health centers, the cornerstones of finnish health care system
TRANSCRIPT
Primary healthcare in Finland
Health centers, the cornerstones of
Finnish health care system
4.3.2016
• Dr. Arja Lassila, MSc, GP, Childneurologist, eMBA
• Chief Physician, Profit Unit of Primary Health Care and Health
Promotion
Ministry of Social Affairs and Health, Finland
N.B. Unofficial translation. Legally binding only in Finnish and Swedish
No. 1326/2010
Health Care Act
Issued in Helsinki on 30 December 2010
(Amendments followed up to 1293/2013)
Primary health care means
public health services provided by local
authorities, health promotion, and any
related provision of
health counselling and health checks, oral
health care, medical rehabilitation,
occupational health care, environmental
health care, as well as emergency medical
care, outpatient care, home nursing, at-
home hospital care and inpatient care,
mental health services, and substance
abuse services where these are not
covered by social services or specialised
medical care; primary health care may also
be referred to as public health services;
Access to primary health
care services Local authorities shall ensure that patients
are able to reach a health centre or other
health care unit without delay during
weekday office hours. In situations where
an assessment of the need for treatment
cannot be carried out immediately when a
patient contacts a health centre, a health
care professional shall assess the need for
treatment no later than on the third working
day from when the patient first contacted
the health centre
4) early identification and treatment of any
health problems in patients requiring
special support, tests, and care, and
referral to further treatment
The provision of medical care shall be
based on the medical or dental diagnosis
ofthe patient and carried out in accordance
with harmonised principles of care,
where available.
The provision of treatment shall bebased
on the most expedient methods and
cooperation.
Maternity and child
health clinic services
Local authorities shall provide within their
area maternity and child health clinic
services for pregnant women and for
families that are expecting a child
as well as for
children under school age and their
families.
Maternity and child health clinic services
include
1) regular checks to ensure the healthy
growth, development, and wellbeing of
foetuses and the health of pregnant women
and new mothers according to individual
needs;
2) checks to ensure the healthy growth,
development, and wellbeing of children at
intervals of approximately one month during
the first year of life as well as annually and
according to individual needs thereafter
3) oral health checks for children at least
every other year;
4) support for parenthood and other
wellbeing of families;
5) promotion of the health of the homes
and living environments of children and
healthy lifestyles of families; and
6) early identification of any special needs
and tests required by children and families
as well as support for children and families
and, if necessary, referral to tests or
treatment.
As regards the provision of maternity and
child health clinic services, the primary
health care services of local authorities
shall be coordinated with organisations
responsible for preschool education, child
welfare and other social services, and
specialised medical care, as well as with
other relevant actors.
School-based health care Local authorities shall provide school
health services for pupils enrolled in
educational institutions providing basic
education in their area. School health
services shall also cover health care during
work experience 1) triennial checks on
the placements.
School health services include
health and safety of school environments
and welfare promotion among learning
communities;
2) annual checks on the growth and
development of pupils and health and
welfare promotion;
3) support for the parents and guardians
of pupils;
4) oral health care for pupils, including
oral health checks on at least three
occasions and according to individual
needs;
5) early identification and support for any
special needs and tests required by
pupils, cooperation with other pupil welfare
organisations to help chronically ill
children manage their conditions, and, if
necessary, referral to further tests and
treatment; and
6) any specialised tests required for
diagnosing medical conditions in pupils
Student health care The primary health care services provided
by local authorities shall include the
provision of student health care services to
students enrolled in upper secondary
schools, educational institutions providing
vocational education, and universities and
other institutes of higher education located
in their area regardless of the students’
place of residence
Occupational health care Local authorities shall provide individuals
employed in places of work based in their
area with access to the occupational health
care services referred to section 12 of the
Occupational Health Care Act (1383/2001)
and as provided in other laws.
Local authorities shall, where applicable,
provide entrepreneurs and other
selfemployed
individuals based in their area with
access to the occupational health care
services referred to in section 12 of the
Occupational Health Care Act and in
statutes issued by virtue of it.
Oral health care Local authorities shall provide their
residents with access to oral health care
services. Provision of treatment at regular
intervals shall be based on a dental diagnosis.
Oral health care services include
1) improving and monitoring of the oral
health of the population;
2) provision of health information and
health checks;
3) tests, prevention, and treatment of oral
diseases; and
4) early identification of any special needs
and tests required by patients, treatment, and,
if necessary, referral to further tests and
treatment.
