Health and social services reform would transform the structure of government and the tasks of municipalities
A government proposal on the health and social services reform prepared by the Government of Prime Minister Marin was submitted to Parliament in December 2020. The reform covers not only healthcare and social welfare but also rescue services.
The objectives of the reform are: to narrow differences in wellbeing and health; ensure all Finns have equal access to high-quality health, social and rescue services; improve safety; enhance the availability and accessibility of services; safeguard the supply of skilled employees; respond to the challenges arising from changes in society; and curb the growth in costs.
The reform will bring changes to health, social and rescue services in the way they are
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Government proposal in brief
In its proposal, the Government proposes that the legislation on the reform would enter into force on 1 July 2021. The responsibility for organising health, social and rescue services would be transferred to newly established wellbeing services counties on 1 January 2023.
The counties would be new public law entities that exercise autonomy within their own areas. In mainland Finland, the new wellbeing services counties would correspond to the current division into regions. There would be a total of 21 wellbeing services counties.
Under special arrangements, Uusimaa would be made up of four wellbeing services counties, and the City of Helsinki would retain its responsibility for organising health, social and rescue services. In addition, a joint county authority for the Hospital District of Helsinki and Uusimaa would be responsible for organising specialised healthcare in Uusimaa.
The highest decision-making body in each wellbeing services county would be a directly elected county council. The first county elections would be held in early 2022. These elections would not apply to the residents of the City of Helsinki.
Funding of wellbeing services counties
The activities of the wellbeing services counties would mainly be funded by central government, and this would be on a universal basis. The funding would 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 would be based on population numbers and some would be determined by criteria for health and wellbeing performance. The funding of rescue services would also be determined on the basis of a risk coefficient.
Establishment of wellbeing services counties would affect the duties and activities of municipalities
The establishment of wellbeing services counties and a system for funding them would transform the current system of central government transfers to local government. To ensure the total tax ratio would not grow, all municipalities would be obliged to reduce local income tax by 13.26 percentage points, and changes would be made to the system of corporation tax. Changes made to the tax structure would not increase taxation.
In 2023, about 173,000 people currently employed by the municipalities or joint municipal authorities would be transferred to the employment of the wellbeing services counties in line with the transfer-of-business principle. In mainland Finland, all personnel in health, social and rescue services would become personnel of the wellbeing services counties.
School social workers and school psychologists working in the education sector in municipalities would also be transferred to the employment of the wellbeing services counties. In addition, personnel working in municipal support services would 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 right of wellbeing services counties to levy taxes is to be examined by a parliamentary committee. A parliamentary study has examined which duties of municipalities, joint municipal authorities and central government could be transferred to the counties.
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.