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Recent report dispels myths for local authorities

Efficiency in health care through improved processes and investments and appropriate allocations.


Efficiency in health care through improved processes and investments and appropriate allocations

Accurate allocation of resources, political responsibility, quality of leadership and compatibility in practical decision making are key issues when improving health care in municipalities. A recent report indicates that a more accurate allocation of health-care investments would be more profitable and would result in improved services.

According to the report, increasing budgets and resources per se will not solve the problems in developing health care. Instead, a realistic comparison of results in collaboration between financial and operative actors will bring substantial added value both to the change management in health care and to political decision making.

Less than expected dependencies

The report dispels some of the myths in terms of the mutual interdependencies within municipal, social and health care. The report found nothing to support the belief that investments in outpatient services would automatically decrease the need for, or costs incurred by, inpatient care or that investments in care for the elderly would decrease the costs in specialist health care. Such links would appear to be much weaker than generally assumed.

It would follow from these findings that simply adding resources to the existing structures will not necessary help those in direst need of services.

The report specifically focuses on how services are produced or could be produced while keeping costs in check and simultaneously maintaining, if not improving, the quality of services. The report covers specialist health care, reception services in basic health care, dental health care and care services for the elderly. The report is the first part of the Maisema project run jointly by local authorities and Sitra’s Health Care Programme, the aim of which is to determine how to secure the provision of sufficient, high-quality statutory health-care services.

Report encourages change

The report is based on the comparison of social and health-care expenditure in the municipality of Raisio, four western municipalities of the Turku region (Naantali, Rymättylä, Merimasku, Rusko), and the regions of Vaasa and Jämsä. The method employed in compiling the report was the purchaser-provider model developed in Raisio, which enables local authorities to plan, steer, implement and monitor health-care costs. It serves simultaneously as a budget and as a financial statement, so that costs and the monitoring of the actual provision of services are genuinely connected.

Following the municipal and service structure reforms, the obligation of local authorities to provide services, on the one hand, and the alarming increase in health-care expenditure, on the other, are forcing local authorities to seek more cost-effective solutions in health care. “We are looking for practices to improve the productivity, transparency and quality of health care. This project is a success because the Western municipalities of the Turku region and the regions of Vaasa and Jämsä have been genuinely committed to testing the Raisio model and to control the expenditure on health care and care for the elderly. Willingness to change is beginning to impact upon the structural core and even upon decisions concerning service provision, ” says Ilmo Parvinen, Business Director of Sitra’s Health Care Programme.

The benefits are evident

“We set out on this project with enthusiasm, so that we could test the feasibility of our model in other municipalities. In return, we have received valuable information on how to develop the model further to make it an even better tool for purchasing and providing health-care services and for their steering. In our own municipality, the effects of the model on the quality and impact of our operations, cost-effectiveness and the fluency of processes and management have already been highly positive, ” says Eero Vaissi, Director of Social and Health Services of the City of Raisio.

“I think the model is very adaptable in other municipalities, too. By comparing municipalities, the pragmatic use of competences and appropriate resources, all parties to the project will reap the benefits of this project in a relatively short time. Based on the results of this report, the model allows the purpose to dictate the steering more than before, and the demand and/or supply is no longer allowed to rigidly influence the direction of development, leading to unpredictable cost development and operations that lack transparency, ” says Vaissi.

Sitra’s Health Care Programme is looking for new solutions to improve the standard of health services. “The report provides valuable information on how to best allocate the limited resources. Health care has long been striving towards cost savings, but instead of focusing on savings, we should pay more attention to how to get more and better services for the same money, and how to implement new ways of organising and providing services and purchaser-provider models. It is the goal of our programme to identify such practices and to spread them throughout the country, “says Hannu Hanhijärvi, Executive Director of Sitra’s Health Care Programme.

The team of consultants who wrote the report were headed by the Director of Social and Health Services, Eero Vaissi, supported by the Nordic Healthcare Group, a knowledge service provider specialised in operations management, leadership and planning in the health-care and welfare industries, and Satu Grönlund, the Head of Finance for Raision Social and Health Care Centre, and representatives of local authorities.

Further information

Ilmo Parvinen, Business Director
Tel. +358 9 352 1970

Health Care Programme
Hannu Hanhijärvi, Executive Director
Tel. +358 9 6189 9440

City of Raisio
Eero Vaissi, Director of Social and Health Services
Tel. +358 400 780729

City of Vaasa
Markku Sirviö, Medical Director
Tel. +358 40 5440575

City of Jämsä
Arto Vesala, Medical Director, Health Care Federation of Municipalities in Jämsä Region
Tel. +358 40 5146926

Publication details

Maisema: Loppuraportti Helsinki: Sitra, 2007. 110 s.
Eero Vaissi, Satu Grönlund, Nordic Healthcare Group
ISBN: 978-951-563-569-9
Download pdf (in finnish)»

Erikoissairaanhoidon liite Helsinki: Sitra, 2007. 20 s.
Download pdf (in finnish)»