Ensuring access to public health care - follow-up

• 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

In March 2005, the Government introduced maximum waiting times for public health care, enforcing a legislation change which implemented the treatment guarantee proposed in the Decision in Principle of the Government issued in 2002. During the first year the change of legislation has had a significant impact on improving the access to primary and specialised health services, though none of the targets specified in the law have been achieved yet.

Purpose of health policy or idea

The purpose of the implemented reform was to reduce long waiting times for public health care. According to the legislation, the patients must be assured of an immediate contact with their municipal health care centre and their need for care must be assessed by a health care professional within a maximum of three weekdays of their contacting the health centre. In non-acute specialised medical care, it is the responsibility of the hospital district that the patient's need for care is assessed within a maximum of three weeks of receiving a referral, and any medical care found to be necessary must be provided within three months or, at the very latest, six months.  

A standardized nationwide system for assessing health care needs was introduced for elective specialised care operations by developing treatment criteria for more than 190 different patient groups or operations. Only patients filling these criteria get the guarantee for elective specialised care operations.   

Main points

Main objectives

To reduce long waiting times to public health care services by setting maximum times in legislation.

Type of incentives

A legislative obligation to comply maximum waiting times was enacted for the public health care providers in the legislation change.

Groups affected

Public 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

The policy has been effective in having a positive influence on public health services. It can potentially have a negative influence on the possibilities to contain costs, but at least this far there are no signs of this.

Political and economic background

For several years, various problems in access to health services have been debated in Finland. Long waiting times for public health services has been one of the most important problems. In 2002, the Government issued "The Decision in Principle by the Council of State on Securing the Future of Health Care". Among other things, it stated that the principle of access to treatment within a reasonable time period would be embodied in legislation by the year 2005.    

Change based on an overall national health policy statement

The Decision in Principle by the Council of State on Securing the Future of Health Care" issued by the Government in 2002.

Purpose and process analysis

Current Process Stages

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

Origins of health policy idea

In response to various problems in public health care the Government initiated in 2001 "The National Project to Ensure the Future of Health Care" originally proposed by the Prime Minister and the Minister of Social and Health Services at the time. One outcome of the project was "The Decision in Principle by the Council of State on Securing the Future of Health Care" issued by the Government in 2002. Among other things, it stated that the principle of access to treatment within a reasonable time period would be embodied in legislation by the year 2005.  

During the year 2004 the Ministry of Social Affairs and Health put together national guidelines defining the limits of access to non-urgent specialized care procedures based on expert proposals. The guidelines were made on 193 diseases or treatment groups compromising 80% of non-emergent hospital care. The guidelines define which patients should receive the treatment guarantee. Scoring systems are used in some of these guidelines. Guidelines were made by groups of specialised physicians from relevant field. They mainly follow existing guidelines and established practice. They are not legally binding.

Parliament accepted the legislation change concerning maximum waiting times in September 2004 and it came to force in March 2005.

Initiators of idea/main actors

• Government: The political parties forming the government had the main role.

• Providers

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

Municipalities and hospital districts which are responsible for providing health care services had somewhat negative position towards the reform, as they anticipated that there would not be enough resources to implement the treatment guarantee. Private providers were in favour of the reform, as they anticipated that municipalities and hospital districts would have to purchase more services from the private sector. Patients and public were in favour of the reform.

Actors and positions

Government
Political parties forming the Government	very supportive		strongly opposed
Providers
Municipalities and hospital districts	very supportive		strongly opposed
Private providers	very supportive		strongly opposed

Influences in policy making and legislation

The change of legislation was the key of the implementation of the idea. All political parties were rather unanimously favouring the policy and legislative process did not significantly influenced to the policy.  

Legislative outcome

success

Actors and influence

Government
Political parties forming the Government	very strong		none
Providers
Municipalities and hospital districts	very strong		none
Private providers	very strong		none

Positions and Influences at a glance

Adoption and implementation

Key stakeholders in adoption and implementation are municipalities and hospital districts. Essential for the reduction of waiting times is the increase in funding of health care services, at least for dissolving the existing queues.

Monitoring and evaluation

The Ministry of Social Affairs and Health observes regularly how the targets defined in law are met.

Review mechanisms

Mid-term review or evaluation

Dimensions of evaluation

Outcome

Results of evaluation

The legislative reform has had significant impact in reducing waiting times. In February 2006, 80% of the population lived in municipalities without problems in getting immediate contact to primary health care (In January 2005 the same proportion was 37%). Only 1% lived in municipalities which were not able to adhere to this criteria. In February 2006, 96% of the population lived in municipalities where the assessment of the need of care by a public health care professional was provided within the enacted maximum of three weekdays in primary health care (In January 2005 the proportion was 49%). In December 2005 the number of those who had waited more than 6 months for a specialised health care admission was 20.000 (in October 2002 it was 66.000 and in January 2005 41.000).  

Expected outcome

The reform has had significant impact to access to public health services. Although during the first year the maximum waiting time limits are not met in all municipalities and hospital districts, the overall development has been very positive. It is anticipated that during the year 2006 the situation will get even better.

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

This policy has improved access to care and diminished geographical inequalities.

References

Sources of Information

Decision in Principle by the Council of State on securing the future of health care. Brochures of the Ministry of Social Affairs and Health 2002, www.stm.fi/english/eho/publicat/bro02_6/bro02_6.pdf

Reform formerly reported in

Ensuring access to health care Process Stages: Policy Paper

Author/s and/or contributors to this survey

Lauri Vuorenkoski

Suggested citation for this online article

Lauri Vuorenkoski. "Ensuring access to public health care - follow-up". Health Policy Monitor, April 2006. Available at http://www.hpm.org/survey/fi/a7/3