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!