Centralizing supervision of health services

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments 7/8

Abstract

This reform aims to increase national level supervision of provision of health services. Currently supervision of health care providers is done in provincial level administration. National level supervision is to be reinforced by expanding the functions of the National Authority for Medicolegal Affairs. Now, its main purpose is to supervise health care professionals. It is anticipated that the reform increases patient safety and decreases differences between municipalities in service production.

Purpose of health policy or idea

The purpose of the reform is to increase the national level supervision of the provision of health services. Currently the supervision of health care providers is carried out in provincial level administration. It is anticipated that this reform would increase patient safety and decrease differences between municipalities in health care service production.

Main points

Main objectives

To increase patient safety and quality of services, and to decrease differences between municipalities in health care service production.

Type of incentives

1. a legislative change expanding the powers of the National Authority of Medicolegal Affairs in supervising health care providers

2. a substantial increase in the resources of the National Authority

Groups affected

Health care providers, patients

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

In theory this is rather fundamental change to the opposite direction of development after a long line of actions to decentralise the decision-making in public health care services. Perhaps currently service production is too decentralised when responsibility of service production is given to more than 400 independent municipalities of which about a half have less than 5000 inhabitants.

Political and economic background

In Finland the responsibility to organise public health services is decentralised to over 400 municipalities. Direct national steering mechanisms have gradually been weakened since the 1980s and currently the municipalities are rather independently able to organise public heath care services. During the last ten years the main national level steering mechanism has been steering by information and legislation. However, the steering by information approach is not considered as effective as it was supposed to be. Currently provision and quality of health care services vary considerably between municipalities.This can lead to conflict with the Constitution which provides equal access to health services according to need for all Finnish residents.

The main responsibility of the supervision of health care providers is currently a responsibility of the six provincial state offices. The offices have social and health departments which are among other things responsible for guiding and supervising both public, specialised and primary health care and private health care in their respective provinces. In addition, their responsibilities include handling of appeals of patients relating to health services provision. Private health services are subjected to be licensed by the provincial state office, while municipal health care services are mainly supervised by reacting to appeals from patients. The only sanction for municipal health care providers is conditional imposition of a fine but in practice this sanction has never been used. For private health care providers more efficient sanctions, such as removing the permit to provide health services, can be used.

At the national level, the National Authority for Medicolegal Affairs is acting under the Ministry of Social Affairs and Health as an agency with the purpose of maintaining and promoting patient security and assuring the quality of health care services through supervision of health care professionals (together with the provincial state offices). However, it has been found that when service production is becoming increasingly complex, it is more difficult to pinpoint failures to individual health care professionals.

After the reform the national level supervision will be strengthened by expanding the functions of the National Authority for Medicolegal Affairs so that the agency would also directly supervise public organisations, health centres, hospitals and other institutions, providing health services.

Complies with

Constitution of Finland

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

The idea to strengthen the powers of the National Authority for Medicolegal Affairs was expressed in a report by Director General Jussi Huttunen for the Ministry of Social Affairs and Health (MSAH) in 2000. The report focused on possible strategies to develop the National Research and Development Centre for Welfare and Health (STAKES). Later it came up in a report made by deputy Director General Aino-Inkeri Hansson for MSAH in 2002. That report specifically concentrated on how to strengthen the steering and supervision of social and health services. After that MSAH appointed a working group to explore the possibilities to expand the functions of the National Authority for Medicolegal Affairs. The working group report was published in 2004. The proposal for the legislative changes was based on this work. 

Initiators of idea/main actors

• Government

Approach of idea

The approach of the idea is described as:
renewed: National level steering and supervision was more intensive before the public sector reforms in the 1980s and 1990s. The current reform can be considered as a reversion to the earlier direction.

Stakeholder positions

The Ministry of Social Affairs and Health (MSAH) is the main actor in this policy process. According to the Constitution the Government has the final responsibility on providing adequate health services for all inhabitants. MSAH has been concerned about the quality and equity of public health care services. The municipalites and other actors have been rather neutral in this process. 

Actors and positions

Government
The Ministry of Social Affairs and Health	very supportive		strongly opposed

Influences in policy making and legislation

The Parliament has passed the related changes in legislation in December 2005. Legislation will come to force in September 2006. The main actor in the process was the Ministry for Social Affairs and Health. 

Legislative outcome

success

Actors and influence

Government
The Ministry of Social Affairs and Health	very strong		none

Positions and Influences at a glance

Adoption and implementation

Key actors in the implementation are the National Authority for Medicolegal Affairs and the six provincial state offices.  

Monitoring and evaluation

There are no specific mechanisms for reviewing the implementation of this reform.

Expected outcome

The expected outcome is that the quality and equity of health care services will increase somewhat. Essential for the success of the reform is that the National Authority for Medicolegal Affairs and the provincial state offices will have sufficient resources for the implementation.   

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

The reform is not yet implemented and above ratings are estimates of probable outcome.

References

Sources of Information

National Authority of Medicolegal Affairs (www.teo.fi)

Author/s and/or contributors to this survey

Lauri Vuorenkoski

Suggested citation for this online article

Lauri Vuorenkoski. "Centralizing supervision of health services". Health Policy Monitor, April 2006. Available at http://www.hpm.org/survey/fi/a7/2