Finland HiT (2019)

On the occasion of Finland’s Presidency of the Council of the European Union in 2019, the European Observatory on Health Systems and Policies has released a new health system review (HiT) for Finland. It highlights Finland’s health system reform and policy process, and takes stock of recent changes and future challenges.

Population health has improved but inequalities in health remain

The Finnish health system performs well, with users expressing comparatively high levels of satisfaction with the quality of services. The gender gap and socioeconomic inequalities in health outcomes have declined but remain substantial. In addition, there are persistent geographical inequities, which are to the detriment of people living in the northern, eastern and central regions.

Municipalities vary in their ability to deliver health services

The health system is highly decentralized; there are multiple co-existing financial flows and three overlapping channels for providing the publicly funded benefits package. This has led to weak stewardship, inefficient cost containment, and fragmentation in service delivery. More recently, examples of successfully integrated services have been developed, in particular within home care for older people, psychosocial services for children and adults, and in hospital-based emergency care.

High cost-sharing has implications for financial protection

Current health expenditure in Finland is below comparable countries, including other Nordic countries, the United Kingdom and the Netherlands. Roughly one fifth of total health spending comes from out-of-pocket payments. Private expenditure on prescription medications is particularly high, amounting to about one third of total pharmaceutical spending. User fees exist also in other areas of health services, with occupational health care being the only exception. Although there are payment caps for medication and service costs, these are set at high levels, and particularly affect people on lower incomes.

Infrastructure has been improved, but matching service provision to population needs remains a challenge

Health care infrastructure and facilities have undergone marked changes in the 2000s, with hospital districts investing heavily in new facilities. Nevertheless, capacity to deliver services that match population needs has weakened. This is reflected in long waiting times in primary care (up to several weeks for a non-urgent GP appointment in some health centres), as well as in elective specialist care. However, expanded roles of nurses have improved access to health services, particularly in primary care.

Achieving greater centralization remains the main goal of health reforms

There is broad consensus that the inherent flaws of the Finnish health system need to be addressed. The separate organization of primary and specialized care and social services is seen as an obstacle to improving health system performance, particularly in the context of an ageing population. Over the past two decades, several governments have attempted reforms, with three core aims: 1) centralizing organizational structures; 2) improving access to primary care; and 3) integrating services (within the health system and between health and social care). The implementation of these reforms, however, remains a work in progress.