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Ensuring access to health care

Country: 
Finland
Partner Institute: 
National Institute for Health and Welfare (THL), Helsinki
Survey no: 
(3)2004
Author(s): 
Lauri Vuorenkoski & Ilmo Keskimki
Health Policy Issues: 
Access
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Abstract

A major challenge in the Finnish health care system is a gap between resources and need of health care services. This has generated long waiting times to some services in primary and hospital care. There are also considerable differences in waiting times between municipalities. At the moment the Ministry of Social Affairs and Health is developing a standardized nationwide system for assessing health care needs by introduction of treatment criteria.

Purpose of health policy or idea

A major challenge in the Finnish health care system is the gap between resources and need of health care services. This discrepancy has generated long waiting times for some services in ambulatory and hospital care.

There are also considerable differences in waiting times between municipalities. The Decision in Principle by the Council of State on Securing the Future of Health Care issued by the Government in 2002 stated that the principle of access to treatment within a reasonable period would be embodied in legislation by the year 2005. A working group was set by the Ministry of Social Affairs and Health to propose an implementation plan for the decision.

According to the decision in principle, patients must be assured of an immediate contact with their health care centre, and their need for care must be assessed by a health care professional within a maximum of three weekdays of their contacting the health centre. In non-acute specialised medical care, it is the responsibility of the hospital district that the patient's need for care is assessed within a maximum of three weeks of receiving a referral, and any medical care found to be necessary must be provided within three months, or at the very latest, six months. Hospital districts are governed by municipalities from that area. If the treatment cannot be provided within the time specified, treatment must be procured from another service provider at no extra charge to the patient.

In January 2004 the working group proposed the creation of a standardized nationwide system for assessing health care needs and introduction of treatment criteria for procedures such as cataract operations, cholecystectomies, prostatectomies, and hip and knee replacements.

Main points

Main objectives

To ensure timely and equitable access to health services according to need in Finland.

Type of incentives

  • Legal obligation for municipal health care providers to provide services within a stated time-frame.
  • The municipality is obliged to cover the costs of alternative providers if the municipal provider is not able to render the needed health service within maximum time limits.

Groups affected

Patients, providers (mainly municipalities and hospital districts)

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low very high very high
Transferability strongly system-dependent system-neutral system-neutral

Political and economic background

This process was derived from the Decision in Principle by the Council of State on Securing the Future of Health Care issued by the Government in 2002.

Change based on an overall national health policy statement

The decision in principle by the Council of State on Securing the Future of Health Care

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Origins of health policy idea

Access to health services needed is guaranteed by the constitution of Finland. However, time limits for waiting have not been previously implemented in Finland.
For several years, various problems in access to health services have been debated in Finland. In response to this the Government initiated in 2001 "the National Project to Ensure the Future of Health Care" originally proposed by the Prime Minister and the Minister of Social and Health Services at the time. The project aimed to solve a variety of ills in the Finnish health care system. One outcome of the project was "the Decision in Principle by the Council of State on Securing the Future of Health Care" issued by the Government in 2002. Among other things, it stated that the principle of access to treatment within a reasonable time period would be embodied in legislation by the year 2005. To implement the statement, the Ministry of Social Affairs and Health nominated a working group to draft a model how to operationalise the principle of access in different health care sectors.

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

  • Private health care providers expect that the guarantee for access to care would force municipalities to purchase more services from the private sector
  • Public providers (i.e. municipalities and hospital districts) have a somewhat negative attitude towards this policy reform as they think there is not enough resources in health care to ensure access to care for the patients.

Influences in policy making and legislation

 Legislation on the reform has been proposed.

Legislative outcome

n/a

Adoption and implementation

Experts at hospital districts are expected to develop treatment criteria for specialised care procedures such as cataract operations, cholecystectomies, prostatectomies, and hip and knee replacements. The hospital districts are expected to continue to introduce treatment criteria for elective hospital care before the legislations should be in effect in 2005. This process is moderated by the Ministry of Social Affairs and Health, as it is also preparing the needed legislative process.

Crucial for the successful adoption is developing such treatment criteria that they can be accepted by experts, authorities and patients.

Successful implementation depends on the municipalities and hospital districts which are responsible for providing public health care.

Monitoring and evaluation

 An information system will be established to provide information on waiting times in the hospitals. An explicit technique for evaluating other aspects of the implementation is not yet presented.

Expected outcome

  • The objective of the policy process is rather ambitious, and it is difficult to anticipate whether it can achieve its objectives.
  • If treatment criteria are developed and guarantee for access to treatment given only to some operations in hospital care where forming the criteria is rather easy, it is possible that these operations are prioritised over other health care services, such as primary health care and mental health services.
  • If the policy process succeeds it will make public health care provision more fair, effective and transparent. It will also improve geographical equality in access to care and make cost containment easier.

Impact of this policy

Quality of Health Care Services marginal rather marginal fundamental
Level of Equity system less equitable four system more equitable
Cost Efficiency very low neutral very high

If the policy reform succeeded to achieve its goals, the standards of public health care provision would improve in terms of fairness and regional equality, effectiveness and transparency. If successful the reform could also make cost containment easier, as there would be more explicit means to define boundaries of public health care services.

References

Sources of Information

Decision in Principle by the Council of State on securing the future of health care. Brochures of the Ministry of Social Affairs and Health 2002

http://www.stm.fi/english/eho/publicat/bro02_6/bro02_6.pdf

Author/s and/or contributors to this survey

Lauri Vuorenkoski & Ilmo Keskimki

Suggested citation for this online article

Lauri Vuorenkoski & Ilmo Keskimki. "Ensuring access to health care". Health Policy Monitor, 04/04. Available at http://www.hpm.org/survey/fi/a3/3