As regards oral health care, the providers
of local authority primary health care
services shall cooperate with specialised
medical care, other health care and social
service personnel
Home nursing Local authorities shall provide their
residents with access to home nursing.
Home nursing shall comprise
multidisciplinary health and medical care
provided according
to a treatment and care plan or on a
temporary basis in the patient’s place of
residence or home or in another
comparable location.
Any care equipment prescribed in
treatment plans for managing chronic
illnesses shall be included in the service.
Medical rehabilitation Local authorities shall provide patients
with access to any medical rehabilitation
required in connection with medical
care.
Medical rehabilitation includes
1) provision of advice and guidance for
rehabilitation;
2) assessment of functional capacity and
work ability as well as the rehabilitation
needs of patients;
3) assessment of options and prognosis of
rehabilitation;
4) therapy aimed at improving and
maintaining functional capacity and other
measures to support rehabilitation;
5) assistive device services;
6) adaptation training; and
7) inpatient or outpatient care to provide
the services referred to in subparagraphs
1–6.
Coordination between
primary health care
and specialised medical care
Joint municipal authorities for hospital
districts are responsible for coordinating
specialised medical care services with the
needs of the population and the
requirements of primary health care
Finland has 317 municipalities (2015)
•Municipalities are self-governing units where the highest
decision-making authority is vested in local councils elected by
residents.
•Local authorities provide basic public services for their
residents, the most important of which relate to social welfare
and health care, education and culture, the environment and
technical infrastructure.
•The total expenditure of local and joint municipal authorities is
approximately 46 billion euros (2015).
•Some 429 000 employees provide services for municipal
residents.
Local authorities provide services for all their residents
(2013) Social welfare and health care services
• •23.6 million outpatient visits to health centers
•3.5 million visits to dentist in health centers
•5.0 million care days in health centers
•8.5 million outpatient visits in specialized health care
•4.4 million care days in specialized health care
•18 000 child protection clients placed outside the home
•89 000 children in child protection open care
•40 000 older people in municipal sheltered housing
•65 000 older people receiving regular home care
•42 000 recipients of informal care support
•138 000 service recipients under the Services and Assistance
for the Disabled Act
•239 000 households receiving social assistance.
Source: The National Institute for Health and Welfare, Statistical Yearbook on Social Welfare and Health Care
2014.
13.4.2015
Social and Health Services
• Social welfare and health care is the largest local government
function and a central part of the Finnish system of welfare
services.
• The right to social welfare and health services is a basic and
fundamental right of the whole population.
• Local authorities are responsible for performing the social
welfare and health care services laid down for them by law.
They may provide the services either alone or secure them
from other organisations or private sector providers.
Health Services
• Local authorities provide primary health care.
• Social services and health care are being developed in Finland
largely as a single entity. In some local authorities, the
administration of social welfare and primary health care
has been combined, and the services are closely co-
ordinated in accordance with the principle of overall regional
responsibility for the population.
• Municipal public-health work is the foundation of the
Finnish health system.
• Local authorities run about 172 health centres; 106 of these
are municipal health centres, and the rest 36 belong to joint
municipal authorities made up of several local authorities.
• The Kainuu region in northern Finland is experimenting on
providing health care services on regional basis.
Preventive health care
• Preventive health care is also considered very important in
Finland. The services of prenatal clinics and child health
clinics, for instance, are available free of charge to all
families. All mothers of newborn babies receive a maternity
package or its value in money. Environmental health care is
regarded as part of basic health care.
Occupational health
• Alongside municipal health care, there is an occupational
health service system, financed by employers and the State,
which is responsible for much of the health care for the
workforce.
• There is also a relatively extensive system of private
medical services, partly financed by the sickness insurance
system.
Hospitals run by joint municipal
authorities
• Hospitals run by joint municipal authorities provide 95 per
cent of all specialist medical care; the remaining 5 per cent
is provided by the private sector.
• Every local authority is required by law to be a member of a
joint municipal authority administering a hospital district.
There are 20 hospital districts in all.
• The service structure of municipal specialist medical care has
been reformed in recent years. Hospitals have also
rationalised their research and patient care practices. The
number of wards and hospital beds are being cut, whereas
outpatient care is being made more efficient and measures
such as outpatient surgery are becoming more common.
