for Health and Welfare published assessment reports on all the 20 hospital districts in Finland in December 2019. The reports focused on assessing the organisation of public health and social services. The situation varies considerably from one hospital district to another. The minimum number of organisations involved in providing health and social services is one, whereas the maximum number is 20 in one district.

24-hour services increase costs

Healthcare and social welfare costs vary considerably by district. The differences in costs are explained by different ways of organising and providing health and social services and by disparities in the availability of services, for example. One underlying reason may also be that districts have their own traditions and practices relating to the service structure.  Now could be the right time to review them in a constructive manner and from the perspective of people’s service needs.

The assessments suggested that the shortcomings in basic public services for families and the shortage of mental health services for adults would have increased the need for special needs for families.

Smoothly functioning basic public services for children and families can be reflected in lower costs for child welfare.

In some districts, healthcare and social welfare costs have increased because of shortcomings in early support services and the abundance of 24-hour services. Shortcomings in the services for elderly people have resulted in a high number of visits to emergency care services, and — if frontline services are not available — these shortcomings will increase the costs of specialised medical care.

There seem to be considerable differences between the districts in the integration of services for the unemployed, for example. The more effectively the services are integrated, the easier it is to activate unemployed people and reduce the amount of labour market support partially funded by municipalities.

It is forecast that there will be further pressures on local government finances. To ensure the provision of, and equal access to, services even in the future, it is now important to use resources wisely. This could mean major changes. Changes are also necessary to maintain and strengthen trust in the service system and the willingness to fund it. The assessment reports provide fact-based information for discussing such changes.