Decision in Principle by the Council of
State on securing the future of health care
According to the Constitution, the state must, according to what is prescribed in
greater detail by law, ensure sufficient social welfare and health care services for all
and promote the health of the population. According to legislation, the responsibility for
arranging services lies mainly with the municipalities.
Arranging health care services is one of the main tasks of municipalities. The state is
responsible for the direction of health policy and the general operational framework.
In recent years, there have been growing problems in the operational framework for and
availability of services, and this is something which must be addressed. For this reason,
the Council of State initiated a national project to ensure the future of health care on
13 September 2001. Based on the health-related needs of the population, the aim of the
project is to ensure the availability, quality and sufficiency of care in the various
parts of the country, irrespective of the residents’ ability to pay.
The service system is being developed in cooperation between the municipalities and the
state, taking into consideration the operations of the private and third sector. In order
to ensure the practicality of the service systems, the Council of State has decided upon
the following measures:
1. Viable primary health care and preventive work
Sufficiently resourced and viable primary health care is the foundation of the entire
health care system. Preventive work is one of the paramount duties of primary health care,
which together with the responsibility of the public for their own health and healthy
habits, inhibits the rise in demand for services and redirects the need for services
towards less demanding, more outpatient-orientated forms of treatment. The government has
previously issued a statement concerning measures to promote health in the Health 2015
programme. The Council of State implements and promotes action by which it is possible to
reduce substance abuse and the overload on the service system caused by such abuse as well
as the existence of the most widespread illnesses and the need for treatment arising from
these.
2. Ensuring access to treatment
In order to decrease differences in the criteria for access to treatment, the Ministry
of Social Affairs and Health, together with the Association of Finnish Local and Regional
Authorities, is preparing nationwide guidelines for non-urgent treatment and queue
management to be implemented by the end of 2003. The preparation work is based on the
following considerations:
- Access to an initial assessment by a primary
health care professional, normally a physician, within three days of contacting the
service.
- Access to an assessment by an outpatient department of a specialised health care unit
must be arranged within three weeks of the issue of a referral.
- Access to medically justified treatment within a reasonable period specified in the
nationwide treatment recommendations or otherwise warranted by the available evidence,
which should normally be within three and no later than in six months.
- If treatment cannot be provided at a facility maintained by the local authority or
federation of municipalities within the time specified, treatment must be procured from
another service provider at no extra charge to the patient.
The principle of access to treatment within a reasonable period will be embodied in
legislation by the year 2005. The Ministry of Social Affairs and Health will more
specifically guide access to non-urgent treatment through decrees and directives that will
come into force on 1 January 2005.
3. Ensuring the availability and expertise of personnel
As of the beginning of 2002, the number of new places for students of medicine will be
boosted from 550 to 600. Training for other health care personnel will be increased
according to the guidelines of the Committee on Estimation of Labour Demand in Social
Welfare and Health Care (Committee Report 2001:7, Ministry of Social Affairs and Health),
and taking specific regional needs into consideration.
The Ministry of Education will revise the decrees concerning the further education in
primary health care and specialised education of physicians as well as similar decrees
applying to dentists, so that the education following each primary physician’s or
dentist’s first degree would include a period of at least nine months’ practical
work as a physician or dentist at a health centre. At least half of the specialised
education should be carried out somewhere other than a university hospital. During
2003–2005, pursuant to sections 47 and 47 b of the Act on Specialised Medical Care,
EUR 8 million will be transferred from the government indemnity on research activity to
the government indemnity on medical and dentistry education. Present practices will be
restored in 2006.
In-service training for personnel will be arranged which, depending on the length of
the basic education, on how demanding the work is and on changes to the job description,
will average 3–10 days a year. The management of health care will be enhanced by
arranging a multi-professional management education programme for the health care sector,
no later than 2005, at universities providing medical and health education. Together with
the Ministry of Education, the Ministry of Social Affairs and Health and the Association
of Finnish Local and Regional Authorities, the universities will be responsible for the
contents of the education. The employer will be responsible for the costs of in-service
training. Health centres and hospitals must ensure that the training subsidy for health
care professionals allocated by the pharmaceutical industry and other corporations is
channelled to units that decide how the support is to be allocated rather than to
individuals.
The state will promote discussions between organisations of trade unions and employers
on the development of bonuses for results with the aim of factoring productive work inputs
into wage-related solutions in the health care sector.
The system of special payment categories is being abolished by degrees. Section 9 of
the Act on Client Fees for Social Welfare and Health Care will be annulled and the state
will promote the development of an incentive system to replace it in connection with the
abolition of the special payment category. If a hospital meets the criteria for access to
treatment referred to in paragraph 2 above, the hospital district may buy in such
outpatient and day-surgery services as additional work from its own personnel after the
actual working hours, which will be paid for by other parties than the home municipality
of the patient, e.g., employers, insurance companies and the patients themselves.
