Interim evaluation: wellbeing services county reform progressing, but corrections needed to achieve objectives
The wellbeing services county reform is progressing towards the set objectives throughout Finland, but there are still many issues left to address. This is according to a broad-based interim evaluation of the wellbeing services county reform made by an independent expert group.
The wellbeing services counties have succeeded in reforming the network of health, social and rescue services and the actual services in their respective areas. At national level, the availability of health and social services remained largely at the same level as before the reform.
According to the interim evaluation, the quality of services and equitable access to them have improved. In particular, the counties have harmonised the criteria for granting health and social services and the contents of these services.
The evaluation shows, however, that there are significant differences between the counties when it comes to the availability and reform of individual services.
According to the evaluation, the availability and operational capability of rescue services have improved since the early years of the reform. Nevertheless, there are regional differences particularly in growth centres where improvements in the availability of services have not fully met the needs of population growth and demographic change. There has been a positive development trend in preparedness for crises and incidents, and the majority of counties consider that preparedness has improved.
The interim evaluation states that the start-up phase of the reform has taken up a lot of resources in the counties. Creating an administrative structure, i.e. a political decision-making and management system, in the counties has been a laborious process.
According to the expert group, leadership capacity varies by county. At the same time, it has been necessary to reform the network of health, social and rescue services, harmonise these services and adapt to a new funding model. Many counties have succeeded in managing people and change. The counties with a clear strategic management model, a competent senior management team and investments in leadership have made faster progress in implementing the wellbeing services county reform than other counties.
Expert group proposes a series of corrections
The expert group was unanimous with regard to its summary and recommendations. Some of the proposed measures need to be launched immediately, while others will take more time to be developed further.
The experts see three alternative futures: counties with an even stronger self-governing status, an alternative based on the development of the current model, or stronger central government steering.
They consider it essential to strengthen a systematic approach to reforming the system of health, social and rescue services across parliamentary terms. This can be done by increasing parliamentary cooperation. National steering and the structures of health and social services in the counties must be reformed boldly far into the future.
The expert group proposes that the number of counties be assessed as a whole at national level. Before the government formation talks in spring 2027, clear operational and financial criteria need to be defined on how to reassess the structure and number of counties.
The interim evaluation states that the national steering of the wellbeing services counties must be strengthened and clarified. The ministries responsible for this steering must reach a consensus on the strategic and consistent steering of the counties and on the key components of government steering as a whole. The experts propose that the ministries coordinate the existing steering instruments to help achieve the operational and financial objectives of the reform.
According to the expert group, the problems identified in the funding model of the counties must be addressed. It is recommended that, in the first stage, counties that accumulate a new deficit in 2025 but that have a sufficiently detailed plan approved by the Government also be allowed to fulfil their deficit coverage obligation by 2028.
The expert group recommends addressing the technical issues related to the knowledge base for healthcare and social welfare and ensuring that all counties follow consistent and reliable practices for recording data (particularly entries concerning diagnoses and morbidity). The recording practices will be audited as necessary to ensure quality.
The group proposes that the funding model should provide more incentives to take preventive and cost-effective measures. Furthermore, it proposes creating a new incentive by extending the scope of the share of imputed funding allocated to the promotion of healthcare and social welfare. As a long-term recommendation, the experts propose that the counties’ own responsibility for financial resources be increased. This would be done by introducing the right to levy taxes if a solution based on a stronger self-governing status was to be selected.
Wellbeing services county reform needs to be assessed regularly
The Ministry of Social Affairs and Health, the Ministry of Finance and the Ministry of the Interior launched a broad-based interim evaluation of the wellbeing services county reform in spring 2025 as part of Under-Secretary of State Marina Erhola’s mandate.
The interim evaluation is based on the Programme of Prime Minister Petteri Orpo’s Government. The Programme states that the Government will closely monitor and assess the functioning of the administrative structure of health and social services, the sustainability and incentive effect of the funding model and the functioning of the service system, including the implementation of service integration and the availability of services.
The aim of this evaluation was to assess how the reform has progressed in the first years of operation of the counties and to examine the preconditions for achieving the long-term objectives set for the reform.
“The implementation of a major overhaul such as the wellbeing services county reform must be evaluated regularly. The reform is one of the most significant administrative reforms in Finland’s history, and it changed the ways in which publicly funded health and social services are organised, provided and funded,” says Permanent Secretary Veli-Mikko Niemi from the Ministry of Social Affairs and Health.
The interim evaluation was conducted by a group of distinguished researchers from various research institutes and higher education institutions. The group consisted of the following members: Professor Arto Haveri from Tampere University; Professor Harri Jalonen from the University of Vaasa; Professor Emeritus Ilmo Keskimäki from the Finnish Institute for Health and Welfare (THL) and Tampere University; Professor Juho Saari from Tampere University; Chief Researcher Liina-Kaisa Tynkkynen from the Finnish Institute for Health and Welfare; Research Professor Emeritus Markku Pekurinen; Professor Mika Kortelainen from the University of Turku and the Finnish Institute for Health and Welfare; Research Professor Teemu Lyytikäinen from the VATT Institute for Economic Research; Managing Director Tiina Ristikari from the Family Federation of Finland; and Director Ville-Pekka Sorsa from the University of Helsinki.
Inquiries:
Saara Leppinen, Director, Ministry of Social Affairs and Health, tel. +358 295 163 630, [email protected]
- Interim evaluation of the wellbeing services county reform (Publications of the Finnish Government 2025:109; description sheet in English)
- Work to advance the wellbeing services county reform and develop the related steering process: Final report on the first task of the mandate of the Under-Secretary of State (Publications of the Finnish Government 2025:56; description sheet in English)
- Material presented at the press conference (in Finnish)
Expert group and research themes of the interim evaluation:
Implementation of the reform and renewal of the service system:
Implementation of the reform in counties
Harri Jalonen, Professor, University of Vaasa, [email protected], tel. +358 29 449 8596
Administrative structure
Ville-Pekka Sorsa, Director, University of Helsinki, [email protected], tel. +358 29 412 4559
Arto Haveri, Professor, Tampere University, [email protected], tel. +358 40 190 4020
Functioning of the service system
Liina-Kaisa Tynkkynen, Chief Researcher, Finnish Institute for Health and Welfare, [email protected], tel. +358 29 524 8517
Tiina Ristikari, Managing Director, Family Federation of Finland (Väestöliitto), [email protected], tel. +358 50 917 7396
Funding model and financial development
Mika Kortelainen, Professor, University of Turku & Finnish Institute for Health and Welfare [email protected], tel. +358 29 524 8302
Teemu Lyytikäinen, Research Professor, VATT Institute for Economic Research, [email protected], tel. +358 29 551 9431
Markku Pekurinen, Research Professor Emeritus, tel. +358 44 971 4581, markku(at)pekurinen.com
National steering
Arto Haveri, Professor, Tampere University, [email protected], tel. +358 40 190 4020
Operating environment:
Key constraints of legislation:
Markku Pekurinen, Research Professor Emeritus, tel. +358 44 971 4581, markku(at)pekurinen.com
Preconditions of counties
Ilmo Keskimäki, Professor Emeritus, Finnish Institute for Health and Welfare & Tampere University, [email protected], tel. +358 29 524 7256
External drivers of change
Juho Saari, Professor, Tampere University, [email protected], tel. +358 40 828 1027