Tens of thousands of employees may have to move from the public to private sector if social and health care customers are granted greater freedom of choice over their service provider as part of the social and health care reform to be implemented in Finland in 2020.
The consequent loss of jobs in the public sector has recently stirred up rumblings of concern among policy makers in Finland.
Lasse Lehtonen, the administrative chief physician at the Hospital District of Helsinki and Uusimaa (HUS), has estimated that transferring responsibility for the production of social and health care services to the private sector will require that public service providers adjust their cost structure by 2–2.5 billion euros.
Lehtonen, who has voiced his reservations about increasing the freedom of choice, was a member of an expert task force appointed to comment on the reform by the Ministry of Social Affairs and Health.
“The responsibility of the public health care sector is to maintain readiness and treat difficult illnesses. My own estimate is that it is only possible to adjust the costs by 20 per cent without crumbling the entire service structure,” he wrote in a blog on Puheenvuoro on 29 October.
He also calculated that public service providers would theoretically have to lay off 50,000 employees if they were to generate 2.5 billion euros in cost savings. Such mass lay-offs, however, are unlikely as public service providers will remain responsible for producing emergency care services.
The reform, he concluded, could consequently increase rather than reduce total social and health care costs.
The Parliament’s Constitutional Law Committee in June stipulated that regional governments must maintain the readiness to produce public social and health care services to guarantee the availability of statutory services in, for example, circumstances where they are not produced in a market-based fashion.
Certain areas of the social and health care sector will additionally remain solely the responsibility of the public sector.
“What this means in practice is that we’d have a double system in both basic health care and special health care. That, of course, costs money,” Lehtonen commented later to Uusi Suomi.
He also pointed out that 80 per cent of the costs of special health care are generated by only 20 per cent of the patients. “Even if a large share of the patients moved elsewhere, the costs would stay,” he added.
The Ministry of Social Affairs and Health remains adamant that increasing the freedom of choice will not undermine the efforts to pare down costs, despite admitting that public service providers will have to adapt to the reform.
Kari Hakari, a director at the Ministry of Social Affairs and Health, estimates that most of the adaptation needs should be offset by the fact that employees will move from the public to private sector.
“It means that these 50,000 employees would move to the private sector and leave the public sector. These people would be changing jobs,” he says to Uusi Suomi, expressing his confidence that the reform will not lead to mass lay-offs.
“If customers switch to private service providers, more employees will be needed in the private sector. It’s not like it has a big reserve.”
Hakari also concedes that the private service providers are unlikely to require the same number of staff as public service providers: “If 50,000 people have been producing services in the public sector, it may be that only 45,000 will do so for the private sector. But in any case they will require more staff.”
Aleksi Teivainen – HT
Photo: Jussi Nukari – Lehtikuva
Source: Uusi Suomi