Roundup: Finnish health care reform meets with legal dilemma

A massive effort to reform the Finnish health and social services has met with major constitutional problems, which has triggered a heated debate in this Nordic country.

The aim of a recently drafted bill, which is being processed in the parliament, is to shift the responsibility of arranging the services from municipalities to the would-be regional authorities. But the parliamentary constitutional committee said last week the bill violated the constitutional autonomy of municipalities.

A last minute effort to amend the bill is under way, but time may run out as the current parliament will close in mid-March. Parliamentary elections are to take place in Finland in April.

Leading Finnish newspaper Helsingin Sanomat stated in its editorial on Saturday that Finland seems to have lost its ability to enact major social reforms.

The newspaper noted that the advice provided by legal experts during the long process were bypassed. The agreements reached by key politicians were published as if they were results even though the process was at the beginning, the newspaper said.

Jaakko Jonkka, the Chancellor of Justice, told Finnish national broadcaster Yle that his office and the experts at the Ministry for Social Affairs and Health were aware of the constitutional problems of the bill. Jonkka did not speculate why politicians allowed the bill to advance this far and did not call it off earlier.

An all party parliamentary working group reached agreement on the health care reform in June 2014.

The questioned bill, aiming to shift the responsibility of providing health services from municipalities to regional authorities, was meant to emphasize the equality in citizens' access to these services.

Jouni Backman, chairman of the social democratic caucus in parliament, remarked in the newspaper Demokraatti that the parliamentary constitutional committee seems to give "more weight to municipal autonomy than to the equal availability of health care."

"That, too, is secured in the constitution," he noted.

Finland has several parallel national health care systems, which have led to increasing inequality in the availability of health care.

Working aged residents, if employed, have access to employment based health care that gives excellent access to see a medical professional. They can see a doctor even on the same day of the appointment.

But in a municipally operated public health centre, the earliest available appointment is usually several weeks away. The law defines three months as the maximum waiting time, but not all municipalities have been able to comply with it.

At the hospital level, the Finnish system is nearly exclusively public and functions pretty well. An ambulance ride assures best available treatment to everyone.

In non-urgent cases, however, the patients using public health centres often have to undergo a much slower progress than those who have access to employment based health care or can afford private medical service.

While the work force enjoy the employment based primary care, pensioners and the unemployed have to find their way through the ailing public health centres.

A third channel is purely private medical care. Those choosing to go to a private doctor at their own expenses get partially reimbursed by the National Social Insurance System.

Critics insist that the support of private care should be canceled and the money should be used for public health. A separate plan on the funding of health care is expected during this year. Endit