Freedom of choice for clients
The Government proposes to increase clients’ freedom of choice as part of the health, social services and regional government reform. On 9 May the Government submitted to Parliament a proposal on the legislation on freedom of choice.
Freedom of choice means that clients have the right to choose themselves where to get health and social services. Publicly funded health and social services would be provided by public, private and third-sector operators, such as organisations and foundations. Client fees would be the same across service providers.
Wider freedom of choice would increase clients’ possibilities of influence as well as improve the availability, quality and cost effectiveness of services. Clients would have more freedom to choose the service providers that best suit them. The goal is to give clients faster access to appointments with healthcare and social welfare professionals and to other services.
Clients would have more freedom of choice
In practice freedom of choice would mean that individuals sign up as clients with the health and social services centre and dental clinic (oral health services unit) of their choice. If the health and social services centre or the dental clinic a client has chosen has units in several locations, the client could visit any one of these units.
Clients could also choose a unit of the unincorporated county enterprise. Unincorporated county enterprises would provide the services not available in health and social services centres or dental clinics. These include, for example, urgent and emergency care services as well as most of specialised medical care and social services.
Health and social services centres, dental clinics and unincorporated county enterprises could grant clients health and social services vouchers, which the clients could use to get a particular service from another service provider. Those clients who receive services for older people or people with disabilities and who have an extensive and long-term need for assistance could be granted a personal budget. They could use the personal budget to get services that best suit their individual situation.
Clients would get more information about service quality
Clients would get more information about the quality of health and social services and about waiting times. Counties and service providers would be required by law to provide information in a national online service and on request even orally and in writing. Health and social services centres, dental clinics and service providers approved to deliver services against health and social services vouchers would be obligated to issue annual reports on revenue, taxes paid and place of taxation, profit and loss, management salaries and bonuses as well as on corporate social responsibility, among others.
Compensation to providers would take into account different kinds of clients
The responsibility for organising health and social services will be transferred to the new counties as of 1 January 2019, as part of the health, social services and regional government reform. The counties would be responsible for ensuring that all residents get the services they need and that services by all service providers form a well-functioning system that runs smoothly. They would pay the service providers compensation for the clients treated. The counties would receive their funding from the state.
The compensation to service providers would take into account factors, such as age and morbidity, affecting clients’ need for services. This means that the counties would pay a higher compensation for clients who are older or more ill. Part of the funding could also be based on performance. This would make it worthwhile for service providers to have different kinds of clients. The counties could also pay additional compensation to service providers operating in remote areas.
Small enterprises too could be service providers
Small enterprises have good chances of becoming service providers that deliver services against health and social services vouchers and personal budgets. Moreover, health and social services centres and unincorporated county enterprises can supplement their own service provision by purchasing services from small or micro enterprises either through competitive procurement or direct procurement. Despite the wide range of services provided by health and social services centres, small enterprises could still provide similar services by means of cooperation agreements or joint enterprises.
Freedom of choice would be extended in stages
The Act on Freedom of Choice is due to come into force at the beginning of 2019. In some counties wider freedom of choice can be introduced already this year through pilots experimenting with health and social services centres and personal budgets. Other counties would establish their health and social services centres by 1 July 2019 at the latest. Clients could choose their dental clinic already on 1 January 2019. By special permit counties could postpone the establishment of health and social services centres until the beginning of 2021. Full freedom of choice should be in use in all counties by 1 January 2023.
Wide-ranging impact assessment included in the legislative proposal
According to the impact assessment, wide freedom of choice will improve access to primary-level services and people’s possibilities to get services on an equal footing. The freedom of choice model, when carefully executed, will create possibilities to curb the growth of expenditure, as has been the target. Compatibility of information systems is a key to a successful health and social services reform.
Tuomas Pöysti, Project Manager, Under-Secretary of State, Ministry of Social Affairs and Health and Ministry of Finance, tel. +358 295 163 012
Kirsi Varhila, Director-General, Ministry of Social Affairs and Health, tel. +358 295 163 338
Outi Antila, Director-General, Ministry of Social Affairs and Health, tel. +358 295 163 164