Helsinki (02.12.2015 - Heikki Jokinen) The Government finally outlined its plans on the long-debated social welfare and health care reform in November. The decision to divide the country into 18 autonomous health care regions will mean transferring more than 200,000 employees to new employers.

”The specialists were not heard. The number of regions is too big to reach the goals of citizens' equal high-quality services, bridge the gap in health differences and have better cost effectiveness”, says Rauno Vesivalo, Chairperson of Tehy - The Union of Health and Social Care Professionals in Finland. He is disappointed by the decision.

”We are very worried about the costs, too”, Vesivalo says. A smaller number of regions would have secured a reasonable division of work and made it easier to coordinate work between the regions, Vesivalo says.

The decision process almost brought down the Government. The main parties of the right-wing coalition Government disagreed on the number of autonomous health care regions that should be established.

In the end, they decided to have 18 regions and also open up public health care to widespread participation by private health operators.

The big number of regions is a victory for Prime Minister Sipiläs Centre Party, which is strong outside the major cities. Opening the doors to private operators is also a great victory for the National Coalition Party which advocates the privatisation of public services.

Private health care in Finland is not run by traditional family doctors, but mainly by large companies mostly owned by international capital funds based in tax havens.

Creating a third level of administration

Currently, health care is the responsibility of joint municipal authorities and local authorities. There are now some 190 of them. From the beginning of 2019 responsibility will rest with the 18 regions, of which 15 will organise health care and social services in their own areas separately or by themselves. Three regions will do this with the support of one of the other regions.

As the 18 regions will also take on other areas of responsibility, public administration in Finland will now be organised on a three-tier level: central government, autonomous regions, local government.

Each of the autonomous regions will get their own decision-making council, elected by direct vote.

The regions will be obliged to carry out other administrative tasks and services, too. ”Rescue services, regional council duties, the duties of the Centres for Economic Development, Transport and the Environment within the scope of regional development, and possibly also environmental health care”, informs the Government.

Employees must be involved

Trade unions are worried about the effects the new system will have on employees in social welfare and health care. Rauno Vesivalo is demanding that the impact of such changes on staff in these sectors must be assessed and clarified before any final decisions are reached.

”As savings won’t come from reforming structures, there is a danger that savings are again being sought at the expense of employees. This can not be the case. This reform can not be accomplished without well-trained social welfare and health care employees.”

Tehy chairperson Vesivalo says that the decision to open up public health care to private operators has to be clarified thoroughly before executing it. There are still many open questions.

Chairperson of the Trade Union for the Public and Welfare Sectors JHL, Jarkko Eloranta issued a clear assessment on the reform measures at the JHL Council meeting.

”The Centre party got their regional model and the Coalition Party their freedom of choice. What the patient, taxpayer or employee will get, is still fully a puzzle.”

For JHL the major issue is the employees, their transfer to new employers and what their new terms of employment are to be.

Eloranta insists that cooperation with employees must begin immediately. It is essential that more time be allowed, more information be forthcoming and more options available if the transfer is to proceed smoothly.