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Finland Table of Contents


Organization of the Health System

Health care was directed by the Ministry of Social Affairs and Health and was administered by the National Board of Health. In accordance with government practices, the ministry decided policy, and the national board determined how it would be administered. Actual delivery of care was the responsibility of local government, especially after the Primary Health Care Act of 1972, which stipulated that the basis of medical treatment should be the care offered in local health clinics. Previously, the emphasis had been on care from large regional hospitals.

The 1972 law resulted in the creation of about 200 local health centers each of which served a minimum of 10,000 persons. As municipalities varied greatly in size, small ones had to unite with others to form health centers, while about half the centers were operated by a single municipality. Centers did not necessarily consist of a single building, but encompassed all the health facilities in the health center district. With the exception of some sparsely settled regions, people were usually within twenty-five kilometers of the center charged with their care.

A basic aim of the 1972 law was to give all Finns equal access to health care, regardless of their income or where they lived. Because most services of health centers were free, subsidies from the national government were required to augment the financial resources of municipalities. The subsidies varied according to the wealth of the municipality and ranged roughly from 30 to 65 percent of costs. By the mid-1980s, about 40 percent of the money spent on health went for primary care, compared with 10 percent in 1972.

Health care centers were responsible for routine care such as health counseling, examinations, and screening for communicable diseases; they also provided school health services, home care, dental work, and child and maternal care. Most health centers had at least three physicians and additional staff at a ratio of about eleven per physician. Because of the high level of their training, nurses performed many services done by physicians in other countries. Most centers had midwives, whose high competence, combined with an extensive program of prenatal care, made possible Finland's extremely low infant mortality rate, the world's best at 6.5 deaths per 1,000 births.

Once it was established that a health problem could not be treated adequately at a center, patients were directed to hospitals, either to one of about thirty local hospitals with some degree of specialization, or to one of about twenty hospitals, five of which were university teaching hospitals, that could offer highly specialized care. In addition, there were institutions with a single concern, such as the sixty psychiatric hospitals, and others that dealt with orthopedics, epilepsy, rheumatism, or plastic surgery. Given the great drop in the incidence of tuberculosis in Finland, the country's dozen sanatoria were gradually being taken over for other purposes. Hospitals were usually operated by federations of municipalities, as their maintenance was beyond the power of most single municipalities. By the mid-1980s, the country's public hospitals had about 50,000 beds, and its 40-odd private hospitals had roughly 3,000. There were another 20,000 beds for patients at health centers, homes for the elderly, and other welfare institutions.

Data as of December 1988