ESPN Thematic Report on Inequalities in Access to Healthcare: Finland
Every resident in Finland is entitled to adequate healthcare, including primary and specialised healthcare and dental care. However, patients must pay part of the costs themselves for both services (client fees) and prescription medicine (partial reimbursement).
The Finnish healthcare system is threefold: National Health Insurance (NHI), a municipality-based healthcare service and occupational healthcare. The co-existence of these three models has resulted in a multichannel system for financing and for access to healthcare, and consequently in different levels of availability and access to care. The current efforts to carry out social and healthcare reform (SOTE) seek to simplify the system and improve equal access to care. Thus, the whole structure and logic of providing social and healthcare services will change, if the reform is passed.
Finnish healthcare is universal, as well as effective: the infant mortality and low birth weight rates are among the lowest in Europe, while survival rates from cancer and other severe diseases are very high. Consequently, Finns are very satisfied with their healthcare system. However, the share of people with unmet medical need in Finland is rather high, the main reason being the long waiting lists. Only 0.1% of Finns say that the reason for their unmet medical need is that care is too expensive. However, user fees may be too much for those people who live on minimum benefits. The government should consider whether it is possible to lower the annual cap of EUR 691.
The popularity of private health insurance is growing. More than half of families with children have a healthcare policy for their children and about one fifth of the adult population has a private policy to cover the costs of medical treatment. One of the most severe challenges for the Finnish healthcare system is that it is socioeconomically biased. Indeed, the OECD has classified the Finnish healthcare system as one of the most unequal in the industrial countries. The main reason for the observed inequality in access to healthcare stems from occupational healthcare, which is free and often more effective than public healthcare.
To improve access to, equality in and the quality of healthcare, a great reform, SOTE, is planned. The reform is also expected to cut costs. The final version of the reform was planned to be accepted by Parliament in summer 2018. However, it is unclear when and whether the reform will be passed at all. And even if it will be implemented in the present form, there are serious doubts whether it will succeed in achieving its goals. When the SOTE reform is accomplished, the government should carefully follow developments in access to healthcare, and take rapid corrective measures if the reform does not produce the desired results. The government must keep records on how equal access is realised in urban and rural areas, in high- and low-resource groups, in groups in the labour market and groups that are inactive.
There are deficiencies in the access of immigrants to services and considerable variation in municipal practice; the danger is that this variation will remain even after the SOTE reform, when private providers have greater responsibility. Therefore, the central government and the 18 counties to be established must set out the obligations of private enterprises to tackle these problems. This should include preventive public health tasks, unless the government takes sole responsibility for those. Cream-skimming in private enterprises might also be a risk factor of the reform. The planned expansion off individual choice requires individuals to have enough information and knowledge to make rational choices between different care providers and different forms of services. The government must ensure adequate help for vulnerable groups – especially those without willing and able family members or friends.
Olli Kangas, Laura Kalliomaa-Puha
- Vertaisarvioitu: ei.
- Avoin saatavuus: kyllä.
- Koko viite: Kangas, O., & Kalliomaa-Puha, L. (2018). ESPN Thematic Report on Inequalities in Access to Healthcare. European Commission. https://data.europa.eu/doi/10.2767/371408