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Yle News explains: What is Sote?

Finnish politicians have been talking about 'Sote' for years, and in 2016 the reform nearly brought down the government—but few normal people understand what they mean. The abbreviation refers to the Finnish terms for health and social care and the drawn-out saga of reforming those services. Here we explain what's at stake—and why we won't dwell too long on the matter in our election debate.

Image: Yle

Finland currently organises health and social care through its 295 municipalities (excluding the autonomous archipelago province of Åland), which are responsible for providing care services for residents. That's more municipalities than the 290 Sweden has to serve nearly double the population, and it is a relatively inefficient way to run health and social care.

Statistics Finland estimates that by 2030 some 26 percent of the population will be aged over 65, up from just under 20 percent now. As older people use more health and social care services, the need for reform will soon become acute.

The last three Prime Ministers have attempted to drive ‘sote’ reform forward, but the current government has gotten further than its predecessors.

Regional regeneration

The government's model transfers responsibility for these services to 18 elected regional authorities, the establishment of which is a long-cherished goal of the predominantly-rural Centre Party of Prime Minister Juha Sipilä.

Experts suggested the new system would be most efficient with four or five regional bodies, but that the reform should bring in a maximum of 12. The Centre Party—which is expected to dominate elections in the 18 authorities established by its proposal—held fast to the broader layer of regional government.

At the same time, the proposal envisages 'freedom of choice' for patients, who will be able to choose from a range of providers (public and private) for their care by 2019. This freedom of choice has been a long-cherished goal of the pro-market, centre-right National Coalition Party, which holds the Finance Minister's portfolio in the current government.

Sticking to the timetable

Advocates point to neighbouring Sweden as an example of health and social care reform producing improved services. The idea is that private providers seek efficiencies and cut costs quicker than public bodies, thereby saving the taxpayer money even if some ends up as profit for private firms. Opposition MPs on the left have expressed scepticism about this effect, noting that in Sweden total costs have risen after the reforms.

Senior officials at the ministries charged with implementing the proposal have suggested that introducing freedom of choice by 2019 might prove too challenging. Other experts have claimed that under the proposal private providers will be able to cherrypick patients, taking on the young and healthy and passing on those in need of expensive specialist care to have their treatment funded by the public sector.

For now, the government says it is sticking to the timetable. The legislation will be debated by Parliament in April, but might not be put to a vote until July—well after the municipal elections. If MPs vote against the proposal, it could be back to the drawing board. Who knew healthcare could be so complicated?

Yle News is holding an election debate on 22 March starting at 2pm, during which Sote discussion will be kept to a minimum. You can watch the debate online at Yle Areena and Facebook (siirryt toiseen palveluun) from 2pm on 22 March.