Tuomas Pöysti: Freedom of choice and competition - How will Finland use it?
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-03.05.20231 Under-Secretary of State, Dr. Tuomas Pöysti
Freedom of Choice and Competition - How Finland will use it?
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Finnish social and health services reforms• Ambitious social and health services reform together with a reform of
regional administration• concerns 50 % of the public sector employees• establishment of autonomous counties with directly elected councils
• Widening of the freedom of choice• Use of multiple producers => modern service ecosystem based on
platform economics• Use of competition and markets in the production of services =>
enhancement of effectiveness
• http://alueuudistus.fi/frontpage
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Objectives of the Finland’s social and health services reform?
Renewal of services
More expedient administration
Better and more fluid functioning of services
Citizen participation Enhancement of economic growth
Cost-effectiveness
to promote and enhance the activities of citizens and enterprises
Administrationas a service
Openness.Customer-focus.
Inter-action and dialogue
Diminuation of differences in health and social wellbeing
Improved equality in services, efficiency of fundamental rights
Slowing of the expenditure growth (1.5 % to GDP)
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Bridging the Sustainability Gap in the Public Finances
The savings target for the health and social services reform package is EUR 3 billion, approx. 1,5 % of the GDPThe expected annual growth of healthcare and social welfare costs must be cut from 2.4% to 0.9% between 2019 and 2029
Functional and performance gains trough digitalisationCompetition => wise use of resources
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New functions of the counties as of 1 January 2019
GovernmentDecisions on health and social services: nationwide work division, division of duties over county borders, policies for service provision, broad-based investments, other measures needed to safeguard availability of services, steering of information management and ICT
18 counties- Responsibility for
organising services- Responsibility for
financial resources- Determines service level
and contract for arranging services
Municipalities
5 collaborative catchment areas
Counties• Healthcare and social welfare• Rescue services• Duties of the regional councils• Regional development duties and tasks related to the promotion of
business enterprise • Environmental healthcare• Planning and steering of use of regions• Promotion of regional culture and identity• Other statutory services organised on a scale that is larger than a
municipality that require deliberation
Collaborative catchment areas • Centralised duties in most demanding services• Streamlining of service structure, investments and services • Development and centres of excellence• Emergency medical service unit • Collaborative tasks and forum• Cooperation agreement
Service providers
•Public, private and third sector service providers
Municipalities• Promotion of health and wellbeing• Local democracy and dynamism • Statutory duties – local tasks• General mandate
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12 units with extensive service around the clock (incl. 5 university hospitals
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The Finnish model for organising health and social services and county government in the future:
Healthy people, fluent services and strong economy
Health and social services and county government reform legislation creates possibilities
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Promoting health and well-
being in municipalities and counties
Strengthening the self-determination and responsibility of
customer
Information, digitalisation and skillful personnel enablers
CitizenFunctional democracy and
participation
The usa of information - Integration og information
The Act on Financing of the
Counties - Criteria for the service needs
and cost containment
Economic growth
Taxpayercost-
effectiveness, effectiveness
Public, private and third sector providers
Promoting health and well-being in all
policies
Effective organising,
producing and managementMultiple producers
model - Same principles for
public, private and third sector providers
New CountyResponsibility to organise duties
Financing responsibilityResponsibility on integrated services and
functioning service chains
Alignment for preparation of the
legislation for wider freedom of choice
Measurements supporting and required
by renewal - Entrepreneurship
Multisectoral counties with
distinct distripution of work
Municipalities as local vital societies
Democracy in the Counties: county council
User- possibility to choose
- possibility to influence
Workforce transfers employees maintain their current terms of
employmentIncorporation has transition
period
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Issues to be addressed
• Freedom of choice in health care• Competition policy, social and health policy or both?• Will it function?
• Is health care exceptional?• Is freedom of choice alien to the social services?• Under which institutions and rules will competition and freedom of choice
work?
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Freedom of choice: cost-effectiveness trought shared decision-making and customer-centred serviceGovernment’s guidelines on the reform 29.6. 2016
Main rule in the primary and community servicesModified principle in secondary and tertiary care
User may choose between public, private or third sector provider
Finnish freedom of choise model. supports user-centred service integration
4 different tools- right to choose primary service provider- client vouchers- personal budget- right to choose among public producers.
The possibilities for producers of different sizes to operate in the market will be secured
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Theory
• Competition good to allocate scarce resources• Freedom of choice with shared decision-making creates incentives for
customer-cenred approach• Freedom of choice balances asymmetries of information and power• Health and social services are trust commodities
• big information problems• trust to service provider is a key decision-criteria
• A good case for public sector financing for universal health services and social services
• There is a case for multiple producers in the productions and utilisation of market mechanisms
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Practise• Conflicting goals in the market and freedom of choice models• Challenge of persons with multiple service needs• Commissioning - provision -distinction in practise• Trust commodity
• conditions for trust• Few persons actively change producers• Different levels of complexity and different business logics in the social and health services
commodities• Information conditions vital for the market• A natural tendency for big producers and concentration of the markets
• incentive structures in the market• risks to be allocated by the market• producer payment systems decisive
• Listing of clients to producers in the opening of the markets is a decisive act• Dependent on the regulation and institutions of the markets
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Primary services
producer Producer selected
by the used to which the user
lists himsels/hersselg
Public service institutions of
the CountyServices outside the freedom of
choice
Assessment of service
needs (gatekeeper)
Producers of services on the
bases of vouchers and
personal budgets
Finnish freedom of choice model
-03.05.2023 Alivaltiosihteeri Tuomas Pöysti12
Will it work?Updates?
alueuudistus.fi
#sote #maakunta2019 #maakuntauudistus@thpoysti
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