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Finland Organization of the Health System
Health care was directed by the Ministry of Social
Affairs
and Health and was administered by the National Board of
Health.
In accordance with government practices, the ministry
decided
policy, and the national board determined how it would be
administered. Actual delivery of care was the
responsibility of
local government, especially after the Primary Health Care
Act of
1972, which stipulated that the basis of medical treatment
should
be the care offered in local health clinics. Previously,
the
emphasis had been on care from large regional hospitals.
The 1972 law resulted in the creation of about 200
local
health centers each of which served a minimum of 10,000
persons.
As municipalities varied greatly in size, small ones had
to unite
with others to form health centers, while about half the
centers
were operated by a single municipality. Centers did not
necessarily consist of a single building, but encompassed
all the
health facilities in the health center district. With the
exception of some sparsely settled regions, people were
usually
within twenty-five kilometers of the center charged with
their
care.
A basic aim of the 1972 law was to give all Finns equal
access to health care, regardless of their income or where
they
lived. Because most services of health centers were free,
subsidies from the national government were required to
augment
the financial resources of municipalities. The subsidies
varied
according to the wealth of the municipality and ranged
roughly
from 30 to 65 percent of costs. By the mid-1980s, about 40
percent of the money spent on health went for primary
care,
compared with 10 percent in 1972.
Health care centers were responsible for routine care
such as
health counseling, examinations, and screening for
communicable
diseases; they also provided school health services, home
care,
dental work, and child and maternal care. Most health
centers had
at least three physicians and additional staff at a ratio
of
about eleven per physician. Because of the high level of
their
training, nurses performed many services done by
physicians in
other countries. Most centers had midwives, whose high
competence, combined with an extensive program of prenatal
care,
made possible Finland's extremely low infant mortality
rate, the
world's best at 6.5 deaths per 1,000 births.
Once it was established that a health problem could not
be
treated adequately at a center, patients were directed to
hospitals, either to one of about thirty local hospitals
with
some degree of specialization, or to one of about twenty
hospitals, five of which were university teaching
hospitals, that
could offer highly specialized care. In addition, there
were
institutions with a single concern, such as the sixty
psychiatric
hospitals, and others that dealt with orthopedics,
epilepsy,
rheumatism, or plastic surgery. Given the great drop in
the
incidence of tuberculosis in Finland, the country's dozen
sanatoria were gradually being taken over for other
purposes.
Hospitals were usually operated by federations of
municipalities,
as their maintenance was beyond the power of most single
municipalities. By the mid-1980s, the country's public
hospitals
had about 50,000 beds, and its 40-odd private hospitals
had
roughly 3,000. There were another 20,000 beds for patients
at
health centers, homes for the elderly, and other welfare
institutions.
Data as of December 1988
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