Good News At The Beginning#

The cornerstone of Finnish society, good healthcare, can be saved. Despite Finland’s dire economic situation, savings can be made without jeopardising important public services.

This is what Kristiina Patja, Professor of Health Care at the University of Helsinki and Chief Physician at HUS, assures.

Patja has a total of 30 years of experience as a doctor and in healthcare expert positions. She has written reports on healthcare prioritization, monitored government programs and their implementation.

She is therefore exactly the right person to tell us how the Finnish healthcare system can be made to work better.

“If we dare to steer change boldly and sensibly, more people will be able to receive care more smoothly and equally than before,” Patja promises.

The information is surprising, because public debate is now pointing in the opposite direction.

Prime Minister Petteri Orpo reminded Yle in an interview hour that the services of a welfare society have their limits. Defence spending is rising and the population is aging. There is not enough money or experts for current-level services.

The Ministry of Social Affairs and Health (STM) warned last week in its vision that social services can no longer mean “everything to everyone”.

Therefore, the range of public services must be prioritised and limited. Cutting back on less useful treatments can save hundreds of millions.

First, The Facts Must Be Acknowledged#

According to Patja, no real savings or corrections can be made without acknowledging three embarrassing facts.

First, the Finnish healthcare model is blatantly unequal. Second, it is overlapping and inefficient. Third, the entire system, not just the public side, must be gutted.

“In Finland, the oldest, poorest and sickest people can have to wait 30 days for treatment. But we, who are basically healthy, can show a pimple to an occupational health doctor tomorrow,” Patja summarises.

We are equal in principle before Finnish law, but in practice we are not, describes Professor Kristiina Patja of the Finnish healthcare system.

The entire funding pot for social and health services is 32 billion euros this year alone, the equivalent of 65 icebreakers.

If we try to make billion-dollar savings mainly by cutting the range of public services, as has been said so far, we will not be addressing the real problem.

Therefore, according to Patja, it is essential that occupational health care, private health care, pharmacies, the Finnish Social Insurance Institution (FSTHS) and official supervision also participate in the voluntary work.

Same Treatment From Different Angles#

The most inefficiency arises from overlapping treatment, Patja says.

She quotes the 18th-century economist Adam Smith: efficient division of labour is productive.

“This means that we should be patient in giving up services that are produced in duplicate.”

According to Patja, duplication arises from the Finnish model itself.

In Finland, different population groups receive primary healthcare from different places. Those who work have occupational healthcare, university students have FSHS, and those who pay out of pocket have private healthcare. Others, such as children, the unemployed, or those of retirement age, have public primary healthcare. The same applies to dental care.

Since everyone can receive treatment from public healthcare, some people treat their ailments in both the public and private sectors. Expensive private visits are subsidised with public funds through Kela compensation.

As a result, the healthiest people on average, such as those of working age who work, receive more care in Finland than those who are older and, on average, sicker.

From a public health and economic perspective, this is not an efficient use of money.

Or as Kristiina Patja puts it: the system does not produce maximum health benefits for the population.

“Of course, we can also maintain the current inefficient model, which has vocal interest groups and defenders,” she acknowledges.

We are back to inequality again. According to Patja, the solution to it and inefficiency are tied to the same recipe. In her opinion, no one who looks at the model honestly can claim that it is equal.

“Politicians are reluctant to say this out loud. Because if we admit inequality, we also admit that it needs to be corrected.”

The idea of unconstitutional healthcare does not fit well with Finland’s international brand of welfare society.

“Are we seeking health, functional capacity and well-being for the entire population through healthcare, or do we accept that some parts of the population have more accessible and comprehensive services than others? This issue needs to be clarified before services can be prioritised,” says Kristiina Patja.

Queuing In Public, Idleness In Private#

Ultimately, it is not about money but about the time professionals spend. Since there is a shortage of nurses and doctors, it does not make sense to use their work to treat ailments that will resolve themselves.

“If I use a huge amount of healthcare resources at a low threshold, that resource will be taken away from someone else. This is its opportunity cost,” Patja explains.

Ultimately, it is about the time of patients waiting for treatment.

According to Patja, the shortage of doctors in the public sector is greatest in those areas where the need is greatest based on population surveys. In the private sector, on the other hand, there are free appointments every day.

The opportunity cost is too high if it leads to a serious illness not being detected in time.

