Author Topic: Health care reform Finnish style  (Read 276 times)

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Offline SCarpelan

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Health care reform Finnish style
« on: February 27, 2017, 10:25:34 am »
So, our government is also planning a healthcare reform. The purpose is to cut costs, integrate the health care and social services together so that the patient's hospital treatment and different rehabilitation and support services act as a whole, add freedom of choice for the patient and improve the overall quality of service.

Mostly these goals are to be achieved by further opening the health care to competition. The public health care services are to be made into publicly owned corporations that compete with the private ones in the same marketplace. The marketplace should have the necessary controls in place so that the newly opened competition and the introduction of profit motive incentivize the corporations to provide the wanted results.

The project is a typical one for the current government. Privatization is a magic word and everything needs to be pushed through as fast as possible so that the pesky democratic process can't ruin their plans for a brave new world. A pattern that has repeated itself several times is the government trying to push a reform or a legislation through without proper consultation and then pulling it back because the public response is too strong and/or the experts point out that the proposition is flat out unconstitutional. At one point one National Coalition parliamentarian complained in an interview about how the "constitutional fundamentalists" are standing in the way of their reforms - pointing out that the constitution guarantees equal rights for everyone and forbids the privatization of certain essential services is so regressive, after all.

Some expert statements (Finnish page, I'll give some translations) about the health care reform draft give a very descriptive picture about this approach with one exception. The draft is actually well done and is open about the flaws and benefits of the plan. Of course, the government is apparently ignoring the flaws despite being completely open about them. Because free market.

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The draft says that a person can pick a social- and health care center and a oral treatment unit for themselves and register as their client. After a service need estimation they can get payment coupons, customer coupons or a personal budget with which to get other social- and health care services they need.

One expert points out that the required control mechanisms and other details are impossible to build in time for 2019:

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- Many important details about how the system operates are still open and/or in conflict with the goals. The reform in the current form is a leap into the unknown, warns professor Huttunen

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Huttunen gives special credit to the preparation of the draft in one area. The impact estimation attached to the draft has carefully analyzed the weaknesses and strengths of the reform.

- If you read them, you can reach only one conclusion: the reform should not be advanced in this form, says professor Huttunen

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The professor of Social Policy says that the the government's freedom of choice model weakens - or makes it impossible - to integrate the services. Additionally, it includes great risks for increased costs.

- Both would mean that the services for the least fortunate people would be weakened, reminds Hiilamo.

The risks in the freedom of choice are repeated several times and they are also included in the critical impact statement of the legal draft.

- The impact draft is confusing to read. If the numerous threats described by the statement are known why is the draft being promoted in its current form? The freedom of choice could be realized in a more limited form without endangering the integration, says Hiilamo.

But free market! Privatization! Public services are inefficient!

Several of the experts also point out that the proposal incentivizes the privately owned corporations to peel the cream from the top - to send the patients who require basic but expensive care to the publicly owned specialist services which will drain their resources needlessly.

Another obvious flaw is the uneven population density in Finland. It is possible that in the major cities the freedom of choice adds competition and brings prices down but not so in the rural areas. There aren't simply enough people to support several health care operators so this would just lead into monopolies in these areas. It should be obvious how well a private corporation who has a practical monopoly treats its customers.

By the way, during the preparation of the reform several politicians who have participated in the process have switched from politics to the private sector. Who have been hiring them? Health care providers. Suggesting that it's because they might have inside information about the preparations is preposterous, of course.

It should be no surprise that the current prime minister is a former CEO with very little experience in politics before being elected. His explicit goal is to not only privatize as many services as possible but also to shape the whole political process to work more like a private sector operator. As he puts it, he has a vision that keeps him going in the middle of all the criticism.

Offline Askold

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Re: Health care reform Finnish style
« Reply #1 on: February 27, 2017, 01:38:24 pm »
...We had a pretty nice country.

Then the Republican-lite politicians decided to tear down the public education and healthcare and privatize all they can.
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Offline SCarpelan

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Re: Health care reform Finnish style
« Reply #2 on: February 27, 2017, 05:33:03 pm »
Many of them would be right at home with the pre-Trump Republican party establishment. Each of the three coalition parties can be seen to represent one of the Republicans' dark sides. The True Finns bring the racism, National Coalition Party brings the bootstraps and the Center Party brings the rural conservative values. IMO the only reason the prime minister is in the Center Party instead of the libertarian wing of the NCP is that he is a Laestadian and they tend to be loyal Center Party voters.

(Edit: forgot the religious fundamentalism in True Finns and to a lesser extent in the Center Party.)

The sad thing is that each of the parties have had also their own sensible policy agendas. Each one of them just decided to sacrifice these in order to please the other coalition parties.
« Last Edit: February 27, 2017, 05:50:55 pm by SCarpelan »

Offline SCarpelan

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Re: Health care reform Finnish style
« Reply #3 on: May 09, 2017, 11:34:56 am »
To make sure that the private healthcare companies act responsibly and don't use tax avoiding schemes, the government proposal includes a requirement that they provide information about their finances. Unfortunately, according to the non-partisan watchdog Finnwatch, half of the data elements that would reveal such schemes are not included in the law as requirements. In other words, the companies are free to evade taxes without the private citizens or the county administrations that buy the services from these companies being aware of it.

Funny. I thought the right-wing libertarian view of the economy demands that the customers are able to make informed decisions in order to provide proper incentives.