A major reform of the social welfare and health care services system in Finland (the SOTE-reform) is currently under preparation. The working group has reached agreement on the key provisions of the reform on 25 June 2014 and a government bill is expected to be published during fall 2014. The SOTE-reform is a flagship issue in the current government program and would represent one of the most extensive legal reforms in recent times in Finland.
One of the main changes introduced by the SOTE-reform is the division of all the approximately 300 municipalities in Finland into five administrative SOTE-regions (FI: SOTE-alue) that are responsible for arranging all social welfare and health care services (both basic primary health care and specialized medical care) in their respective area. Under the current system, each municipality is responsible for arranging and funding basic primary health care for its own inhabitants, while specialized medical care is arranged for within the 20 hospital districts in Finland (further divided between five university hospitals). As the state supports the municipalities through subsidies, and the municipalities, in turn, seek to obtain efficiency benefits e.g. by entering into so-called federations of municipalities (FI: kuntayhtymä), the current system is burdensome to supervise and leads to major differences in the quality of services offered to the municipality inhabitants. Adding the continuous cost reduction pressure, the current system also inevitably leads to tug of war between the municipalities as concerns the duties and responsibilities connected with basic primary health care vis-à-vis specialized medical care.
Hence, the main aim of the SOTE-reform is to ensure that all citizens are entitled to the same level of health care and social welfare services, with the further aim of increasing the general quality and efficiency of the social welfare and health care services. Moreover, administrative costs are expected to decrease since the decision-making and distribution of funds in each region will be centralized and supervised by one body only, and since one of the major changes is the separation of the decision-making body (the SOTE-regions) from the service providers (the municipalities, as public service providers). Each SOTE-region will be proportionately financed by their member municipalities (a fee proportional to the number of inhabitants) and every four years each SOTE-region will decide on the division of service responsibilities between the municipalities within their respective regions. The reform is also meant to smooth over the distinction between basic primary health care and specialized medical care that many times has led to patients being tossed between the two, and rather form an integrated service unit capable of providing optimal both basic health and more demanding medical care in accordance with each patient’s particular needs.
The general reception of the SOTE-reform has been positive, however, some private social welfare and health care service providers have taken a more sceptical stance. Since the SOTE-regions will be better equipped to produce their own services, some private service providers fear that less service will be bought from the private sector and that the role of private service providers will be reduced to acting as subcontractors in the future. Other dissatisfaction has also surfaced, which mainly criticises that the introduction of the new SOTE-regions will not increase efficiency nor reduce costs, but has rather only added another administrative layer to the mix.
The proposed SOTE-reform is still far from a finished. However, the ambitious aim is for the legislative framework to enter into force as of January 2015 and the five new SOTE-regions to take over in January 2017.
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