Finland
Organisation and objectives:
Financing
of the healthcare is based on taxation:
• the target is
equality;
• the availability of services should
be equal;
• not depending on
domicile;
• not depending on social status of
solvency.
Based on legislation and statutes and degrees
The communities and local authorities have the main
responsibility for organising the services. The decision-making is
based mostly on the local self-government, which, however, is
directed and guided by laws and statutes, considering the resources
available.
Legislation
The Common healthcare Act from 1972 defines the services of
primary and basic healthcare. The act of specialised healthcare
decides on the hospital system, which includes 21 central hospital
districts and the Helsinki University teaching hospital. The act of
specialised care defines also to which hospital district every
community has to belong.
Basic organisations
In Finland there are about 450 communities. There are 258 health
centres as organisations of one or more communities. About 3,400
doctors, 58 per cent of whom are women, are working there. They are
mainly employed as health centre general practitioners (GPs), 1,060
of them have the speciality of general medicine. One thousand, three
hundred doctors are working as family doctors meaning that they have
their own population responsibility additionally to other health
centre functions. The patient pays to the community as fee for
service 0-150 FM a year depending on the decision of the community.
Definition of tasks
The community can produce the basic services itself by employing
the personnel, or together with other communities. The health
centres financed by the communities or federations of communities
are producing the health services.According to the Common healthcare
Act 1972 the communities are responsible for producing the following
services.According to the Common healthcare Act 1972 the communities
are responsible for producing the following services:
• the preventive functions are basic in the primary
healthcare and that is provided by our guidance centres or
clinics together with the consulting and surgery functions of
the GPs. We have special clinics for the maternity care,
childcare and contraceptive clinics. Also many kinds of health
inspections belong to the field of basic healthcare. In the
health clinics the specialised nurses work together with GPs;
• the health centre provides the inhabitants of the
community with medical nursing services including the surgery of
GP,lab and x-ray. In the health centres there are also beds
mainly for geriatric care. Mainly it is GP level, although in
part of the country the basic healthcare also produces some
special hospital care. The care can also be provided for the
people as home care, when there is a home care nurse helping the
GP;
•the rehabilitation services and the providing
rehabilitation instruments belong to the functions of basic
healthcare;
•mental health services can also be included in the
functions of the GPs, the medical director of the health centre
has the responsibility of compulsory care of the mentally ill
patients;
• the medical rescue functions are also included in the
ambulance services of the communities. They can produce these
services themselves or buying them by any private providers;
•the health centre organises the school healthcare and the
student healthcare;
•the health centre organises mass screening and mass health
inspections;the health centre organises the GP level acute
services around the clock.
Relations to specialised care
The specialised care usually needs a referral from the doctor,
either from the public GP or a private doctor. But in fact many
patients go to the specialised hospital care without a referral
through the first aid clinic or just phoning. The healthcare GP can
refer the patient to his or her own area's central hospital or in
special cases to other hospitals if the patient has made or arranged
financial obligation agreement with the community.
Future
The basic or primary healthcare will be strengthened and it has
been seen also at the political level as a possibility to control
the economic situation. There are trends emphasising the scaling and
the differentiation of the care and agreement of healthcare systems
within districts. It is also allowed to buy a special are
consultations from private doctors and the aspect of competition has
been emphasised recently. There have been attempts to prohibit the
increasing costs of healthcare and the trend is recently more
towards open care. The family doctors have been seen as an answer to
this. On every level the co-operation between basic healthcare,
specialised care and the social workers will be clarified and in
future the family doctor has better possibilities to follow up the
patient also while in specialised care and also to influence the
money flow which is going with the patient.
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