Public Health Care and Globalization - Finland

1. Eeva Ollila Public Health Care and Globalization - Finland

2. 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

3. 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

4. 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)

5. 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)

6. 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

7. 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

8. 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