Government decision on next steps in reform package on healthcare, social welfare and autonomous regions

On 9 November, the Government published more information about its policies on the reform package on healthcare, social welfare and autonomous regions, and on how they will be divided. There will be 18 autonomous regions in the country, of which 15 will organise healthcare and social services in their area themselves. Under new legislation, the remaining three regions will provide the services with the support of one of the other autonomous regions. Besides healthcare and social services, other duties will also be brought together under the autonomous regions.

Public administration in Finland will be organised on a three-tier level as follows: central government, autonomous regions, local government. With these functions being transferred from nearly 190 different designated authorities to 18 autonomous regions, the number of joint statutory organisations, namely different local authorities and healthcare and social welfare service providers, will be markedly reduced.

The existing division into regions will be used as a basis for dividing the country into autonomous regions. Responsibility for the organisation of healthcare and social services will be transferred from joint municipal authorities and local authorities to the autonomous regions on 1 January 2019. Where an autonomous region deems its resource capacity insufficient for organising healthcare and social services, it is possible to seek government approval to arrange the services in cooperation with another autonomous region.

The Government will make the provision of healthcare and social services more versatile. Each autonomous region will provide the necessary healthcare and social services itself or together with other autonomous regions, or may use the services of the private sector or the third sector. Professional managers will head the provision of services arranged by the autonomous regions removed from the decision-making processes for arranging healthcare and social welfare services.  

The autonomous regions must evaluate the expediency of providing services themselves in relation to the service provision of the private sector and the third sector as well as those provided in collaboration with other regions. Quality and cost data on services provided by the regions themselves and those provided by private service providers must be made public in a commensurate way. Procedures will be prepared to make sure that new service providers and small and medium-sized enterprises will be able to provide the services.

There will be units operating on a broad basis around the clock in 12 hospitals. All the other existing central hospitals will offer a more limited range of 24-hour services and will provide specialised services.  This way there will be 24-hour A&E services in different parts of the country in the future too. 

More freedom of choice gives customers faster access to care

The existing multisource financing will be simplified and customers will be given more freedom of choice. The preparation will begin in November 2015.

New legislation on freedom of choice will be one part of the reform package. This way customers can choose between public, private or third sector service providers. Freedom of choice will henceforth be the main principle at the basic service level. Where appropriate, the same principle will also be used in specialised healthcare and social welfare services. The aim is that legislation simplifying multisource financing and increasing freedom of choice will enter into force 1 January 2019. Freedom of choice serves to create more robust services, especially at the core level, and safeguard swifter access to care. Freedom of choice will be guaranteed for customers by bringing in uniform quality principles for services and by disseminating public information that helps people make their choices about the services.

The drafting of the act on organising healthcare and social welfare services and the act on autonomous regions will draw on these Government policies . Following a consultation round in spring 2016, the Government will decide on their in-depth opinions relating to the acts. The aim of the policies is to create a good basis for revamping the service system and for bridging the sustainability gap by EUR 3 billion. Furthermore, the goal is to achieve uniform service quality and availability in accordance with the Constitution.

Central government steering will be strengthened

During the reform process, the Government will decide on the organisation of healthcare and social welfare services. These decisions will be made on the basis of proposals presented by the autonomous regions and after consulting the regions. The decision on the organisation of healthcare and social welfare services will include a public service pledge and strategic development goals. Additionally, the Government will decide on the duties and division of responsibilities between the national and regional specialised units, university hospitals and other centres of expertise. The Government will also be in charge of steering the production structure and any large investments, and will safeguard the execution of freedom of choice.

By creating interoperable ICT systems, it will be possible to ensure effective functioning and successful cooperation between the autonomous regions. A national joint procurement unit and national support services owned by the autonomous regions will also be established.

The autonomous regions will be multiplex

A council elected by direct vote will exercise the highest decision-making power in each autonomous region. In addition to the duties in healthcare and social welfare services, the autonomous regions will be responsible for the following functions: rescue services, the duties of the regional councils, the duties of the Centres for Economic Development, Transport and the Environment within the scope of regional development, and possibly also environmental healthcare. In January 2016, the Government will in decide on the preparation of the regional government reform package and on the duties to be transferred to the autonomous regions. Decisions will also be made on given regional duties that might be transferred to local authorities.

The Ministry of the Interior, the Ministry of Employment and the Economy, the Ministry of Social Affairs and Health, the Ministry of Agriculture and Forestry, the Ministry of Education and Culture, the Ministry of Transport and Communications and the Ministry of the Environment will each assess the duties to be transferred to the autonomous regions and how the transfers should be carried out. The Ministry of Finance and the Project Manager leading the reform package will coordinate the reports of the ministries for Government decision-making.

Questions and answers on the Government’s policy approach to regions
Principles of division into regions, and check marks of the healthcare and social welfare reform
All appendices in Finnish

For more information

Juha Rehula, Minister of Family Affairs and Social Services (healthcare and social welfare reform), tel. +358 295 163 108
Anu Vehviläinen, Minister for Local Government and Public Reforms (regional government reform), tel. +358 2955 530 426
Tuomas Pöysti, Permanent State Under-Secretary, tel. +358 295 163 012
Hanna-Maija Kause, Special Adviser to Minister Rehula (healthcare and social welfare reform), tel. +358 50 566 7949
Sami Miettinen, Special Adviser to Minister Vehviläinen (regional government reform), tel. +358 46 923 4695