Healthcare in Finland
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Finland has a highly decentralized three level socialized system of health care and alongside these, a much smaller private health care system. Responsibility for health care is devolved to the municipalities (local government), Primary health care is obtained from district health centers employing general practitioners and nurses that provide most day-to-day medical services. The general practitioners are also gatekeepers to more the more specialized services in the secondary and tertiary care sectors. Secondary care is provided by the municipalities through district hospitals where more specialist care is available. Finland also has a network of five university teaching hospitals which makes up the tertiary level. These contain the most advanced medical facilities in the country and they are where Finnish doctors learn their profession. These are funded by the municipalities, but national government meets the cost of medical training. These hospitals are located in the major cities of Helsinki, Turku, Tampere, Kuopio, and Oulu.
There is a high level of co-operation between the various sectors with almost all having access to computerised patient data based on open source software originally developed for the U.S. Veterans Health Administration and compliant with CDA subset of HL7 interoperability standards [1]. Since the 1980s, the planning system for basic health care has been extended and now plans not just health care services but also care homes for the elderly and day care for children creating a fairly seamless cradle to grave system.
The separate private health care system is very small. Between 3 and 4 per cent of hospital in-patient care is provided by the private health care system and the remainder by the public or socialized system. Physiotherapy, dentistry and occupational health services are the main areas where the private sector is most used, although the municipalities by law also have to provide basic dental services. Employers are obliged by law to provide occupational health care services for their employees, as are educational establishments for their students as well as their staff. Only about 10 per cent of the income of private sector income comes from private insurance. Most is paid for out of pocket, but a significant share of the cost is reclaimable from the National Insurance system KELA. Spectacles, however, are not publicly subsidized.
A Patient’s Injury Law gives patients the right to compensation for unforeseeable injury that occurred as a result of treatment or diagnosis. Health care personnel need not be shown to be legally responsible for the injury thus avoiding the development of a litigious blame culture and the development of defensive medical practices. To receive compensation, it is sufficient that unforeseeable injury as defined by law occurred. A law on patients’ status and rights, the first such law in Europe, ensures a patient’s right to information, to informed consent to treatment, the right to see any relevant medical documents,and the right to autonomy. Legislation also lays down the time frame in which a person must be ensured access to necessary medical care and defines the small percentage of treatments that are to be considered as non-urgent. Doctors comply with care guidelines set by medical experts, but these are just guidelines and doctors are free to decide independently how to treat patients. The government does not dictate how doctors may treat their patients.
Finland's health care services are more highly socialized than the European average. The quality of service in Finnish health care is considered to be good and according to a survey published by the European Commission in 2000, Finland has the highest number of people satisfied with their hospital care system in the EU: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%.[2] Finnish health care expenditures are below the European average.
Overall, the municipalities (funded by taxation, local and national) meet about two thirds of all medical care costs and the remaining one third by the national insurance system (nationally funded), and private finance (either employer funded or met by patients themselves). There are caps on total medical expenses that are met out of pocket for drugs and hospital treatments. All necessary costs over these caps are paid for by the National Insurance system. Public spending on health care in 2006 was 13.6 billion euros, equivalent to 2,586 euros (US$ 4,031) per person annually. The increase over 2005 at 8.2 per cent was below the OECD average of 9 percent. Household budgets directly met 18.7 per cent of all health care costs. [3]
Main sources: Finland report on Health Care Systems in Transition (WHO) and Health care in Finland (Ministry of Social Affairs and Health publication)
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