Being here, it seems a missed opportunity not to talk a bit about the Finnish health care system, especially given the fact that cardiovascular disease is the number one killer in Finland. While cardiovascular mortality has declined in recent decades as a result of an increased focus on prevention, better diagnosis and the same modern treatment we're used to, it is still a major problem.

 

This is an affluent, highly educated country, but a lot of people still smoke, and sedentary behavior is increasing, along with a more risky diet. As far as the Finnish health system goes, health services are available to everyone, regardless of their financial situation. The system is financed by extracting a percent of income for coverage, with the percentage increasing as income does. Public health services are mainly financed from tax revenues; partly municipal, partly state tax. The central government’s contribution is determined by several factors, including population numbers, age structures and morbidity statistics. Overall, Finland spends less on health care than most other EU member states.

 

Finnish Lessons for Reform?

Of course, the Finnish system is not without its faults. In recent years, a decline in public sector health-care expenditure has led to increases in costs to households. In addition, practice competition and markets in health care do not—and for the most part—cannot exist as a result of unequal bargaining power over hospital care and essentially monopolies in more rural areas. Efforts are currently underway to gather comparative data to improve the performance of hospital districts lagging behind (sound familiar??). In addition, ensuring equity in care across different population groups and areas has been a continuous task, which is something we need to keep in mind as we look at U.S. health care reform.

 

The Finns have a parallel private system that many employers add as a perk HR benefit. It beats waiting in queues for procedures and elective services. Many doctors have both a partial private practice and still work in the public system. Folks tell me the private system is good for elective and outpatient care, but that if you're “really sick” you want the public system.

 

To date, there has been a lot of talk in the U.S. health reform arena about improving access. If we use Finland as an example, it seems we need to be conscious of the fact that access doesn’t necessarily translate into equitable care. On the other hand, emergency rooms here are for emergencies, not primary care. And, despite high quality, costs are far below ours. Doctors here seem generally well compensated and highly respected.

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