Therefore, in Patja’s opinion, the ratio is wrong if the primary solution in healthcare savings efforts is, for example, cutting expensive cancer treatments for terminally ill people.

“The cost savings on expensive treatments are hundreds of millions. Still, it is more expensive for society to leave some diseases untreated,” Patja states.

Increased testing and imaging also burden public healthcare. A small fluctuation in the results of a home test can be a cause for concern, and on the other hand, a test that is essential for identifying the disease may be missing from the package. That is why the price of the tests should include the fact that the matter will be completed, says Kristiina Patja.

This Is How The Trick Is Done#

We are also tested, imaged and examined sometimes just because we are used to doing so.

Patja would explode the cherished imagination of Finns that a doctor’s visit, a lab test or an X-ray would mean the same as the best treatment.

“Finns have been taught that quality is when a huge number of measurements and operations are performed. It is not quality, but what is done based on research.”

Let’s go back to economist Adam Smith: productivity improves if the right people do the right things.

Patja opens up: The best person to perform the initial examination of a back pain patient may be a physiotherapist. What if you could get to a physiotherapist’s office without having to first explain the problem to a nurse and then, after waiting in line, to a general practitioner?

“There is a lot of duplicate work. The most inefficient thing is to do things efficiently that shouldn’t be done in the first place,” Patja sums up the observations of his three decades of career.

Sometimes the best quality is to do nothing after careful consideration.

A large part of healthcare procedures, such as some lower back X-rays and antibiotic courses, do not provide any health benefits at all. They cost hundreds of millions of euros annually.

Occupational Health Should Focus On Mental Health#

In Patja’s opinion, the current occupational health care system is missing the real meat, i.e. statutory preventive occupational health care.

“The entire idea of occupational health has disappeared.”

Instead of occupational health care preventing accidents, mental strain and prolonged sick leave, it has become overlapping treatment of illness alongside private and public care. Patja sees no reason to maintain this.

The idea could be rediscovered if occupational health took more responsibility for mental health problems and preventing their prolongation.

Mental health reasons are the biggest reasons for sick leave and early retirement among young adults.

“Occupational health professional expertise should be focused on preventing mental health problems in the workplace and in the way work is done.”

Unnecessary Nervousness About Tests#

Unnecessary public health care can also be burdened by private ultrasound and MRI scans, which you can go to at your own expense. Self-diagnosis, or “test if you are healthy” home tests, falls into the same category, as Patja describes them.

“Autumn laboratory package for menopausal women, now MRI scans are on sale, she describes the advertisements that rain down on her phone.”

Increased measurement is visible at doctors’ offices.

Even a small deviation in an ultrasound can be a cause for concern, as can checking the results of a home test on your own.

Sometimes a customer has to clarify the matter in a public specialist health care facility. Further tests carried out with taxpayer money may reveal that the results have been affected by stress or a viral infection.

According to Patja, healthcare companies should not sell tests and imaging without careful thought about what is being measured and why.

“The price should include the seller’s responsibility to explain to the patient what is involved and to complete the matter.”

Aftercare For Cosmetic Surgery#

Fixing problems does not mean pitting the private and public sectors against each other, but rather fair rules of the game, Patja says.

The private sector can produce public services efficiently, but it means that the system must have uniform tasks, content, objectives and funding basis.

“This way, private services that better meet the needs of the region can be created in different parts of the country.”

Therefore, according to Patja, multi-channel financing should not be dismantled, as long as the money coming through it is directed according to uniform rules of the game.

For example, it is wrong for the public sector, which operates on tax funds, to take care of some of the private sector’s follow-up treatments without compensation.

“The public sector should not need to clean up the traces of cosmetic surgery infections, for example. The price paid from one’s own pocket should cover the entire treatment process. Private individuals should have their own insurance for damages.”

Frog In A Kettle#

Finally, Patja draws a timeline on the whiteboard of the Department of Public Health, describing how the root causes of the plight of social and health care were sown in the 1990s.

In 1991, the reform removed state control and the costs of specialised medical care were transferred to the patients’ home municipalities. Costs exploded and the recession hit, which led to municipalities saving primary health care to the mess it is in now.

“Because the situation has developed little by little, we are like a frog in a kettle.”

Now we are back to the starting point, i.e. the social and health care reform that came into effect at the beginning of 2023 returned public health care funding to state control. The health system just changed in the meantime.

What needs to be fixed now is what happened in the meantime.

Source: Yle (in Finnish)