Q&A: What does the social and healthcare reform mean for you?

The upcoming reorganisation of health and social care provision in Finland has raised a number of questions, so we got some answers from the experts.

Voting is underway in Finland's first county council elections. Image: Hilma Toivonen / Yle

Ahead of regional elections planned for 23 January, we asked social and healthcare experts to answer questions from the audience on the upcoming reform of services in the sector.

The elections will deliver new 'county councils' for 21 new regional authorities that will be in charge of healthcare, social care and emergency services in each region, with the exception of Helsinki.

Yle spoke to Heini Huotarinen from the Justice Ministry and 'Sote' reform expert Marina Erhola, who is leading the reform in the Päijät-Häme region.

Accessibility of 'Sote' services — Marina Erhola

Can I use a health centre near my workplace and one near my home when I'm not at work, if they are in the same healthcare region?

In principle, people should be customers of one healthcare centre. Regions can, of course, decide on different arrangements. But often it's appropriate for services to be concentrated in one place.

Urgent care can be sought almost anywhere, as it can now. And as digital services become more common, care can even be given while you're sitting at home.

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Marina Erhola runs the Päijät-Häme healthcare region. Image: Petteri Bülow / Yle

How will occupational healthcare be arranged? Both for employees of the healthcare region and for others who use public occupational health services.

Public sector occupational healthcare will now be transferred to the new healthcare regions. And the region can decide whether it will provide these services itself or outsource them. At present, a lot of occupational health services are purchased from the private sector.

Private companies can arrange occupational healthcare in the best way they see fit. There are unlikely to be big changes in practical arrangements from the current setup; although, of course, that depends on the regions themselves.

There is currently a right to choose your health centre, enshrined in law. Can people choose a health centre in a different region?

Yes, that will be possible if there are clear reasons for doing so. For instance, if there is a second home in another region and people spend a lot of time there. In that sense this won't change.

What kind of changes will there be to mental health and child protection services, for which there are big queues? Will it be quicker and easier to access these services?

Strengthening basic services, which include these services, is one of the cornerstones of this reform. There has been a desire to ensure that we can direct more money towards them. Now, they will be under one budget and the wellbeing and healthcare region will direct money towards the right services according to the needs of its residents.

The reform itself is cost-neutral, so the total sum spent won't change. But from one budget money can be sent to those areas it is needed most.

Now that family carers have been transferred to the new administration, will there be a reduction in support payments for them?

The reform itself will not cause a reduction. Each region decides for itself how big the support payments will be. There are minimum sums that must be paid: 400 and 800 euros, depending on how much care is required.

But in future, each region decides how much money it will put towards family care. Those areas where more than the minimum is paid can, of course, reduce those payments to the minimum required.

During the Sipilä government it emerged that private firms were trying to sign long-term rental agreements on hospital space. There was a readiness for tendering processes. Now there has been much less talk of it. How will private provision look under these reforms?

The current legislation offers excellent possibilities for both public and private providers to offer services, in my opinion.

This model is different from the Sipilä government's model, especially in terms of freedom to choose providers. But I believe that the private sector is relatively satisfied with the current solution.

Healthcare regions are getting pots of money from the central government. How much, in euros per resident, is the variation between regions and what factors influence that funding? Is the funding just as big for the next seven years, or will it reduce in terms of euros per resident? If so, what is the justification for that?

That sum, in euros per resident, varies according to the region. It is decided in future on the basis that 80 percent of the figure is decided based on the region's need. THL has worked for years on defining this so-called needs index. It is influenced by several factors, including how sick people are in any given region.

The resident-based portion of funding is around 16 percent and the final four percent is based on the conditions of the area, for instance, archipelago provision or speakers of foreign language.

The relevant point is that we are now changing to a needs-based funding system. Before, when money has come from individual municipalities, there have been big differences between them. Some municipalities have not gotten what they needed, and others have used larger sums for 'sote' services. As these differences are ironed out under the new system, differences will become evident between regions.

Emergency services are now to be managed by these regional authorities. Is the emergency services budget ring-fenced in each region's budget?

No. They are part of the general budget. So each region's board and assembly decides on how to allocate money between 'sote' services and emergency services.

The emergency services budget is around two percent of the total, so its not that big but it's important.

As we are adjusting nurses and apparently also doctors' salaries upwards, how will things go for the wages of other support workers? Will they increase and if so, by how much?

This discussion about pay harmonisation is still in progress. Wages have to be harmonised to a certain level in each region, so that salaries for the same tasks are equal. And now there has been a discussion about whether to harmonise them at the median level or above that at a higher level.

Naturally there are differing opinions on this among employers' and workers' organisations. And funds have not been allocated for harmonisation at a higher level.

Pay harmonisation affects all employees in the region; however, not just doctors and nurses.

Why were 21 regions founded, when experts recommended fewer than ten?

That was a political compromise. 21 is a big number, and there are very small regions in that number. But it's a significant change from the current number of municipalities (310). I am myself of the opinion that 12-15 would be a good amount. And my personal opinion is that the number of regions will shrink. The whole social and healthcare system has broad responsibility and it could be too much for a small region.

My own region, Päijät-Häme, has around 200,000 residents, and I have thought that is pretty much the minimum for a welfare region.

Elections and county councils — expert Heini Huotarinen

How many voters will be offered the chance to vote at home?

That is a legal right for those who cannot get to polling stations without unreasonable difficulties. Registration for this has already passed, and those who have registered will, of course, be able to vote at home.

We don't yet have numbers from this election, but generally there are around 10,000 home voters in each election.

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Heini Huotarinen works at the Ministry of Justice Ministry. Image: Petteri Bülow / Yle

How will the Covid epidemic affect voting? Will those in quarantine be able to vote?

Getting sick from Covid will not prevent people from voting. So voting possibilities will be arranged for those in quarantine. In practice, that means that on election day people will be able to vote outdoors.

But as in other elections before Covid, voting might be difficult if on election day people are too sick to get to polling stations, and they haven't voted in advance.

Will there be any extra staff on hand at polling stations to prevent congestion and overcrowding? How will security at polling stations be organised?

Good question. In the municipal elections, the number of election officials was increased in many municipalities because of Covid, and the same systems will continue now. People will have questions and will need guidance on the arrangements around queueing, among other things.

Can voters bring their own pens?

Yes they can. There are pens for all at the polling stations, but people can also bring their own. It can be an ink pen, a pencil or a felt-tip pen, although with a felt-tip you should take care it doesn't smudge on the ballot paper. If the number is not clear, the vote could be rejected.

In these elections, municipal candidates are not elected, but rather parties' candidates from the region in question. In practice, it is the same election method as in parliamentary elections, where the electoral district's main vote-magnets help a lot of others in their parties get through. So within the party lists the balance between municipalities might not correspond to the vote share between municipalities. Can someone voting for a candidate from a certain municipality ensure that the vote goes to candidates from that municipality?

Our electoral system is a mixture of party and candidate elections. Now, candidates have been placed in healthcare and wellbeing regions, with no quota for each municipality or other arrangement in the system itself to control which municipality's candidates get through.

In the campaign, voters can, of course, seek to support candidates from their municipality, and that will increase his or her chances of getting elected.

Why were these elections not postponed? The municipal elections were postponed even though the Covid situation was much better then.

The biggest difference from the municipal election is vaccine coverage. That enables us to protect voters and election workers better than before. At the same time, voters in quarantine will be better able to vote.

Postponing the elections has not been proposed, either; no party has proposed that. In the municipal elections all but one parliamentary party supported postponement.

THL has said that voting is a low-risk activity. It has a shorter exposure period than grocery shopping, for example.

Why is there no 'Sote'-reform in Helsinki? Is it that wealthier areas can afford to maintain municipal healthcare in smaller units?

The Helsinki city board will, in future, handle health and social care and emergency services provision. This is primarily because of Helsinki's size. Helsinki is bigger than any of the other new regions being created.

It's not to do with wealth, in my opinion. Just the population size.

The county councils will have members who are on municipal councils and in parliament as well. What priority will they place on their tasks?

Positions as a county council member are handled on top of other duties and day jobs. So all those elected to these bodies will work on their free time, and that applies to members of parliament too.

But of course, it's an interesting question from the perspective of democracy, whether voters want to elect the same people to run the same things at different levels.

Legally speaking, there's no bar on serving on these different bodies at the same time. But voters can consider that at the ballot box.

How many working days will council members need each day, when meetings take up their time? And how much will they be paid?

Payments are decided once the regional bodies are established. Not much has been decided around these issues, as this is an entirely new layer of administration. Council members' duties won't take up working time, as they are handled during people's free time. I believe meetings will be held mostly in the evening.

In some areas, there will be two meetings a month in the spring season, when there are lots of things [to decide]. But normally, meetings will be about once a month or otherwise the kind of number that allows people to handle a normal day job as well.

Can you vote for a candidate not from your area?

In these elections you can only vote for candidates in your own area. But you are able to vote in advance outside your own region. In that case, it is important to ensure you check the candidate's number from the candidate book available at every polling place [as it won't be on the posters listing candidates from the local region].