The Finnish Health Care System - Institute for Strategy and ...

The 2005 introduction of maximum wait times for municipal care hasimproved timely access, especially for hospital-based services. However, somehealth centres and hospital districts still fail to comply with the guarantee. Legislationhas also not yet defined maximum wait times for health centre physicianappointments for non-acute care amid deteriorating access to these services.In April 2008, 37% of Finns lived in municipalities with waits of more thantwo weeks for non-acute physician appointments, up from 25% in September2005.Differences across socioeconomic groups in mortality amenable tohealth care are wide and seem to be expanding. (Arffman et al. 2007) In 2000,the extent of income-based inequity in access to physician visits in Finland wasamong the highest of any OECD country, along with the United States andPortugal. (Van Doorslaer et al. 2006) There are also significant income-baseddifferences in screening, dental care, coronary revascularizations and someelective surgeries. (Teperi et al. 2006)Among the most important reasons for socioeconomic differences inaccess to services is the expedited access to care offered by private and occupationalhealth care providers in relation to municipal care. Private and occupationalservices are more commonly used by wealthy people and this contributesto differential access according to socioeconomic status. (Häkkinen2005) To some extent, social inequalities may also arise from the fact thatoccupational health care is offered free of charge, whereas the patients of municipalhealth care have to pay modest user-fees.The municipal system also limits competition for patients. In a valuebasedsystem, both the payers (i.e. “health plans”) and providers of care competeon value or to deliver better health outcomes per euro spent. In Finland’spublic system, municipal “health plans” do not compete for members sinceindividuals do not choose their municipalities of residence based on factorsrelated to health care.Competition is also limited on the provider side. In theory, municipalproviders could compete with private providers on the basis of value. However,in practice, municipal providers have not competed meaningfully with theprivate system, which does not provide a full spectrum of services. (Competitionbetween providers is discussed in detail in the next Section.)Instead, cost shifting takes place both within the public system and betweenpublic and private organizations. Within the public system, cost shiftingbetween municipalities and the NHI leads to perverse incentives vis-à-vis valuecreation. Since municipalities pay for most care but the NHI compensates residentsfor lost wages, hospitals have little financial incentive to treat patientsquickly. During the years, this has led hospitals to use lengthy queues to balancethe demand and supply of services. Municipalities pay for medicationsdelivered in hospitals, but the NHI pays for drugs taken at home. Hospitals45