Gaining health : analysis of policy development in European ...

2.1.7. Monitoring and evaluation
Finland has had regular surveillance systems in place for
many years, providing an excellent database for the monitoring
and evaluation of health policy. Considerable effort
is made to provide data on the local level and give local
authorities support in the use and processing of such data.
The quality has been enhanced through pilot projects to
improve the standardization of data and test hypotheses.
Evaluation takes place on various levels from that of general
policy to evaluating the effectiveness of specific methods of
treatment.
Finland reports regularly to international organizations
such as WHO and the EU, participates actively in Nordic
monitoring exercises, and collaborates closely with the
Baltic countries. Indeed, in the 1980s and 1990s, efforts expended
in international monitoring and evaluation exercises
perhaps detracted to some extent from similar domestic
exercises, particularly from the need to discuss broadly the
policy implications of the results. Undoubtedly, however, a
valuable body of internationally comparable information and
exchange of experience has been created.
Health 2015 goes a step further, calling for the regular
monitoring and evaluation activities of the Government and
individual ministries to include progress in health policy implementation.
In particular, the social and health report made to
Parliament every four years is expected to indicate progress
across sectors and at different levels of government.
Health 2015 also continued the Finnish tradition of seeking
constructive criticism and provided for an external
evaluation of health promotion structures, resources and
activities. This took place in collaboration with WHO in
2001 (12). An external evaluation of national health policy is
expected during the present decade.
Since this type of evaluation is not widespread across
Europe, it is worth highlighting the Finnish attitude towards
critical evaluation. For example, when in 1989 the terms of
reference for the first WHO review of the Finnish Health
for All policy were being agreed, the then Minister was
asked what the position would be if the external review
group expressed views unattractive for Finland and with
which domestic experts did not agree. Her reply was, “You
publish whatever you find”.
2.2. Health promotion strategy
Health 2015 was considered to deal largely with health
promotion and disease prevention issues and there was
therefore no separately labelled “health promotion strategy”.
However, the new government action plan calls for
a strategic plan for health promotion. An ad hoc working
group set up in MSAH has almost completed its work.
2.3. Health services policies
Even though the municipalities were owners of PHC centres
and hospitals, MSAH closely controlled health care development
until the early 1990s by earmarking funding for
investment and staffing. In 1993, the Ministry of the Interior
brought in far-reaching reforms, giving greater autonomy
to the municipalities by replacing earmarked subsidies with
block grants. Similar changes were taking place in other
Scandinavian countries such as Denmark, and with similar
results. In return for greater autonomy at the local level,
the central level had to compromise on the achievement
of centrally defined targets. In recognition of the problem
of balancing local autonomy with considerations of equality,
Norway and Sweden have apparently preferred to compromise
local autonomy to some extent in the interest of
greater equality in relation to child care, for example (22).
Since 1993, state support for statutory services in Finland
has been based on a needs-criteria formula (population, age
structure, morbidity, etc.). This has led to certain disparities
among municipalities. Furthermore, the total cost of health
care met by households has been rising steeply, reaching
19% in 2003 (23), which may act as an obstacle, particularly
to preventive care.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases