Public%20Health%20Care%20and%20Globalization%20-%20Finland

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Public Health Care and Globalization - Finland

• Eeva Ollila

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Globalization and Health care--Some common
features

• Increasing commercial interests in the production
  of health services
• Increasing (multinational) for-profit service
  actors
• Problems with equity of access, increasing
  inequities in health
• Challenges in regulation
• Increasing health care costs and problems in
  public financing
• Increasing prices of pharmaceuticals, emphases on
  high technology
• Taxation capacities decreasing
• Deficit of health care workers
• Flow of workers from public to private, from
  South to North

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Finnish health care system

• Decentralized health care system with
  municipalities responsible for organising health
  care
• Multi-channel financing with non-ear marked state
  subsidies, municipal taxes, social insurance and
  user fees
• Primary health care mostly produced by the
  municipalities, specialised care by hospital
  districts, private provision with social
  insurance subsidies especially in cities in open
  care/ occupational health

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Globalization and its implications for the
national health care

• National trends
• New public management (NPM), preparing for
  outsourcing Bureaucratic commercialization,
  purchaser-provider split, contract steering,
  pricing according to DRGs, private sector
  management techniques, decentralization
• Outsourcing ( and privatisation) likely to
  increase
• (procurement law and the project on municipal
  and service delivery restructuring, pressures to
  decrease the size of the public sector)
• Maintenance of public financing (tax or insurance
  based)

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Globalization and its implications for the
national health care

• Regional and global pressures
• Neo-liberal political atmosphere
• EU the four freedoms, internal markets,
  competition, procurement directive, services
  directive, directive on health services,
  financial policies (EMU criteria), ECJ decisions
• OECD (public governance and management) NPM
• WTO (TRIPS, services)

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Globalization and its implications for the
national health care

• Financing
• Pressure to lower taxes, lowered state subsidies
  put pressures on municipal tax-based financing,
  increased user fees on services and on
  pharmaceuticals as a result regressive financing
• Pressures for increased funding
  Commercialization, new expensive technologies,
  increased expectations, aging

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Production of health services

• Outsourcing and privatisation increasing
• Fragmentation of the service delivery system
• Competition practices increasingly taking
  production decisions to court
• Responsibilities remain with the municipalities

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Globalization and its implications for the
national health care

• Governance - Steer more - row less
• Information steering, project steering, laws,
  regulations, monitoring, financing
• The framework of regulation is changing
• Regulation from the Ministries of Health to the
  Courts