Major regional and social welfare and health reforms to enter into force on 1 January 2019

As of the beginning of 2019, Finland will implement a major, historically extensive administrative reform as the responsibility for the social welfare and health services, so-called sote services, so far carried by about 190 municipal operators, will be taken over by 18 counties that are established as a part of the reform.

The organising and production responsibilities of the counties will be separated. The county in charge of the organisation will be responsible for the inhabitants of the region being provided with the necessary sote services.  The funding to the county is allocated by the State.

At the county level, the  sote services are produced by a county public utility that will be responsible of the specialised healthcare services, emergency services and all inpatient care.

The primary level medical, nursing and social welfare consultation services will be produced by sote centres that can be established by the county, private operators or third sector operators. Starting from the year 2019, the customer can choose the sote centre and enrol as the patient for one year at the time. The counties will pay the sote producers a compensation for the customers treated.  Through the change, private healthcare providers will have an increasingly central position in the production of public sote services.   

As far as healthcare services are concerned, occupational and student healthcare will remain outside the public sote service system and will continue to be financed separately. In addition, a genuinely private healthcare sector, financed by the customer personally or through their private insurance policies, will be created outside the public sote services. According to the plans, as of the beginning of the year 2021, the National Insurance Institution Kela will no longer pay reimbursements for private doctors' fees.  

Sote reform timetables

  • The package of legislative proposals concerning the sote and the regional reform was submitted to Parliament in early March and complemented with the proposal regarding the freedom of choice of customers in May.
  • It is expected that the legislative packages will be adopted by Parliament in September 2017.
  • January 2018 will see the first county elections, with the new political councils starting to operate in March 2018.
  • The counties will be responsible for the sote services in their jurisdiction as of 1 January 2019.
  • In principle, the customers’ freedom of choice will be in force as of the beginning of 2019 but the change will be characterised by long transitional periods and pilot experiments so that the freedom of choice will be fully operative nationwide as of the beginning of 2023.

Nationally centralised care 

With the aim of increasing the efficiency of healthcare operations, the intention is to agree in more detail on the division of competence areas in specialised healthcare.  The so-called centralisation degree has been sent for a round of opinions about this legislative initiative.

In the future, Finland will have 12 specialised healthcare emergency hospitals operating 24/7. Five of them are university hospitals. According to the proposals, each university hospital district will have national coordination responsibilities. For example, the Helsinki University Central Hospital would become responsible for coordination of the oncology centre, the Tampere University Hospital for rheumatic diseases while the Oulu University Hospital for health technology assessments. If the annual aggregate number of particular operations, treatments and procedures is fewer than 50, it is proposed that they are directed to one single university hospital.  

The proposal also contains a general limitation of hospital surgical rights if the total number of certain operations does not exceed a level defined in the decree.  For example, the annual minimum requirement for breast cancer operations is 100.

Two-channel financing of medicines continues

The sote reform still remains short of the political outlines that would simplify the multichannel financing system, and also of the concrete legislative proposals regarding, for example, the discontinuation of the private doctors' fee reimbursements, the transfer of the travel expense reimbursements, now paid by Kela, to the counties as well as the funding of the Kela reimbursements for medicines. Prime Minister Sipilä's Government intends to outline these issues during the current year while the mandate of the working group on the health insurance benefits and funding will expire towards the end of 2017.  

As the changes of the health insurance funding have not kept pace with the sote, regional and freedom of choice changes, their implementation will probably be taken up during the following Government term.

At this point, the funding of the outpatient medicines reimbursement will remain separate from the funding of the pharmaceuticals used in the public sote services (in other words, the financing of pharmaceuticals used by hospitals).  

Under the auspices of the Ministry of Social Affairs and Health, the ongoing task force work by Professor Ruskoaho focuses on the structure of the reimbursement system - in other words, how the reimbursements will be paid to patients. The deadline for this work is June 2018.

The healthcare services produced within the public sote service structure will include

  • the specialised healthcare inpatient services which are the responsibility of regional public utilities. This regional production unit will take over the inpatient care that is currently the responsibility of municipalities.
  • the primary-level consultation services, such as general practitioner and nurse consultations and basic social welfare services produced by the sote centres
  • in the future, the counties responsible for the service organisation may decide the extent to which child and maternity health clinics and specialist consultations are transferred to the sote centres

Changes in pharmaceutical industry’s operating environment

The sote reform will significantly change the operating environment of the pharmaceutical industry for aspects such as the steering of pharmaceutical care, procurements and HTA assessment of hospital medicines. The major impact will take place in the hospital medicines regime. In the new sote structures, the development of the pharmaceutical services and pharmaceutical care is tightly linked to the implementation of the plan of action focusing on rational pharmacotherapies at the Ministry of Social Affairs and Health level.

A speaker for the innovative pharmaceutical industry, Pharma Industry Finland PIF works for the objective ensuring the Finns access to the novel medicines with proven usefulness at least as rapidly as is guaranteed to patients in other Nordic countries. On that note, PIF proposed in April that the establishing of the sote operations should be accompanied by the institution of an independent HTA body to assess novel medicines, vaccines, devices and methods. Moreover, the different funding channels should introduce Horizon scanning that would allow them to systematically anticipate the pharmaceutical and vaccine innovations that are entering the market. 

At the Ministry of Social Affairs and Health, the preparatory planning of more specified details of the regulation regarding the pharmaceutical service and pharmaceutical care is only just starting.