The Finnish Health Care System: A Value-Based Perspective

Michael E. Porter, Bishop William Lawrence University Professor, Harvard Business School
Juha Teperi, Medical doctor and health services researcher at the University of Helsinki
Lauri Vuorenkoski, senior researcher at Finland National Institute for Health and Welfare (THL)
Jennifer F. Baron, Senior Researcher, Institute for Strategy and Competitiveness, Harvard Business School
The Sitra Reports - Helsinki 2009

Available online as PDF file [117p.] at:
http://www.isc.hbs.edu/pdf/Finnish_Health_Care_System_SITRA2009.pdf

“….This report applies a value-based framework of health care delivery in order to provide a holistic view of the current state of Finnish health care. This report consists of three parts. Section 2 presents a brief overview of the general principles of value-based care delivery. Sections 3 to 7 then utilize these principles to analyze the Finnish health care system as it looks today. While the text aims to cover the essential features of the Finnish system, special attention is paid to aspects that are crucial from a value-based perspective. Finally, Section 8 proposes a set of general conclusions and recommendations for Finland….”

“……..In only a few decades, Finnish health care has developed from a somewhat rudimentary health care system into one that is internationally acclaimed. Every permanent resident in the sparsely populated country has access to an extensive set of services, yet total per capita health care costs remain lower than in most comparable countries. Despite recent concerns about equity issues, Finns are generally very satisfied with their health care services.

However, as in any country, Finland cannot rest on its laurels. Advancing medical science raises a new bar for quality in terms of the outcomes achieved in the treatment of illness. An aging population and rising public expectations threaten to increase costs and impede timely access to care, thus jeopardizing sustainability.

One challenge in particular, the aging Finnish workforce, affects not only patient demographics but also the availability of clinicians. The upcoming wave of retiring health care professionals will occur at just the time when Finland will need more of them. To overcome these challenges, every health care system will have to use its resources more effectively; the achievements of past decades are to be maintained and built upon. Access and equity will remain necessary characteristics
of optimal health care systems, but they are insufficient goals in terms of improving quality and achieving financial sustainability.

Instead, the value created by the system as a whole must be continuously improved; for each euro spent, more health needs to be achieved. The large variations in health care quality and costs have been described and documented in many advanced economies, signaling a lack of consensus concerning best practices, not only in individual care processes but also in the organization of care delivery itself. Finnish researchers, for example, have shown that outcomes like disease-specific mortality rates vary across and even within providers in a way that cannot be explained by the severity of the condition or other initial patient conditions…..”

Content:

I Introduction

II Principles of value-based delivery
The fundamental goal is value for patients
The only way to truly contain cost and increase value is to improve health outcomes
Care should be organized around medical conditions over the full cycle of care
Value is increased by provider experience, scale, and learning at the medical condition level
Value must be universally measured and reported 3
Reimbursement should be aligned with value and reward innovation
Competition should occur for patients based on value, while encouraging the restructuring of care
Electronic medical records must enable the restructuring of care delivery, support integrated care and produce outcome measures
Health plans or funding agencies should contribute to value, rather than act as passive payers

III Overview of the Finnish health care system

IV Access and standards for coverage
Municipal health care system
National health insurance system
Private insurance
Occupational health care system
Assessment

V Structure of health care delivery
Providers
Employers
Patients
Suppliers
Clinical guidelines

VI Health information technology
Assessment

VII Results measurement
Use of measurement data in health care management Assessment

VIII Overall assessment and recommendations
Intensify outcome measurement and link it to incentives and management
Create integrated practice units
Strengthen primary health care
Create true health plans
Reimburse full cycles of care
Increase value by service consolidation combined with competition
Encourage innovation in care delivery and its structures
Invest in health information technology
Increase the role of patients in health care
Moving to action

References