The Government wants a customer-oriented freedom of choice model
Following negotiations held by the Ministerial working group on reforms, on 27 June the Government agreed on further preparation of freedom of choice legislation and the simplification of multisource financing.
The Government wants people’s different service needs as the point of departure for the Finnish freedom of choice model.
Four different freedom of choice means are under consideration: health and social service centres providing a broad range of basic-level services; own teams or health and social service stations providing a narrower range of services; service vouchers; and personal budgeting. The Finnish freedom of choice model will narrow down differences in health and wellbeing, will make access to services more equitable and bolster basic services. The Finnish freedom of choice model will play a part in helping curb the increase in expenses in health and social services by EUR 3 billion and helps people take responsibility for their own health and wellbeing.
The various conditions in different parts of the country will be taken into account. A constitutional evaluation and an assessment on how the freedom of choice will be realised among the most vulnerable will be made during the preparations. A sufficiently comprehensive assessment on the financial implications including a cost-benefit analysis will also be carried out. The impact assessment will examine the effects of different freedom of choice realisations and of the simplification of the multisource financing by concrete implementation models including ICT solutions. The assessment will take into account the impact on the administrative burden of service providers of different sizes and their ability to operate on the markets. It will also examine how smoothly customers of the different services can operate. The freedom of choice model ensures that people’s basic rights and good administrative practices are materialised.
Different ways of implementing freedom of choice suit different people
Several parallel ways of implementing freedom of choice responding to differing customer-service needs will be prepared for the legislation. For example, some customers need a wide range of services and support in making choices. Effective service guidance and counselling is needed for them.
In social services, freedom of choice is ill-suited to authoritative decisions and measures involving compulsion. On the other hand, in many social services, freedom of choice is a good tool for strengthening the customer’s participation and self-determination. Major use of official authority focused on the customers of services will continue to be the task of regional government authorities. Other official authority and administrative tasks, within the limits prescribed in the Constitution, can also be given to a private body.
In basic-level services, as a rule it is ensured that customers have equal opportunity to choose between a public, private and third-sector producer. At the same time, the current right to choose between public-sector producers is maintained.
During further preparation, the extent and appropriateness of the selection of services provided by health and social service centres based on population responsibility will be evaluated relative to the needs of different customer groups and access to the market by different-sized producers. Secondly, own service teams or health and social service stations operating on the basis of population responsibility and providing only certain narrower basic-level services will be evaluated. In addition, the possibilities for service vouchers and personal budgeting will also be determined. The aim is that customers can choose integrated services that meet their needs and that enterprises of different sizes, including small and medium-sized enterprises, can offer services.
The customer can choose specialised-level health and social services only when applicable. Freedom of choice is possible especially in the case of systematically planned, non-emergency procedures. The different modes of freedom of choice and financing must be implemented so that the service providers do not have incentives to undertreat or overtreat or to refer customers to specialised-level services unnecessarily.
Prevention the focal point of occupational health services
No changes will be made to the current position and basic tasks of occupational health services, but the services must be streamlined with other health and social services. Occupational health services in the future will place more emphasis on prevention and activities promoting work ability.
The role of student welfare services as a (school health services and the services of school psychologists and school social workers) lies in supporting studies in the educational institution and in preventive and corrective measures related to it. It does not naturally fall within the sphere of basic-level freedom of choice. In connection with preparing the freedom of choice and hand in hand with it measures are being drawn up to ensure that student welfare services for children and youths in need of specialised medical services are streamlined with health and social services to prevent non-access situations. At the same time measures are being prepared to make sure that customer data is in transferable form for streamlining the services. Close cooperation among the municipality and the educational service providers and the county health and social services is necessary in student welfare.
Possible needs to reform the activities of the Finnish Student Health Service FSHS will be evaluated during further preparation.
Similarly, a model for freedom of choice in oral health services will be worked out during further preparation. It is, in principle, an essential part of the sphere of services encompassed by freedom of choice, but its implementation cannot increase the total costs of health services.
Simplification of multisource financing supports regional government’s responsibility for organising services. Counties have overall responsibility for the financing of services and for seeing to it that the services obtained for the money spent are as effective as possible. Reimbursement for travel costs incurred for medical care and reimbursement for outpatient treatment medicines may be transferred to become the responsibility of the counties. Private health insurance reimbursements will be terminated following a transitional period. The impact of freedom of choice on customer charges will also be evaluated during further preparation. Legislation governing customer charges will be overhauled starting in January 2017 as outlined by the Government on 5 April 2016.
Law drafting governing freedom of choice is proceeding as outlined by the Government and is on schedule. It will proceed so that the Government’s draft proposal will be circulated for comment in November 2016 and the proposal will be presented to Parliament in the spring of 2017. This way it can be discussed in parallel with the Government’s proposal for health and social service reform and regional government reform.
Tuomas Pöysti, Project Manager, Under-Secretary of State, Ministry of Social Affairs and Health and Ministry of Finance, tel. +358 2951 63012
Hanna-Maija Kause, Special Adviser to the Minister of Family Affairs and Social Services, tel. +358 2951 63109
Sami Miettinen, Special Adviser to the Minister of Local Government and Public Reforms, tel. +358 2955 30057
English translation of the press release published on 1 July 2016.