The Health and Social Care Reform that was finally passed by the Parliament in the summer of 2021 centralised responsibility for organisation of the health and social services from municipal to regional level (Wellbeing Services Counties, WBSC), and health system financing to the state level. However, the choice and competition model from the initial package was on the contrary replaced by stricter regulation on purchasing services from private providers. The overall aims of the government set for the reform included: reducing inequalities in health and wellbeing; ensuring equity and quality of health, social and rescue services; improving the availability and accessibility of services, especially in primary care; ensuring the availability of health workforce; responding to the challenges of societal changes; curbing the growth of costs; and improving rescue services.
The WBSCs are responsible for organizing primary and secondary health care as well as social and rescue services for their residents. In addition, each of the WBSCs belongs to one of five collaborative areas, organized around five university hospitals. The collaborative areas allow centralisation of organization of tertiary level services provided in the university hospitals, and distribute responsibilities between university hospitals for highly specialized care, such as treatment of rare diseases.
The Uusimaa region consists of four WBSCs and the City of Helsinki, which are responsible for primary health care, social care and rescue services. Specialist care for the four WBSCs and for the City of Helsinki is delivered by the Hospital District of Helsinki and Uusimaa.
The Health and Social Care Reform was passed in the summer 2021 and takes full effect in January 2023. The election of WBSC councillors was held in the spring 2022, establishing the composition of councils for each county, and leaving a relatively short timeframe to develop operational processes. Some WBSCs, however, were ahead in the implementation of the reform, because in some parts of the country municipalities had already established more centralized joint authorities for health and social care, aiming to achieve a greater integration of services.
The reform has been controversial and there have been debates about the number of WBSCs, their incentives to operate efficiently, and the lack of competition in the system, to name a few. Thus, it is probable that the next government, expected to be elected in the spring of 2023, will continue to make adjustments to the system. The implemented reform can be described as a first step in the series of reforms, which at a later stage may also include adjustments to financing, particularly the share that is channelled through the NHI scheme and occupational health care.
Beyond this, reforms that have taken place in the past decade have largely been incremental and mainly focused on modifying existing features without fundamentally changing the structure of the health system. A series of measures were taken to reduce the share of public spending on health. Some of these translated into reduced levels of reimbursement for medicines, and increased user fees.