• .
• Specialist medical care is investing in quality systems. Various
auditing systems are being introduced. Information systems
in specialist medical care, such as medical histories and
systems for patient administration and referrals are being
computerised.
• As part of health care, hospitals are forming networks, and
the cohesion of the entire health-care sector is being
improved.
• Fees are charged for visits to health centres and stays in
hospital
Specialized medical care in a nutshell
• Specialized medical care is the responsibility of the
municipalities
• In order to facilitate cooperation between the municipalities
Finland is divided into 20 hospital districts; hospital areas can
be established
• Focus is on providing medical care in the patient’s native
language
• The hospitals are owned and run by joint authorities
• There is a minority language board in hospital districts with
bilingual municipalities
• The five university hospitals operate in co-operation with a
faculty of medicine
Physicians in Finland
• There were 27 433 physicians licensed in Finland in the
beginning of 2015.
• The number of physicians of working
age (under 65 years) living in Finland was 20 403.
• Several physicians from other EU countries obtain a license
even in Finland, but don’t come to work here. Therefore the
medical workforce of Finland is smaller than the number of
licensed
• Annually about 600 new physicians graduate in Finland.
• Physician density in Finland is one physician of working age
per 268 inhabitants.
• 93 % of physicians living in Finland are members of the
Finnish Medical Association.
• In the beginning of 2015 the Association had 24 993
members,1 517 of whom were medical students
Medical education
• On January 1st 2015 the total number of specialists
licenses was 19 886, of which 14 904 were held by
physicians under 65 years.
• 65% of Finnish physicians (16 137) are specialists.
• There are 12 182 specialist physicians of working age, of
which 6 911 are female.
• General Practice: 3 091 ( 2 379, 1 506)
Primary health care
• Primary health care is organized by municipalities and is mainly provided by some 160 local health
centres. Primary health services include:
• Consultations with a doctor for people who have become ill and for the treatment of chronic illnesses -
patients may be referred to specialists or for further examination
• Health centres often have a ward for patients requiring nursing care
• Health counselling, including health education, contraception advice, maternity and child welfare and
medical examinations
• Screening and vaccinations
• Oral health services
• School and student health care
• Mental health services
• Emergency treatment, emergency cases also handled by hospitals
• Home care services
• The MSAH is responsible for developing legislation covering primary health care.
• Health Care Act 2010
• Primary Health Care Act 1972
• A key aspect of the MSAH's National Development Programme for Social Welfare and Health Care (Kaste)
is the organisation of health services to make them more client/patient focussed.
• National Development Programme for Social Welfare and Health Care (Kaste)
• Municipalities may organise primary health care services alone or in collaboration with other
municipalities, or they may procure them from private providers. People may also use service vouchers
to procure services from the source they prefer.
• The law on client fees regulates fees for health care services provided by health centres.
OECD
• Good health is one of the most important things to people
and also brings many other benefits, including enhanced
access to education and the job market, an increase in
productivity and wealth, reduced health care costs, good
social relations, and of course, a longer life.
What does OECD say about Finland
• Better Life index: Key Findings
• Most OECD countries have enjoyed large gains in life
expectancy over the past decades, thanks to improvements in
living conditions, public health interventions and progress in
medical care. Life expectancy at birth in Finland stands at
almost 81 years, one year above the OECD average of 80
years. Life expectancy for women is 84 years, compared
with 78 for men, close to the average OECD gender gap of
five years, with a life expectancy of 82 years for women and
77 years for men. Higher life expectancy is generally
associated with higher health care spending per person,
although many other factors have an impact on life
expectancy (such as living standards, lifestyles, education and
environmental factors).
How is your health in general?
• When asked, “How is your health in general?” 65% of people
in Finland reported to be in good health, less than the
OECD average of 68%. Despite the subjective nature of this
question, answers have been found to be a good predictor of
people’s future health care use. Gender, age and social status
may affect answers to this question. On average in OECD
countries, men are more likely to report good health than
women, with an average of 70% for men and 66% for women.
In Finland, the average is 65% for men and 64% for women.
Not surprisingly, older people report poorer health, as do
those who are unemployed, or who have less education or
income. About 77% of adults with a disposable income in
the top 20% in Finland rate their health as “good” or “very
good”, compared to about 49% for those with a disposable
income in the bottom 20%.
Thank You!