4. The reform of functions and structures
Primary health care is organised as regional, operational entities. The recommended
population base is 20,000 – 30,000 inhabitants and units structured in this way have
12–18 physicians. When configurations are formed it is, however, necessary to take
regional differences into consideration and to ensure the operations of smaller but
efficient units. When formulating the network of operational units, attention is paid to
the fact that distances should not be a hindrance to using services. Mental-health
outpatient services, psychosocial services, services for substance abusers and associated
emergency services should be arranged as an operational regional unit in association with
the private and third sectors.
Operational cooperation and the division of work in specialised health care will be
carried out according to specific spheres of responsibility. Methods for joint procurement
of medicines and materials are still under development. Emergency services are being
rationalised. During 2003, the Ministry of Social Affairs and Health will introduce a
decree to be implemented nationwide on research and treatment and according to spheres of
specific responsibility. The hospital districts will enter into agreements regarding
cooperation, amalgamate
or form health care districts. In order to develop cooperation and the distribution of
work, by 31 May 2003 the hospital districts in specific spheres of responsibility should
submit a plan the to Ministry of Social Affairs and Health in respect of demanding
treatment that can be planned in advance, operating teams for small numbers of patients,
treatment services and support services. The cooperation can be imple-mented either by
combining hospital districts or within the framework of existing hospital districts. The
Ministry of Social Affairs and Health will process the plans and allocate funds for
projects where necessary. If the plans do not lead to appropriate solutions from the
operational viewpoint, the hospital districts may be obliged to take action by legislative
amendments. District hospitals will form health care districts together with the primary
health care units in their areas or will operate as part of the central hospital in their
area.
In laboratory and imaging operations, there will be a changeover to units formed out of
one or
more hospital districts, and municipal enterprises and state-of-the-art technology will be
utilised. The principles for the determination of sickness insurance compensation for
laboratory and imaging examinations in the private sector will be reduced to the level of
the production costs of the most efficient units by the end of 2002.
Nationwide electronic patient records will be introduced. The preparation of national
treatment recommendations and regional treatment programmes will continue and their
application in practice will be enhanced, so that the increase in efficiency will achieve
rationalisation-related benefits. Existing data on efficiency will also be put to use in
rehabilitation work. The rationalisation of prescriptions and medicine use will be
promoted by supporting the Rohto project which is being carried out for this purpose. The
projects to reform the operations and structures mentioned above will be completed by the
end of 2007 and it is estimated that, with their help, it will be possible to achieve
savings of EUR 0.2 billion a year.
5. Augmenting the finances of health care
As of 2003, state subsidies for social welfare and health care allocated to the
municipalities will be increased by EUR 104 million a year in accordance with decisions
made in government framework negotiations. According to the project, the need for
additional funding is a result of the increased demand for services caused by the change
in the age structure of the population, the introduction of new technology, and the
additional costs arising from attaining the standards required by in-service training and
quality recommendations.
Providing that the reform of operations and structures has got under way as proposed,
the state subsidies allocated for municipal social welfare and health care and their
percentage value will be gradually increased to permit the attainment of the
aforementioned aims. The stability and predictability of municipal financing will be
improved. Regulations on client fees and the payment ceiling will be reformed.
The elimination of queues for examinations and treatment is being discussed by the
state, the Association of Finnish Local and Regional Authorities and the hospital
districts. State grants will be disbursed for the abolition of queues on the basis of
these negotiations. The necessary amount of additional grants will be decided on the basis
of a separate study.
The service system is being developed as programme work advancing in stages, for which
EUR 8 million will be allocated in next year’s budget and from 2004 to 2007 a project
allocation of EUR 30 million annually. The operational and structural reforms proposed in
the projects will have been implemented by the end of 2007. Project funding will be
allocated for the regional provision of services, the development of the division of work
between hospital districts, and supporting the solutions following their operational and
administrative amalgamation. Discussions concerning the division of work between hospital
districts are being held according to the specific sphere of responsibility.
In addition to the project funding, the state supports the development and introduction
of national electronic patient records with separate funding amounting to EUR 0.8 million
and the Current Care (EBM) and Medicine projects with EUR 1.4 million and EUR 1.3 million
annually in the period 2003–2007. Financing for a unit for the evaluation of health
care methods will be boosted to EUR 2.5 million by 2007.
6. Implementation of the proposals for the project
A management group appointed by the Ministry of Social Affairs and Health will be
formed to carry out the project. The Ministry of Social Affairs and Health will coordinate
the implementation of the programme. For this purpose, a grant of EUR 0.3 million will be
allocated for 2002 and an annual grant of EUR 0.8 million for the period 2003–2007.