Can Sote reform improve foreigners' experience of Finland's social and healthcare system?

Our audience had many ideas for improving the system as Finland heads into a healthcare vote.

Foreigners in Finland said language barriers were a problem in accessing services. Image: Derrick Frilund / Yle

Finland's health and social care providers are to be controlled by new county councils from next year. Voters go to the polls at the end of January to elect the new bodies.

We asked our audience what they think should be the big issues on the agenda for politicians elected to these new councils, and they had plenty of ideas.

Language barriers

Lots of people mentioned language difficulties when trying to navigate the system.

Many would-be patients said they don't know which service to contact, reported being misunderstood when describing the help needed and said they did not receive required help, in addition to many other challenges.

One respondent, Sara**, recalled how she ran into a multitude of unnecessary and wholly avoidable problems when she attempted to solve a particularly sensitive personal problem in English. This included being misunderstood and receiving erroneous advice that further exacerbated her problem—until her Finnish spouse stepped in to help.

"I should be entitled to receive help without discrimination, but that did not happen. I should not have to bring [my spouse] just to get someone to listen to me," Sara said.

Henna Leppämäki, a Senior Specialist with the Ministry of Social Affairs and Health, told Yle News that Finland's Language Act as well as the Administrative Procedure Act entitle a person to interpreting services if they cannot speak Finnish or Swedish. This provision will be continued, and potentially improved, under the Sote reform, she added.

"Most municipalities have contracts with interpreting service providers and remote services are more common and widely used especially during and after the Covid-19 pandemic," she said.

The social or healthcare service provider should arrange and pay for the interpreter, Leppämäki added, but it is important that the patient or client also requests this service.

On a broader level, Anu Castaneda, team lead of public health agency THL's Migration and Cultural Diversity Team, suggested the Sote reform could introduce improvements in how Finnish is used in the provision of services.

"Answers to this problem could be, for example, developing the use of simple Finnish language, supporting people in learning Finnish, developing multilingual and multichannel aspects in health services, and training professionals in areas of equality and encountering cultural diversity and people from different backgrounds," Castneda said.

The introduction of measures such as these, and their extent, would depend on the makeup of the regional councils elected on 23 January.

'Gatekeeping' and the appointments obstacle course

Another recurring problem was the difficulties many people reported experiencing while trying to book an appointment, especially to see a nurse, doctor or dentist.

Difficulties in getting a referral to a specialist was a common complaint, and even initial appointments can sometimes seem hard to come by in parts of the system.

Margarita* told Yle News that she felt "completely dismissed" as she kept hitting dead ends when she turned to a branch of the public services system for help.

Despite all these challenges, Margarita recalls that she slowly made progress and finally received the referral she needed to proceed. However, her case was then further delayed for an additional two months because an official "forgot" to send her referral.

"I was not living, I was surviving, I was in pain. They knew this," Margarita said. "I needed help, and [the official] forgot."

The health ministry's Senior Ministerial Adviser, Tapani Hämäläinen, said that people who feel they are being denied access to services are entitled to escalate the case to the health centre's management or else to the Patient or Social Ombudsman.

"If people feel that they have been treated improperly by social and healthcare services, or if they need advice about their rights, they can consult the Patient Ombudsman or Social Ombudsman," Hämäläinen advised.

Every municipal health centre has a Patient Ombudsman and there is a Social Ombudsman in every municipality. Their contact details can usually be found on the websites of either the health centre or the municipality.

Both of these offices, Hämäläinen added, can also help people to file complaints about social or healthcare services to a Regional State Administrative Agency (Avi), or in some cases to the National Supervisory Authority for Welfare and Health (Valvia).

THL's Castaneda also recommended contacting Finland's Non-Discrimination Ombudsman if anyone suspects they are being denied access to services for discriminatory reasons.

"In questions of equality the Non-Discrimination Ombudsman may be contacted with a low threshold and they investigate the situations case by case," she said.

Shortcomings in preventative care

Quite a number of respondents cited the apparent lack of preventative care within the Finnish system. They worried that smaller, relatively less significant issues have the potential to become much larger, more serious problems if not dealt with swiftly and effectively in the early stages.

"Failure demand, meaning how often you have to be in contact to get your problem sorted, is only now being recognised as a problem [by Finnish authorities]," one respondent said.

"Detecting and treating a minor condition early enough can prevent the need to save a life later on."

There are a number of different stages to preventative care, including the patient's own responsibilities, but one key step is early diagnosis and prompt treatment of potentially life-changing or even fatal diseases.

Kirsi Paasovaara, a senior specialist at the ministry of health, told Yle News that switching the focus of services to preventative and proactive work is one of the government's key objectives for the Sote reform.

"The focus of services will be shifted from specialised healthcare to primary health care and preventive work. The role of social welfare will be emphasised more than previously," Paasovaara said.

Knock-on effects

While most of the respondents mentioned so far in this article reported that their issues were eventually resolved to some extent—albeit after a period of stress and frustration—Yle News also learned of a small number of cases which have had very serious knock-on effects for the people involved.

In one case, Anna** relayed to Yle News how a doctor's misdiagnosis almost led to her losing her home.

In the summer of 2020, Anna went to a clinic complaining of severe pains, but was told that it was nothing serious and would soon pass. The pains persisted, however, so she went to a different doctor for a second opinion, where her correct—and very serious—diagnosis was discovered.

Anna's temporary work contract expired at around the same time as the misdiagnosis, but she could not renew her contract or find a new job due to her medical condition. She was also not entitled to any sick leave payments.

While undergoing a series of operations over the first few months of 2021, Anna's financial situation deteriorated rapidly due to continued complications and delays receiving social welfare payments, as confusion over her original diagnosis led to misinterpretation of her entitlements.

With no income coming in for months at a time, the bills began to pile up and were eventually passed on by the creditors to debt collection agencies. This led to many additional problems including repeated threats of eviction.

"I am speechless about how the healthcare and social services system works in Finland," Anna said. "If you are facing financial problems, you will not get any help from anywhere."

According to Kirsi Paasovaara of the health ministry, Anna's case is a prime example of the problems that can arise when different departments work in 'silos', meaning that they operate within their own bubble only, as has often been the case under the previous system.

However, she added that the Sote reform intends to tackle these issues.

"The reform will develop healthcare and social welfare services and reorganise their structure. Basic public services and preventive work will be strengthened. The aim is to ensure that people have smooth access to health and social services and receive help for their individual needs," Paasovaara said.

Check out our simple guide for all you need to know about the upcoming regional election.

* Margarita asked that Yle News not use her surname.

** The names of Sara and Anna have all been changed to protect the identity of the interviewees.