An entrance to the Päijät-Häme Central Hospital in Lahti in April 2020. The Finnish government’s plan to generate cost savings in health care has stirred up concerns among experts and physicians. (Heikki Saukkomaa – Lehtikuva)

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ILMO KESKIMÄKI, a research professor at the Finnish Institute for Health and Welfare (THL), has expressed his concern about the apparent lack of thought put into newly unveiled government proposals to reduce health care funding.

“These haven’t been subjected to any kind of careful examination,” he stated on YLE A-studio on Wednesday.

Keskimäki argued that some aspects of the proposals suggest the government may not even know what it decided at the framework session, pointing to the proposal to scrap “plastic surgeries bordering on aesthetics” from the service offering of special health care.

No such plastic surgery exists, Virve Koljonen, a professor of plastic surgery at the University of Helsinki, stated to Helsingin Sanomat last Thursday. She underscored that the public sector offers no purely aesthetic plastic surgeries but focuses exclusively on reconstructive and restorative surgeries.

“There’s always an underlying sickness that we’re treating. We also have nationally agreed criteria that we abide by,” she said to the daily newspaper.

Overall, trimming the service offering of the public special health care and social care system is estimated to provide savings of 170 million euros.

Keskimäki on Wednesday also expressed his disapproval with the discussion about amending care guidelines, reminding that the guidelines are founded on research data that cannot be altered with political decisions.

“There’s no justification for this kind of micromanagement,” he said.

The Finnish government convened last week for its long-awaited framework session to hammer out additional measures to patch up the budget deficit. It agreed to pursue savings in health care, for example, by discontinuing night-time emergency services and around-the-clock preparedness for surgeries at hospitals in five localities to save some 30 million euros.

The decisions have also kindled concerns among physicians.

Helsingin Sanomat on Sunday reported that the Finnish Medical Association has voiced its alarm with the government proposal to extend the care guarantee from two weeks to three months, arguing that the extension would in practice abolish the guarantee entirely.

The guarantee prescribes how long patients can be made to wait for non-urgent care after initial contact and care needs assessment. It was shortened from three months to two weeks by the previous government, with the idea that ensuring quick access to care would ultimately be less costly because it prevents conditions from worsening.

The Finnish Medical Association pointed out that the government is simultaneously increasing reimbursements for private medical expenses by 500 million euros in 2024–2027.

This, it argued, represents a complete about-face when it comes to the private sector. Although recent years have seen the outsourcing of public health care services to private service providers, the proposals that emerged from the framework session represent a step further: the government is subsidising private services while cutting public services.

The about-face has kindled no open public debate, Jukka Mattila, the director of political affairs at the Finnish Medical Association, lamented to Helsingin Sanomat.

The government estimated that extending the care guarantee enables it to slash funding for well-being services counties by 132 million euros. The counties have been responsible for organising rescue, social and health care services in Finland since January 2023.

Mattila viewed that lay-offs and furloughs are the only means to reduce the costs of the care guarantee, meaning services will erode and waiting times will increase.

“Well-being services counties got to a good place relatively quickly in terms of ensuring access to care in two weeks, and now it’s being undermined like this. I hope it won’t happen,” he commented to the newspaper.

Mattila estimated that the extension of the care guarantee, growing reimbursements for private health care costs and decreasing local services are a combination that justifies the uncertainty of citizens about the future of public health care in Finland.

Also health care professionals, including physicians, have waited for the government to follow through on its promise to strengthen basic health care.

The newly unveiled proposals are a step in the opposite direction, eroding confidence in the system.

Similar concerns were voiced last week by Liina-Kaisa Tynkkynen, a senior researcher at THL. Tynkkynen described three months as an unacceptable target time in basic health care in an interview with Helsingin Sanomat last Thursday.

“This is yet another measure that the government takes to complicate specifically the situation for basic health care in well-being services counties. The government is at the same time increasing reimbursements [for private health care], which is something I’m very critical of in this circumstance.”

Tynkkynen viewed that the decisions on the hospital network are justified, given that hospitals and special health care have been spared from significant cost cuts while such have been made in basic health care.

Aleksi Teivainen – HT

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