Frequently asked questions about the health and social services reform
This site provides answers to frequently asked questions.
What are public health and social services?
Health and social services are services the state finances through tax revenue. They include, among others,
- outpatient services
- hospital services
- oral health services
- mental health and substance abuse services
- maternity and child health clinics
- child protection
- services for people with disabilities
- housing services for older persons
- home care
What are the goals of the health, social services and regional government reform?
The health, social services and regional government reform will give the public administration in Finland a clear three-tier structure: state, counties and municipalities. The aim is to modernise administration and services so that they are cost-effective and responsive to client needs. The reform is scheduled to come into force on 1 January 2020.
The objective of the health and social services reform is to reduce inequalities in health and wellbeing, to make services more equal, better available and more effective and to curb growth in costs.
The objective of the regional government reform is to coordinate regional state administration and county government and to create an appropriate division of responsibilities between the regional state administration, the counties and the municipalities.
How will the administration model outlined by the Government help bridge the sustainability gap?
Resources can be used more effectively when services are organised by 18 counties instead of the current municipalities and joint municipal authorities. This requires a smooth integration of primary and specialised health and social services. It will help reduce institutional care, reinforce prevention and postpone older persons’ need for services. Counties are larger and stronger operators than municipalities, enabling a better division of responsibilities and more efficient use of new service forms.
New digital services will have a major role in generating savings, and interoperable ICT systems will guarantee that information flows between different operators. Central government steering must be strong enough to ensure that best practices spread across the country and that resource and content steering are efficient.
Why should the health and social services reform also curb rising costs?
The ageing of the population will increase the need for health and care services. It has been estimated that, compared to the current level, population ageing will increase the need for older persons’ services as much as 70 per cent and for healthcare services about 20 per cent by 2035. The production costs of services have also increased, and they are expected to rise faster than the overall price level.
A system reform is necessary to safeguard the sustainability of public finances and deliver on the public service pledge on the availability and quality of treatment and care.
A major part of health and social services are financed by tax revenue, but since the total tax ratio is already high in Finland there is little scope for increasing the revenue.
Will the buildings owned by municipalities be transferred to the counties?
The ownership of the facilities of municipal health and social services will not be transferred to the counties; instead, the counties will rent the facilities for a fixed period of 3 years. However, the movable property related to organising health and social services will be transferred from municipalities to counties.
Follow-up preparations will seek to ensure that individual municipalities will not be burdened by empty premises and renovation liabilities.
The counties will receive the assets and liabilities of hospital districts and special care districts and regional councils as well as all related real estate and facilities.
How will transfers of personnel be carried out, and will they impact employee benefits?
The healthcare and social welfare personnel and some support service employees currently employed by municipalities and joint municipal authorities will be transferred to the employment of the counties in line with the principles relating to a transfer of undertakings. In addition, approximately 5,000 employees will be transferred to the counties from the state regional government. A total of over 220,000 persons will become employees of the counties and their companies as of 1 January 2020.
The legislation on local government officials and the collective agreements legislation will continue to apply to the personnel. They will be amended to apply also to the counties’ personnel. The counties will become members of Keva (former Local Government Pensions Institution) and the counties’ personnel will continue to be covered by the municipal pension system. Local Government Employers KT will also act as the counties’ employer representative. The costs of personnel transfers and pay harmonisation will be kept to a minimum.
In the new employer organisation, the counties’ status will correspond with their personnel numbers and economic weight. County-owned companies may choose whether to join the local government pension scheme and the local government and county collective agreements.
How will health and social services be financed?
The counties’ funding will consist of central government financing and the client and user charges collected by the counties. The counties will have no right to levy taxes. As a rule, the central government financing will be allocated to the counties based on needs-based factors defined in legislation. The financing is not earmarked; the counties decide themselves how they use the funds in health and social services.
Will client charges go up?
Legislation on client charges will be amended. The drafting of this legislation started in spring 2017. The criteria for charges in healthcare and social welfare will be streamlined to make service integration easier. Client charges will be collected for services even in future to curb the rising costs and to encourage client to take more responsibility for their health and wellbeing.
How will the language rights of clients and patients be ensured in the health and social services reform?
People’s language rights will be safeguarded in health and social services even in the future. Clients and patients will have the right to use a national language, i.e. Finnish or Swedish, as well as to be heard and receive documents in administrative matters in Finnish or Swedish. Language rights are laid down in the current Language Act, Sámi Language Act and Sign Language Act as well as in the forthcoming Act on Organising Health and Social Services. Health and social services will be organised in both national languages – Finnish and Swedish – in counties where there are both Finnish and Swedish-speaking municipalities or bilingual municipalities If all municipalities in a county are monolingual, services and related administration will be provided in that language.
Of the proposed counties, five will be bilingual, with Swedish as the minority language in all except Ostrobothnia. The right to use the Sámi language in official transactions mainly applies to the Sámi homeland
According to the Language Act, a public authority must on its own initiative ensure that an individual’s language rights are fulfilled in practice. When services are organised, activities must be planned such that the Language Act is adhered to.
The participation of clients and patients must also be safeguarded in situations where a client or patient and personnel do not have a common language or an individual cannot be understood due to a sensory or speech disability or other reason. Such language groups include those that use Finnish and Finnish-Swedish sign language. If it is not possible to provide an interpreter, understanding must be ensured in other ways.
What does the public service pledge mean?
