Health and social services reform will transform the structure of government and the tasks of municipalities
The legislation concerning health and social services reform entered into force on 1 July 2021. The responsibility for organising health, social and rescue services will be transferred to newly established wellbeing services counties on 1 January 2023.
The reform will bring changes to health, social and rescue services in the way they are
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Wellbeing services counties in a nutshell
Wellbeing services counties are new public law entities that exercise autonomy within their own areas. There will be a total of 21 wellbeing services counties. In mainland Finland, the wellbeing services counties will correspond to the current division into regions, with the exception of Uusimaa.
Under special arrangements, Uusimaa will be made up of four wellbeing services counties, and the City of Helsinki will retain its responsibility for organising health, social and rescue services. In addition, the joint county authority for the Hospital District of Helsinki and Uusimaa will be responsible for organising specialised healthcare in Uusimaa.
A directly elected county council will be the highest decision-making body in each wellbeing services county. The first county elections will be held on 23 January 2022.
These elections will not be held in Helsinki, where members of the local council will continue to make decisions regarding health, social and rescue services.
Funding of wellbeing services counties
The activities of the wellbeing services counties will mainly be funded by central government, and this will be on a universal basis. The funding will be divided among the counties by using imputed factors that describe the service needs and circumstantial considerations in regard to health, social and rescue services duties.
Some of the funding will be based on population numbers and some will be determined by criteria for health and wellbeing performance. The funding of rescue services will also be determined on the basis of a risk coefficient.
Establishment of wellbeing services counties will affect the duties and activities of municipalities
The establishment of wellbeing services counties and a system for funding them will transform the existing system of central government transfers to local government for basic public services. To ensure the total tax ratio will not grow, all municipalities will be obliged to reduce local income tax. In addition, changes will be made to the system of corporation tax. Changes made to the tax structure will not increase taxation.
In 2023, about 173,000 people currently employed by the municipalities or joint municipal authorities in healthcare and social welfare and rescue services will be transferred to the employment of the wellbeing services counties in line with the transfer-of-business principle.
School social workers and school psychologists working in the education sector in municipalities will also be transferred to the employment of the wellbeing services counties. In addition, personnel working in municipal support services will be transferred to the employment of the counties if at least half of their present duties are devoted to municipal health, social or rescue services.
The autonomous regions will enable a gradual transition to multi-sectoral counties. In summer 2021, a project was launched to determine which new duties could be transferred to the wellbeing services counties in the future. At the same time, preparations to introduce a county income tax were launched.
What role does the Ministry of Finance have in preparing the health and social services reform?
The Ministry of Finance is responsible for drafting legislation on the establishment, administration, funding and personnel of the wellbeing services counties, and the counties’ asset arrangements, and for coordinating implementation of the legislation.
Proposals concerning changes to municipalities' duties and funding and changes to tax legislation also fall within the responsibilities of the Ministry. The reform will also affect the planning of general government finances.