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A new perspective for improving Finnish health care

In his presentation “Redefining health care”, Professor Michael E. Porter, Harvard Business School, stressed a number of key issues in improving the health care system in Finland.

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“A new perspective for improving Finnish health care” a decision-maker event, arranged at Finlandia House in Helsinki on 2 October 2008, gather together over four hundred key visionaries, players and decision-makers in health care to outline the necessary future changes in health care structures and services.

In his presentaiton “Redefining health care”, Professor Michael E. Porter, Harvard Business School, stressed a number of key issues in improving the health care system in Finland.

Value creation

– When improving health care, it is essential that all actors’ interests and incentives are aligned around value creation for patients. The health value is defined as health outcomes achieved per unit of cost. Costs themselves are often the focus of health care reform, but high costs are symptoms of the underlying rather than the problem itself. Ultimately value in health care will be determined by patient health outcomes. And the best way to reduce health cost okver time is to improve patient outcomes, says Professor Porter.

Strengthening treatment equality and free provider choice

Professor Porter also emphasises citizens’ equality and freedom of choice when selecting health care services. The availability of health care is not enough, and finding treatment does not necessarily guarantee high-quality treatment and the best possible health value.

– All citizens must have free provider choice and access to the highest-quality care. This leads to a situation where the best service providers grow and improve further, which drives up value in the system, says Professor Porter.

According to Professor Porter, the Finnish “personal doctor” model is good for the continuity of primary care, but does not support the customer’s freedom to choose the highest-quality care.

Improving structures and measurement

– Delivery should be reorganised to integrate services into integrated practice units that manage the full care cycle, including prevention, ongoing disease management and follow-up care. In practice, service providers would supply all of the services needed to treat a particular medical condition (and its most common co-occurrences) in a single “integrated practice unit”. While some single disease Centers of Excellence are examples of the “integrated practice unit” model, most providers (e.g. hospitals) would operate multiple “integrated practice units”, says Professor Porter.

– The evaluation of care effectiveness should also be standardised and expanded to cover all actors in health care. Result measurement efforts should expand from productivity and cost measures to also include short- and long-term health outcomes. The results should be measured over the full cycle of care, not just for individual interventions or particular types of providers, points out Professor Porter.

Many countries share the same challenges

– Countries with universal access to care often face many of the same problems as those that have uninsured citizens. Fragmentation of care delivery and reimbursement that rewards volume of services, not health, will lead to uneven quality and high and rising costs, says Professor Porter.

– Improving the Finnish health care system requires entirely new approaches. “The maintenance and development of high-quality and customer-oriented services also require that the health care actors’ tasks and responsibilities and priorities are redefined in an open-minded way. When the care outcome begins to steer operations, we already have the correct direction, says Hannu Hanhijärvi, Executive Director, Sitra Health Care Programme.

Health value for the Finnish health care system

Juha Teperi, Programme Director, Ministry of Social Affairs and Health, linked Professor Porter’s health value model to Finnish circumstances.

– Finland is surely one of the world’s leading countries when it comes to compiling health data. The functionality of health care is monitored through the costs it causes, and the costs are often individual. However, the whole should be examined with respect to how much total health value is being created,” says Teperi.

– Health centres are an example of a well-functioning system that provides value. However, their problem is that they face continuous financial stress, which is partly due to the difficult funding system. Health centres are key players, and their functionality is a precondition for a well-functioning health care system. Well-functioning health centres emphasise preventive work, coordinate the care given by different units, avoid the care of non-medical problems by means of health care, and support individual coping at home,” continues Teperi.

According to Porter’s model, health value can also be improved through specialisation and competition. In addition, the customer’s role and position as a maintainer of personal health and as a service user has to be supported.

– In Finland, customer volumes are simply so low that all kinds of services cannot be provided everybody. Customer’s benefit and the right to receive the highest-quality care in special health care is best implemented through specialisation and service centralisation, says Teperi.

– In Finland, competition is often unilaterally considered as competitive bidding or privatisation when it should be more about competing on health outcomes and involve both public and private service providers. If health outcomes are not the first priority, and each organisation is only evaluated on the basis of the costs established, the easy way out is to transfer costs from one location to another.

Further information
Sitra, Health Care Programme
Hannu Hanhijärvi, Executive Director, tel. +358 9 6189 9440, firstname.lastname@sitra.fi

Ministry of Social Affairs and Health
Juha Teperi, Programme Director, tel. +358 9 160 72414, firstname.lastname@stm.fi

Web cast of the seminar as of 3 October 2008 »

Speakers »

Additional recommendations will be included in a forthcoming report schedyked to be completed at the end of 2008. The report is being prepared by Dr. Juha Teperi and Dr. Lauri Vuorenkoski with Professor Porter and Jennifer Baron, Senior Researcher at the Institute for Strategy and Competitiveness at Harvard Business School.

Further background on Professor Porter’s health care work, including recent publications, presentations and press coverage, can be found on the Institute for Strategy and Competitiveness website at http://www.isc.hbs.edu/

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