Priority-setting in Finnish healthcare

The characteristics which affect priority setting in the Finnish healthcare system include strong municipal (local) administration, no clear separatio n between producers and purchasers, a duality in funding, and the potential for physicians in public hospitals to practice in the private sector, This system has its strengths, such as the possibility to effectively co-ordina te social and healthcare services, and a strong incentive to take care of l ocal needs, because of municipal responsibility to finance these services l argely through local taxes. However, the municipalities are typically too s mall to take advantage of these potentials, their knowledge is scarce espec ially of secondary care and their negotiating power with respect to hospita ls is low. Local politicians also have a dual role: they represent the need s of the local population but simultaneously they are decision-makers in ho spitals. Full-time physicians are allowed to act in a dual role as well; th ey can run a private practice, which is paid for on a fee-for-service basis , while the hospital pays (mostly) a fixed monthly salary. The share of fin ancing which flows from the National Sickness Insurance system to healthcar e users may have adverse effects on the local use of resources. The broad n ational consensus statement on patient-level priorities did not reach any g eneral rules on priorities. Strong support was given to citizens' equal rig ht to access all healthcare services. In healthcare practice, this general rule has some exemptions. First, the reimbursement schemes for prescribed d rugs vary depending on the severity and chronic nature of the disease. Seco ndly, the tax-financed dental services for the young are clearly prioritise d over those of older citizens, In the consensus statement, emphasis was pu t on improving the efficiency of producing health services in order to avoi d having to impose patient-level priorities. (C) 1999 Elsevier Science Irel and Ltd. All rights reserved.