|Implemented in this survey?|
The purpose of the planned public sector reform is to create a firm structural and financial basis within municipal services so that the organisation and provision of services will be secured in the future. At the same time quality, effectiveness, availability, efficiency and technological change of services are taken into consideration. The project concerns all services organised by municipalities, not only health care. The expected outcome is a restructuring of municipalities and services.
The main purpose of the planned public sector reform is to create a firm structural and financial basis within municipal services. The more detailed objectives in the ongoing reform planning are among others:
The planned reform is expected to lead to major legislative changes which in succession are expected to affect the bulk of public sector in Finland. The precise effect on health care remains to be seen.
To create a firm structural and financial basis within municipal services so that the organisation and provision of services will be secured in the future.
Non-financial: legislative changes are being planned
Municipalities, providers, central government
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The aim of the project and the expectations regarding the outcome of the project are innovative and radical and there is wide consensus about the need for reform. However, at present, there is no
consensus about the concrete actions to be taken. Thus, the degree of innovation and structural impact remain open.
Many municipalities have expressed their willingness to reform, but at the same time, they seem to want to preserve the current structure of municipalities. Consequently, the current judgement about the possible outcome of the project is that it might merely lead to a merger of the smallest municipalities while leaving the basic municipal structure largely unchanged.
The project was originally not included in the Government's programme. It first came up in discussions between Ministers in February 2005 on the possible solutions to secure services organised by
municipalities. The background for these discussions were concerns about the increasing financial difficulties faced by municipalities and the growing need for health and social services because of
the ageing of the population. The latter would reduce the availability of workforce as a remarkable number of personnel within social and health services would retire in the next decade or so, and at
the same time, it would increase the need for workforce.
A policy paper regarding state economy in March 2005 contained a commission to reform municipalities and services. The Government subsequently launched a project to planning a reform on restructuring municipalities and municipal services in May 2005.
Need to comply with the aging of the population, anticipated shortage of health and social care personnel in the future, and economical prospects of municipalities
|Implemented in this survey?|
The policy idea is not new. It has been discussed and proposed in differing forms with differing emphasis for over a decade. Prior policy documents and initiatives have been among others "The Project to Change the Balance of Care", "The Guidelines on Health Care in Finland", "Health Care into year 2000", and "The National Project on Safeguarding the Future of Health Care Services". Prior initiatives have not led to major concrete changes.
The approach of the idea is described as:
renewed: First voiced in the Project to Change the Balance of Care at the beginning of the 1990s. The current policy idea has been influenced by the public sector reforms in Denmark.
Local level - Various experiments have taken place at the local level (see Survey (2)2003, Finland: County level management of welfare services). Experiences with mergers of municipalities have been mixed.
The idea of the project came up in discussions between ministers in February 2005 on the possible solutions to secure services organised by municipalities. A policy paper regarding state economy
in March 2005 contained a commission to reform municipalities and services. The Government subsequently launched the project to restructure municipalities and services in May
Within the Government, the project is supervised by the Ministerial Working Group. It will make the political conclusions and review proposals made by the Group on Restructuring Municipalities and Services. The Group on Restructuring Municipalities and Services is responsible for the preparation and supervision of the practical implementation of the project and is chaired by the Minister of Regional and Municipal Affairs. In addition, the project is prepared by four Preparatory Working Groups involving representatives from various ministries, municipalities and labour market organisations.
|The Government||very supportive||strongly opposed|
|The Ministry of the Interior||very supportive||strongly opposed|
|The Association of Finnish Local and Regional Authorities||very supportive||strongly opposed|
The health policy idea is likely to lead to legislative changes. The expected minimun change is a new framework legislation.
|The Government||very strong||none|
|The Ministry of the Interior||very strong||none|
|The Association of Finnish Local and Regional Authorities||very strong||none|
The project has made three different proposals for organising basic services: model of basic municipalities, regional model, and district model. The first one would merge the smallest
municipalities into larger ones with a minimum population size of 20 000 inhabitants. The regional model would introduce 20 municipalities with a relatively large population size and responsibilities
similar to those of the current municipalities. The third model would integrate primary and secondary health care as well as certain social welfare services into one and the same organisation with a
population size of 100 000 - 200 000 inhabitants while leaving the responsibility for the remaining basic services to current municipalities.
The three models have been presented to the public and have been widely discussed and commented by the municipalities.
In April 2006, it was not yet clear which of the three models or whether a fourth model, not yet presented, would be adopted. Whatever the final proposal is, it is expected to involve major legislative changes, major changes in the administration of municipalities, mergers of municipalities, and possibly some other changes. Moreover, the adoption process is going to involve a wide variety of actors within the public sector.
No monitoring and evaluation are planned so far.
The expected outcome is improvement in the access to services and better control of total health care costs.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
The expectations regarding the improvement of cost-efficiency and quality are high. In practice, the reform might only lead to some marginal changes in quality, equity and cost-efficiency.
www.intermin.fi/intermin/hankkeet/paras/home.nsf/pages/indexing Project to restructure municipalities and services; including documents
Jutta Järvelin and Markku Pekurinen