Municipal leaders and decision-makers of Helsinki, Espoo and Vantaa are pressing hard for changes to the government's planned reform of social and health care, known as 'sote', as the full scale of funding cuts in the country's most populous region becomes clear.
Some 300 million euros in spending cuts are projected in the government's preferred model, which aims to expand competition and private provision in healthcare while simultaneously transferring responsibility for it from municipalities to newly-created regional governments to be elected this year.
”This kind of planned overhaul is not good. People haven't understood all the risks [involved],” said Juha Metso, Espoo's director of basic social services.
Markus Syrjäinen, Espoo city council's Director of Finance and Administration, produced figures this week projecting that the Uusimaa province, which includes the Helsinki area, will face a 300-million-euro shortfall in the first year of the new system.
The figure includes transitional expenses that would accompany the shift away from municipal responsibility for providing health care. Another portion is made up of the increasing demand for services by an ageing population. As thousands of new residents flock to the Helsinki region each year, health and social care provision must grow in proportion.
Leaders in the Helsinki metropolitan area have said that such transitional costs had not been taken into account in calculations made by the Ministry of Finance.
Hunting for cuts
Leading the rebellion is Jan Vapaavuori, the National Coalition Party Mayor of Helsinki who has declared trenchant opposition to the reform advanced by the government coalition that includes his own party. Vapaavuori's power base is strong, with some 30,000 people voting for him in the last municipal elections, and his party includes other critics of the reform including liberal-minded MP Elina Lepomäki.
Their critique is two-pronged. The new regional governments, which are dear to the rural Centre Party, have no tax-raising powers and therefore no incentive to reduce costs. Private providers, meanwhile, could be incentivised to cherry-pick young, healthy customers and leaver the older, sicker and more expensive patients for public providers to pick up.
The chunk of money cut from budgets in the Uusimaa region will be the most substantial due to its population of 1.6 million--nearly a third of the total population of Finland.
Municipal leaders interviewed by Yle estimate that of the 300-million-euro deficit that Uusimaa will face, Helsinki will have to cough up 100 million euros per year, Espoo 50 million, and Vantaa 40 million euros. The remainder would be left for the rest of Uusimaa to come up with.
”Losing 100 million euros per year in Helsinki would be equivalent to giving up child protection services in its entirety. That gives you an idea of the scale that we are talking about,” says Helsinki deputy mayor Sanna Vesikansa.
According to the Helsinki-Uusimaa Regional Council, the financial deficit would decrease over time, but not by much. In 2030 the deficit would still be 100 million euros for the entire Uusimaa region.
The Helsinki-Uusimaa Regional Council have agreed with government officials that weekly negotiations will be held to thrash out funding issues. In addition, the leaders of the Helsinki Metropolitan Area said the transition should be carried out with patience and in baby steps.
”This should be done in the same manner as the primary education reform was done back in the day. Start from small provinces and proceed step by step,” said Ritva Viljanen, mayor of Vantaa.