|The new Health Care Act|
|Implemented in this survey?|
The Ministry of Social Affairs and Health set up a working group in 2007 to make proposals for a new Health Care Act. Originally the bill was supposed to be passed in 2009 and it was meant to be accompanied by a bill on a new administrative structure for health and social services. The law-drafting process was, however, delayed and the bill on administration was postponed over the elections in 2011 due to disagreements between the main government parties.
The Ministry of Social Affairs and Health set up a working group in 2007 to make a proposal for a new Health Care Act that should merge the Primary Health Care Act (enacted in 1972) and the Act on Specialized Medical Care (enacted in 1989) (HPM 12/2008). Originally the bill was supposed to be passed in 2009 and it was meant to be accompanied by a bill on a new administrative structure for health and social services. However, disagreements about the content of the new acts have occurred between the main government parties; the National Coalition Party and the Finnish Centre Party. Particularly, the disagreements concern the legislation on the continuation of the restructuring of the service system, which was already launched when the temporary Act on Restructuring Local Government and Services came into force in 2007 (HPM 11/2008 & HPM 7/2006).
While the Centre Party Ministers of Social Affairs and Health and the Interior wanted to follow the original proposal made by the working group, the Coalition Party Minister of Health and Social Services made a new proposal to organize health and social services in the autumn of 2009. The Minister suggested that the country is divided into 40-60 health and social service areas that are responsible for primary health care and social services as well as for most of the specialized medical care. The health care areas should be formed according to the municipal borders and their population base as well as economic position should be strong enough to secure their operational preconditions. The most demanding tasks of specialized medical care and some special social services would become more centralized and belong to the responsibility of five responsibility areas that potentially would be formed based on already existing tertiary care regions.
In February 2010 the Government and all party leaders announced that the proposal of 40-60 health and social service areas would not be executed as such. However, the municipals and municipal co-operation districts would be given a possibility to organize their services based on a special pilot legislation that would be in accordance with the health and social service area proposal.
The most recent proposal concerning the new Health Care Act was made in March 2010, as the Prime Minister came up with an idea of founding a national health care fund worth some 15 billion Euros. The fund would be the sole source of health care finance and account for the services of all Finnish inhabitants. It would replace the municipalities and the compulsory National Health Insurance that presently have the main responsibility of health care provision and financing of health care.
In addition to the service structure, there has been a controversy over the increased patient choice. According to the bill, the patients would be free to choose services provided by any municipal health centre within the same tertiary care region. In the future, the patient choice is supposed to be extended to a countrywide practice.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Restructuring the health care system has been on the political agenda since 2000 and there seemed to be a wide consensus on the enactment of a new Health Care Act as well. However, the law drafting process itself has been highly controversial. On the one hand, there have been disputes between the main government parties on the content of the bill. On the other hand, some proposals have raised opposition among physicians and other health care professionals. The proposals can be seen rather novel in the context of the Finnish health care system. This applies particularly to the proposal of the national health care fund. However, some of the ideas have already been piloted and can not be counted entirely new.
|Implemented in this survey?|
There have been competing proposals between the government parties and, thus, the content of the bill remains controversial. Presently, the government cannot be said to either support or oppose the current bill proposal as the content is most probably unclear.
As far as the proposals made by the government parties are concerned, some municipalities are probably satisfied to have a possibility to run health and social region pilots. Such service structures have already been established by some municipal co-operation areas as a result of the project to restructure municipalities and services. The views on the increased patient choice are, however, various, as the possibilities to answer the potentially growing demand and increasing competition differ between municipalities. As to the law drafting process, the influence of the municipals is not very strong. However, the government cannot make proposals that are totally opposed by municipalities. The role of the municipalities becomes more important if the implementation state is reached.
Hospital districts, currently running specialized medical care in Finland, generally opposed the proposal for 40-60 health and social service areas and are obviously satisfied as it is not included in the bill as such. However, the hospital districts are still against the proposal for increased patient choice. They fear that increasing patient choice would potentially increase competition between hospitals and lead to "an arms race situation". According to them, this might result in closing of hospitals that do not succeed in the competition. As to the national health care fund, the hospital districts have not yet expressed their opinion.
The Social Insurance Institution of Finland:
As far as the general law drafting process is concerned the Social Insurance Institution of Finland (Kela) has no major influence. However, if the government decides to begin with the preparation of the national health care fund, the influence of Kela is of importance.
|Municipalities||very supportive||strongly opposed|
|Hospital Districts||very supportive||strongly opposed|
|The Social Insurance Institution of Finland||very supportive||strongly opposed|
The government was supposed to submit the revised bill to parliament in spring 2010. However, due to the controversies and competing proposals it is unclear whether the process is going to progress.
|Hospital Districts||very strong||none|
|The Social Insurance Institution of Finland||very strong||none|
The implementation process cannot begin as the bill has not been passed.
The most fundamental reform would occur if the national health care fund was established, as it would truly alter the roles of municipalities, hospital districts, the Social Insurance Institution of Finland as well as of private service providers. Also an increased patient choice would change the current system rather fundamentally as to date the possibilities to choose a health centre or hospital have basically been none. Also the service structure is likely to change. However, that must be seen resulting also from several other legislative reforms (e.g. The Finnish Act on Restructuring Local Government and Services) and policy programs (e.g. Development Programme for Social Welfare and Health Care). Hence, the sole influence of the Health Care Act is difficult to evaluate.
The content of the bill has been subject to major controversies between the main government parties. The current content and the state of the law drafting process are, thus, unclear and it is even possible that the government is not able to reach consensus on the content. This would, at worst, vitiate the whole Health Care Act. Moreover, the parliamentary election will take place in the spring of 2011, which, also in Finland, often affects the politicians' willingness to execute any major controversial reforms.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
At this stage, the impacts of the reform are not easy to predict. At worst increased patient choice may deteriorate the quality if the most popular health centres are not able to answer the growing demand. Moreover, the increased patients choice could make the system more inequitable as the most prone groups of patients may not be able to make appropriate choices. The more potential scenario might, however, be that the possibly increasing competition on patients between hospitals and health centres forces the health care providers to improve the service quality. The possibly increasing competition between service providers might also have positive impacts on cost efficiency.
The increased population base of municipalities or cooperation areas might reduce the inequalities if the possibilities to arrange adequate services improve also in the areas that presently struggle with lacking resources. In addition, due to the increased population base, scale benefits might be obtained. Services may, however, become more centralized, due to which distances between patients homes and health care facilities may increase in some areas.
The New Health Care Act. Memorandum of the Working Group Preparing the Health Care
Act. (English summary available at http://www.stm.fi/c/document_library/get_file?folderId=39503&name=DLFE-9404.pdf)
|The new Health Care Act|
Process Stages: Policy Paper, Legislation