The need for a research programme

Finland has long been considered to have one of the world’s most advanced health care systems, with excellent service access as well as service quality. However, recent international comparisons, national evaluations and data on the job-related stresses and strains of health care staff have drawn a rather different picture. Health services funding is in crisis, existing services do not match up with the population’s needs, and health differentials between population groups are growing, in spite of efforts to curb this trend. As the population in the country continues to grow older, the need for health services is also set to increase. The dependency ratio is changing so that a proportionately smaller workforce is having to foot the bill for rising pension and health care costs. In this situation there is a need for a coordinated research programme with a focus on health services research.

People want and expect to have a high standard of health services as well as adequate access to those services. They also want to have the best treatments available. Given the pace at which modern medicine is advancing, notions of what represent the best treatments available are changing all the time. People in Finland, too, want to benefit from the latest medical and technological innovations without any delay. The funding bodies of public health services (i.e. local governments, the central government and, ultimately, citizens themselves), all expect to see an effective and efficient operation. Equity in both health and access to health services has been one of the key objectives of Finnish social policy ever since the 1960s. However, it has become increasingly difficult now to achieve these partly conflicting goals.

The steering mechanisms of the Finnish health care system were radically overhauled during the 1990s. The launch of a new state subsidy system and other similar reforms at the beginning of 1993 meant that Finland moved from a central government controlled health policy to an almost entirely decentralised model. In Finland, responsibility for the organisation and provision of health services rests with local councils. With the reforms of the early 1990s, local governments gained full independence to decide how they were to spend their central government transfers. The recession that was sweeping the country at the same time caused tax revenues to plummet, leading to the introduction of radical steps of prioritisation in health care.

International forces of change have a major impact on the development of health care and the contents of health policy, and will do so to an ever greater extent in the future. Key among these forces are the general economic development, the global pharmaceuticals industry as well as the free movement of labour, goods and services within the EU area and the enlargement of the European Union. Internationalisation presents both new opportunities and new threats, and research can significantly contribute to how these challenges are met.

The National Health Project revealed several shortcomings in the Finnish health care system. The list of recommendations drawn up by the project were mainly geared to the near future; for instance, the role of research in addressing the problems and in finding alternative solutions was ignored. Long-term political decisions need to be based upon hard scientific research evidence on the impacts, effectiveness and equity of health care as well as upon comparative, international data on alternative ways of organising the necessary funding and service production. It is particularly important that the impacts of the population’s age structure and other developments in society upon the need for health services and funding are predicted in a sound and scientifically sustainable manner.