Overview

Since January 2023, the health system in Finland has been organized into 21 Well-being Service Counties (WSC), the city of Helsinki, and the HUS group (former hospital district of Helsinki and Uusimaa) which are responsible for providing services. Municipalities retain responsibility for public health functions. Population coverage is comprehensive for residents, but employed people enjoy better access to ambulatory services through the occupational healthcare scheme. The main gaps in coverage relate to relatively high user charges and long waiting lists.

In 2021 current health expenditure amounted to US$ PPP 5613 per capita and 10.3% of GDP, reflecting the injection of additional funds in response to the COVID-19 pandemic and population ageing. Public expenditure on health accounted for 80%, and out-of-pocket payments accounted for 17% of the total.

The implementation of the structural reform and the establishment of the WSCs took place at the time of a poly-crises (such as the aftermath of the COVID-19 pandemic, the war in Ukraine, large public debt in Finland), coupled with chronic health system strains such as population ageing and shortages of health workers. WSCs started off with fairly large deficits, new pay settlements for health care workers and historic underreporting of budget costs by the municipalities. Other than these financial challenges, the implementation of the reform has been smooth. The reform has brought a major shift in the balance of power between local, regional, and national authorities, as national level stewardship has been strengthened substantially, especially in terms of financial steering.