The impact of financial and organizational reforms in Finnish healthcare

    Description

    The 1993 government subsidy reform coincided with the worst economic recession in Finland since World War II. The extreme circumstances provided a "test laboratory" for organizational behaviour within the Finnish public healthcare system. Two in-depth studies, the first covering six municipalities, and the second eight municipalities, described in detail structural, organizational and service pattern changes, influenced by the reform and the recession. A detailed material was collected, consisting of formal documents, surveys and interviews (with decision-makers, professionals and patients) as well as official statistics. Observations on municipal decision-makers were summarized in a model of strategic behaviour. Strategic choices, organizational changes and changes in service mix were described and related to characteristics of the municipalities, the role of actors and organizational culture within municipalities.

    A case study of a hospital closure showed that healthcare professionals involved chose a rational planning approach, and failed to identify potential allies among the decision-makers. Supporters of a competing hospital were better positioned visavis decision-makers and blocked a possible local coalition opposing the closure.

    The programme has been engaged to evaluate an organizational experiment, unique in Finland, and with important policy applications. The social services and primary care of a municipality are contracted out in total to a voluntary, private, not-for-profit organisation, basically engaged in health promotion. The organisation intends to include health promotion and active community involvement in the services offered to the population. The decision-making and policy development process will be monitored and activities described. The impact on the behaviour of the population, consumption of services, health status and service production will be evaluated with a before-and-after approach. The study is controlled. The same data collection and analysis will be performed in three similar municipalities that organise their services traditionally.
    StatusFinished
    Effective start/end date01/01/200031/12/2010

    Fields of Science

    • 314 Health sciences
    • Finnish healthcare
    • organizational reforms
    • decision-makers.