Country Profile

Finland

Reforms in publicly funded health care are inevitable

by Antero Heloma, MD, Finnish Institute of Occupational Health

 

Like other Scandinavian countries, Finland has healthcare systems that are universal and primarily publicly funded with revenues from income and other taxes. These systems were built to guarantee equal service for all regardless of individual income. A few decades ago, the public health system was seen as more democratic alternative than the private or semi-private insurance-based system.

Private health care services developed as an alternative to the public system. This private sector, however, has mainly organized out-patient services and has few private hospitals. The state compensates about 20 to 35% of private service fees from national insurance funds. Employers are required to provide occupational health care services for all employees, but other healthcare services are voluntary. Employers receive up to 50% compensation for occupational health services from national insurance funds.

This system worked well as long as the state economy was in balance and the GNP was rising. Insecurity in funding began in the early 1990s during a severe economic recession. The economy gradually recovered by 1997, but the healthcare system never regained the secure financing it had once enjoyed. Finland joined the European Union in 1995 and the Economic and Monetary Union (EMU) in 1998, which also changed economical structures and lowered income tax rates.

 

Public Health System At Risk

New and expensive medical treatments as well as the growing elderly population put the public system at risk. Hospitals in some scarcely populated areas had to be closed, which gaved savings, but meant longer distances to treatment for many people. Discussion of prioritization became important. It meant balancing available funds with the criteria for delivering services to patients. The determinants in prioritization are, among other things, age, estimated probability for recovery, and the personal and economical benefits achieved by the treatment.

Nowaday, principally everyone can still get first-class health service in the public system, especially in emergency situations, but waiting lists for non-emergency operations have become longer and it is difficult to get treatment for some health problems. It has been necessary to reduce the hospital staff, and it is increasingly difficult to hire extra staff to cover the sick leaves and vacations of health personnel. All of this has increased the burden of the remaining personnel. It is difficult to get doctors to work in remote areas. A growing number of trained unemployed nurses have moved to work in England while many doctors have moved to richer Norway in search of better salaries.

The government has allocated more funds than before for preventive approaches like health education and promotion. The Finnish Parliament has suggested that health promotion funding elevated to 1% of the tobacco tax revenue, which is the level recommended by the World Health Organization.

Despite the dark clouds on the public health care, the public system is not likly to collapse. Less than 8% of the GNP is used for health care, compared to the 15% used in the United States. However, the health care reform must progress with health promotion playing a more prominent role and new additional funding systems have to be considered in future.

 

Dr. Antero Heloma can be reached at: Uusimaa Regional Institute of Occupational Health , Arinatie 3A, FIN-00370-Helsinki, Finland, e-mail: Antero.Heloma@occuphealth.fi
 
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