In the media

Vestre’s first study trip should be to Finland

By Grete Kvernland-Berg

Dagens Medisin

13 May 2024

The new Minister of Health in Norway, Jan Christian Vestre, faces the difficult task of streamlining the healthcare system. A crucial part of his work should be to explore the possibilities of eliminating a layer of management in the organisation. Finland can serve as an inspiration.

Norway spends approximately 450 billion kroner annually on health, including operating more than 40 hospitals across four regional health authorities, a wide range of specialist health services, and primary health services in 356 municipalities. According to a 2023 OECD report, we spend far more on health per capita than the Nordic countries and the EU countries’ average. We have more doctors and nurses per thousand inhabitants than the OECD average, yet we face longer waiting times for certain treatments and a risk of poorer treatment outcomes compared to other countries.

The big question is what should Minister of Health Vestre tackle first? The Health Personnel Commission stated that the way we organise, deliver, and finance health services will not be sufficient in the future. This is because we will face a shortage of healthcare personnel, more older people, and those with chronic illnesses will need more help. At the same time, the population is now more knowledgeable about their health and their rights and is demanding better services.

Division becomes a barrier

In today's Norwegian healthcare system, services are fragmented, managed at several different levels, with municipalities and hospitals managing separate budgets. This division creates a barrier to ensuring that patients receive the necessary help when they need it most. For example, children suspected of having autism face a long assessment period within various municipal agencies before receiving help from specialist health services. After treatment by specialist health services, they must be reassessed in the municipality to get the help they need at school, home, and in respite care.

Fragmented services particularly affect children and young people, the chronically ill, frail elderly, and those with mental illness. These patient groups depend on seamless and well-integrated care pathways where specialist and primary health services work hand-in-hand to provide the right treatment at the right time – without the patient being bounced between different systems. When services are not well integrated, it often leads to longer waiting times for treatment, more hospital readmissions, a worsening of the disease, and increased costs.

Comprehensive reform

Finland has taken active steps to address their future challenges. Last year, Finland began implementing one of the most comprehensive healthcare reforms in its history, a reform that unites all health and care services at a single level, whether they are offered in the municipality or in hospital. Responsibility and decision-making power are now concentrated at the county level, supported by unified state funding. The goal is to establish effective and seamless care pathways, as well as to promote effective cooperation.

Since 2010, the South Karelia region in Finland has carried out an ambitious integration of primary and specialist health services. They established what they called “Health and Care Centres,” where municipalities entered into agreements to provide coherent and easily accessible services. The centres offer services that meet patients' needs, regardless of whether they need primary or specialist health services.

Integrated services

South Karelia has focused on developing integrated services for specific patient groups, such as home-based rehabilitation services for the elderly, services for children and young people, and psychosocial services for adults. The merging of services in the region has enabled more holistic follow-up and prevention, increased efficiency, and optimised resource allocation as personnel can be allocated as needed. This has, for example, led to a higher proportion of the elderly population living at home because they receive well-integrated services from both specialist and primary health services in their homes.

The experience of South Karelia illustrate the great potential for improving patient pathways and maximising resource utilisation through better coordination and cooperation within the healthcare system.

Three measures for sustainability

By applying lessons from Finland to a Norwegian context, we can identify three measures we should implement to create a more sustainable healthcare system:

  • Unified financing. It is necessary to secure unified financing from the authorities that can be used to support collaboration and integration of health services. This contributes to setting common incentives and gives healthcare providers the opportunity to collaborate on more effective and holistic service offerings.
  • Less administration. Some administration is good, but too much will undermine efficiency and the ability to innovate. Fewer tiers in healthcare services will reduce the number of management and administrative levels, mean less time spent on case processing, and lead to more money going directly to patient-related activities.
  • Municipalities and health authorities need more knowledge about sustainable service models. It is vital to spread knowledge about these models and to demonstrate how they can be used in practice, including looking at examples from other countries. In addition to Finland, Spain is another European country that has made progress in offering integrated health services to the population, and where hospitals and municipalities play on the same team.

Organisational structures in Norway’s health sector rarely make the headlines in Norwegian public debate. Yet, it is here that the potential for improvement is perhaps the greatest. Therefore, Vestre should simply book a study trip to Finland as soon as possible.

Read the article in Norwegian

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