The purpose of the public service pledge is to inform the county residents how the county intends to organise its services. At the same time, it will promote the organisation of health and social services so that the views and needs of clients are also taken into account. The purpose of the service pledge is also to increase the transparency of activities and thereby improve the quality, effectiveness and cost-efficiency of services. A public service pledge gives the county residents the opportunity to monitor and assess how the services are being organised. People can also give feedback and make suggestions on how to better organise services. The public service pledge may not expand or reduce the current scope of statutory services. All the changes will be written in the law.
What does the integration of health and social services mean?
The integration of health and social services means that all services will be under the management of a single structure, that is, the county. The counties will be responsible for integrating the services into client-oriented packages and effective service and care chains. This applies to public health and social services both at the primary and specialised level. In addition, all financing will flow through the counties to the service providers. The counties will also be responsible for making sure that public, private and third-sector services within the scope of the client’s freedom of choice work seamlessly together, that information flows smoothly and that the services meet quality criteria.
How will service organisation and provision be separated in the counties?
Counties will assign the organisation and provision of services to separate organisations. Counties’ own service provision must be separate from the counties’ other operations. For this purpose there will be one or more unincorporated county enterprises in one county.
As the organiser, each county will be responsible for public administrative duties, the functioning of the whole service system and meeting peoples' basic rights. Public authority will only be exercised under liability for acts in office.
How will the diversity of services be ensured in all counties?
The Act on Organising Health and Social Services and the new Service Provider Act will include provisions that aim to ensure a sufficiently extensive supply of private and third sector services in addition to publicly provided health and social services. The conditions for such a genuine multi-provider model and freedom of choice are already effectively in place across the country.
If the service structure of a county is not diverse enough, the Government could request from the county a report on the situation. Under the new legislation, counties may be obliged to organise a tendering process if other steering interventions have not rectified the situation. The Government will consider options for special competition regulations to prevent the formation of excessively large service provider clusters.
What are collaborative catchment areas?
The counties will be grouped into five collaborative catchment areas for the purpose of regional service cooperation and joint research and development activities. There will be a university hospital in each of the five collaborative catchment areas (Helsinki, Turku, Tampere, Oulu and Kuopio). They will be formed based on the current catchment areas for highly specialised medical care. The counties of each collaborative catchment area will draw up a cooperation agreement for healthcare and social welfare, where matters such as inter-county services and investments to be made in healthcare and social welfare in the collaborative catchment area are settled.
Which services will be centralised and provided regionally or nationally?
Services and procedures that require a broad population base, large number of clients and a high degree of specialisation or that are less common and more expensive will be brought together at either a national or regional level in either the five university hospitals or seven other hospital units operating on a broad basis around the clock. This will be ensured through cooperation obligations that apply to all counties. Expertise in specialised level social services may also be gathered to larger clusters, but an effort will be made to deliver services close to the clients.
Provisions on the coordination of health and social services organised by the counties will initially be contained in the Health Care Act and, at a later date, in the forthcoming Act on Organising Health and Social Services. In keeping with the Government Programme, the implementation of the reform will begin in healthcare even before the health, social services and regional government reform package enters into force on 1 January 2020. The Government submitted a proposal to Parliament regarding the reform of the urgent and emergency services in healthcare and social welfare on 27 October 2016. The intention is that the new acts would enter into force on 1 January 2017. The transition period of the decrees issued under the act would be 1–3 years. The division of duties between hospitals providing 24-hour emergency care services, the bringing together of surgical procedures and the launching of the primary and specialised 24-hour health and social services would, nevertheless, take place on 1 January 2018 at the latest. Provisions on social welfare tasks that will be centralised nationally and regionally will be issued later.
What happens to local services? Will they disappear?
The county's responsibility will be to make sure that health and social services are available and reasonably accessible for everyone. New practices will be introduced to ensure this. In sparsely populated rural areas, for example, electronic and mobile services must also be used to secure availability. The counties will also have the responsibility to provide services themselves. This will ensure sufficient availability and cost-effectiveness of services. The counties will also provide public health and social services when no one else provides the services. This could happen in some rural areas where there are not enough service providers to ensure clients their freedom of choice.
How significant is digitalisation in the reform?
Digitalisation will play a major role in the reform. According to productivity studies, around half of the operational efficiency and productivity gains will derive from the harnessing of ICT and digitalisation. Digitalisation also creates possibilities to encourage people to assume more responsibility for their health and wellbeing. In addition, digitalisation will facilitate new kinds of business harnessing wellness technology and gene technology.
What acts will be passed as part of the regional government, health and social services reform and what is the schedule of their drafting?
The most central acts governing the reform are the Counties Act, the Act on Organising Health and Social Services, the Implementation Act, the Act on the Financing of the Counties and the Freedom of Choice Act. In addition, several acts need to be amended due to the reform. The changes concern for example tax legislation, the act on central government transfers to local government for basic public services, legislation on the status of employees, election legislation and general administration legislation. The acts on the provision of health and social services will also be reformed.
These are related to the establishing of the new counties and to health and social services. The Government issued a proposal to Parliament regarding the amendments in March 2017. The Freedom of Choice Act is still being prepared and a proposal to Parliament is due in spring 2018. The aim is that Parliament discusses all the above-mentioned acts at the same time in spring 2018. A Government proposal on a simpler multisource financing system for healthcare and social welfare will be issued in autumn 2018.