Public Health Care and Globalization - Finland

National Research and Development Centre for Welfare and Health

Knowledge for welfare and health 1

Public Health Care and Globalization

- Finland

Eeva Ollila



Globalization and Health care--Some common features

Increasing commercial interests in the production of health services Increasing (multinational) for-profit service actors Problems with equity of access, increasing inequities

in health Challenges in regulation

Increasing health care costs and problems in public financing Increasing prices of pharmaceuticals, emphases on

high technology Taxation capacities decreasing

Deficit of health care workers Flow of workers from public to private, from South to

North



Finnish health care systemDecentralized health care system with municipalities responsible for organising health careMulti-channel financing with non-ear marked state subsidies, municipal taxes, social insurance and user fees Primary health care mostly produced by the municipalities, specialised care by hospital districts, private provision with social insurance subsidies especially in cities in open care/ occupational health



Globalization and its implications for the national health care

National trends New public management (NPM), preparing for

outsourcing: Bureaucratic commercialization, purchaser-provider split, contract steering, pricing according to DRGs, private sector management techniques, decentralization

Outsourcing ( and privatisation) likely to increase (procurement law and the project on municipal and service delivery restructuring, pressures to decrease the size of the public sector)

Maintenance of public financing (tax or insurance based)




Regional and global pressuresNeo-liberal political atmosphereEU: the four freedoms, internal markets, competition, procurement directive, services directive, directive on health services, financial policies (EMU criteria), ECJ decisions OECD (public governance and management): NPM WTO (TRIPS, services)




Financing Pressure to lower taxes, lowered state

subsidies put pressures on municipal tax-based financing, increased user fees on services and on pharmaceuticals: as a result regressive financing

Pressures for increased funding: Commercialization, new expensive technologies, increased expectations, aging



Production of health servicesOutsourcing and privatisation increasingFragmentation of the service delivery systemCompetition practices increasingly taking production decisions to courtResponsibilities remain with the municipalities




Governance - “Steer more - row less”Information steering, project steering,

laws, regulations, monitoring, financingThe framework of regulation is changingRegulation from the Ministries of Health to

the Courts

Public Health Care and Globalization - Finland

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