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Purchaser-provider model alleviates cost pressures in health care

Purchaser-provider model alleviates cost pressures in health care. Maisema survey gave an overview of the health care services in the municipalities in the Mikkeli region and differences in operations and expenditure.


Mikkeli region social and health expenditure analysed

A so-called Maisema survey, conducted in the Mikkeli region, gave an overview of the health care services in the municipalities in the region and differences in operations and expenditure. A comparison between nine municipalities shed light on their respective cost structures. The model employed in the survey has proven a feasible tool for analysing and steering the service structure in both individual municipalities and entire regions.

The Maisema survey concentrated on how and at what cost nursing and care services, doctors’ and dentists’ surgeries as well as mental health and substance abuse services were organised in different municipalities. The survey involved the relevant authorities in the municipalities of the Mikkeli region – Mikkeli, Hirvensalmi, Kangasniemi, Mäntyharju, Pertunmaa, Pieksänmäki, Puumala, Ristiina, Suomenniemi – as well as the Etelä-Savo Hospital District, and Sitra.

The survey revealed substantial differences in expenditure which might not be entirely explained by variation in age structure or morbidity. The biggest differences were detected in the cost of nursing and care services and specialist health care. Nursing and care services vary from €6,900 to €9,400 for those over 75 years, depending on the municipality.

The report also provides methods for keeping health care expenditure in check, while providing services of similar or even higher standard. Such information is vital for local authorities who, following the restructuring of municipal services, are seeking ways to fulfil their statutory obligations to offer services that are sufficient in quantity and quality.

– The survey provided information on the aspects of health care which can still be optimised, says Kimmo Mikander, Mayor of the City of Mikkeli. At the same time, we also saw examples of models that are already running smoothly. The report will shape our social and health care strategy and provides the necessary background facts when planning the activities of the region.

According to the report, the City of Mikkeli could further streamline its health care operations to save €15 million. Similar savings could be achieved in the other municipalities in the region through optimising services.

– A specific allocation of costs, reviewing processes and investment of resources while increasing transparency and adopting new forms of co-operation are now paramount in the development of health care, says Mikander. Here in Mikkeli we are already highly committed to complete the next stage of the project, which involves change management.

The model employed for compiling the operative and financial data for the report was the purchaser-provider model developed in the municipality of Raisio, which enables local authorities to plan, steer, implement, and monitor health care costs.

– The advantage of the model is that it allows the analysis of service provision as a whole, and will reveal if, for example, savings in one area only really mean multiplied costs in another, says Eero Vaissi, Director of Social and Health Services for Raisio and coordinator of the consultant team for the project. The model enables genuine steering and management of service provision and rapid response to any distortions there may be in the structure, which usually is the main cause of cost overruns. In the Maisema project, the ‘Raisio model’ was complemented by a new way of benchmarking the region’s municipalities, so price comparisons could also be made between the operative and financial impact of service structures.

The Maisema project is at the core of Sitra’s Health Care Programme activities.
Says Hannu Hanhijärvi, Executive Director of the programme:
– Our earlier positive experience with the viability of the Maisema project was repeated, this time in the Mikkeli region. Thanks to the project, we will be able to obtain reliable information on how the productivity, transparency, and quality of health care can be improved in practice. It is very rewarding to see how willingness to change is beginning to reach the structural core and even decisions concerning provision.

The team of consultants who wrote the report were headed by Eero Vaissi, Director of Social and Health Services, supported by the Nordic Healthcare Group, and Satu Grönlund, the Head of Finance for Raisio Social and Health Care Centre, and representatives of the hospital district and local authorities.

Further information

Kimmo Mikander, Mayor, tel. (015) 194 2000, 044 794 2000,
Maria Närhinen, Manager of social- and health care services, tel. 044 794 4200,

Other Mikkeli region municipalities
Directors of basic services and social affairs in these municipalities

Maisema project Survey
Eero Vaissi, Director of Social and Health Services, tel. +358 400 780729,
The report is published at Sitras web site in Finnish »
Mikkelin seudun maisema 1 hanke
Nordic Healthcare Group
E. Vaissi, S. Grönlund, H. Hietala
Helsinki: Sitra, 2008, 141 s., ISBN 978-951-563-606-5

Ilmo Parvinen, Business Director, Sitra, tel. +358 50 352 1970,
Hannu Hanhijärvi, Executive Director, Sitra, tel. (09) 6189 9440,

What is the Raisio purchaser-provider applied in the Maisema project ?