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Primary care in Finland

Primary care in Finland. Trends 2010 – 2012 In Särö 6.9.2012 Arto Virtanen. Topics. Health care reform Privatisation Positive trends for general medicine Salaries. Arto Virtanen. GP in Nurmijärvi County since 1985 Rajamäki Health station in Nurmijärvi:

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Primary care in Finland

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  1. Primarycare in Finland Trends 2010 – 2012 In Särö 6.9.2012 Arto Virtanen

  2. Topics • Health carereform • Privatisation • Positivetrends for general medicine • Salaries

  3. Arto Virtanen • GP in Nurmijärvi Countysince 1985 • Rajamäki Health station in Nurmijärvi: • Nurmijärvi has 41000 inhabitants, • 40km north of Helsinki • Rajamäki has 6000 inhabitants, 3 GP:s • Non-specialist • GPF Board since 2002 • GPF Chair since 2011

  4. Municipalitiesresponsabilitiesarechanging • Soon? • Municipalities • organizeprimary and areresponsoble for secondarycare • Universityhospitaldistricts (5) • Organizetertiarycare • Before • Municipalities • OrganizePrimaryCare • Hospitaldistricts • Municipalities as members • Organizesecondarycare • Organizetertiarycare

  5. Reasonings for systemchange • primary and secondarycareshouldworktogether, in the sameorganisation • The social sectorshouldbealsoincluded in this • Manymunicipalitiesaretoosmallto arrangelocalhealthcarebythemselves. • In the sametime a big politicalissue • A separatecentralgovernmentplan to reduce the number of municipalitiesmoreorlessdrastically • Nowover 300, plan: 50?

  6. Size and numbers of municipalities 2011

  7. Privatisation • Holehealthcentersoutsourcedsince 2004 • City of Lahti started with itscentral - region • At peaktherewere 40 outsourcedcenters, now 38, soon 40 again (Samaria/Espoo and Hakunila/Vantaa as new ones) • Lack of GP:s • Monetarysavings • Organisationalchanges • Ideologicalreasons (private = moreefficient) • HiredGP:sthroughcompanies • Since 2000, first in out of hourswork • Nowalso long lastingcontracts

  8. PrivateCompanies (revenue 2011) • Attendo-Medone 250 mill € • Mediverkko 65 mill € • Pihlajalinna 30 mill € • Coronaria 20 mill € • MediRadix 12 mill€ • Doctagon 11 mill € • MAST Data 4 mill € • MediVida 2 mill € • Puumedi • Terveydenhuolto.com

  9. How much of the healthproduction-labour is outsourced? • In primarycare 7% • In secondary and tetiarycare 1,7 % • In both: verywidegeographicaldifferences

  10. General medicine is improvingitsbrand • Lack of GP:s is lessening (partlyevengone) • General practice as a speciality is gainingpopularity • 1.1.2012 specialists in differentfields: • General medicine: 2882 • Internalmedicine 1659, psychiatry 1340, General surgery 1266, occupationalhealthcare 1007

  11. Work-happiness(Lääkärilehti: Harri Haimakainen, Arto Vehviläinen, Esko KumpusaloVsk. 66 • Nr: 42 / 2011 • s. 3133 - 3138) • ”I wouldsuggestworking in a health-center as a career for my children” • 2002 39% • 2006 52% • 2010 60% • ”Working in a health-centertakesall my powers” • 2002 60% • 2006 48% • 2010 44% • ”I willbeable to work in a health center up the retirementage” • 2002 47% • 2006 60% • 2010 66%

  12. Workingpart-time: • 1996 5% and 2010 20% of GP:s • Of these: women 2/3 and 1/3 men, the samepercentage in allagegroups • ICPC vs ICD 10 in Finland: • Physiciansuse ICD 10 (except a couple of municipalities) • Nursesuse ICPC • National data collection of eitherone

  13. Officially 2 paymentsystems • Own GP • Responsibility to takecare of a namedpopulation • Populationsusually 1800-2700 • Workingtimenotmeasured • 25-40% of paymentdepending on the workload (fee for service) • Traditional • 37 hours/week • 10% of paymentdepends on the workload (fees for service)

  14. Many-manylocalagreements • Now the majority of GP:sworkunderdifferentlocallyagreedwork/paymentsystems • Everyhealth center hasdifferentagreements • Listmodels • List of patients (somepatientsorallpatients) • Fee for service: 30-60% of totalincome • Worries:Motivates to serveshortlymanysimplepatients • Fixedwages • Allinclusive • Worries: Motivates to spendtimepeacefully in the office

  15. Salariesdevelopments • 2012-2013 centralagreement: 2,4% • 2010-2011 development • Normalhourswages +3,6% for physicians • Communal-sectoralltogether 2,5% • Total wages the difference 4,3% vs 2,5% • Since 2000 (index 100) wageshaverisen • Physicians in the communalsector to 160 • others in the average to 150

  16. Wages • In Regularhours 2011 • 6500 € / monthGP:s • 5800 € / monthhospitaldoctors • GP:sgetbetterpayed in start of theircareerbuthospitaldoctorsarecomingslower to theirpeak • Wagedevelopment 2009 -2011 amongGP:shasbeenpositive • nonspecialists+ 12,8 % • specialists+ 6,5% • Differencenowabout 600€/month

  17. Let´skeep us fitIthelps in keepingothersfit

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