Finland: #23 in the 2020 World Index of Healthcare Innovation
Finland aggressively restricts patient access and choice, but ranks among the better socialized systems in quality.
By Gregg Girvan, Mark Dornauer, and Avik Roy
Introduction
Finland ranked 23rd overall in the World Index of Healthcare Innovation with a score of 43.65. Finland performed best in Science & Technology (46.78, #9), thanks to its world-leading adoption of electronic health records. On the other hand, Finland ranked dead last in Choice (27.20, #31) owing to its stringent restrictions on patient access and choice. Long waiting times and high levels of cost-sharing are the norm.
Over the last three decades, life expectancy in Finland increased by 5 years, as care for chronic conditions improved alongside prevention and treatment programs. Alcohol consumption and smoking remain major health concerns, and obesity rates continue to rise. While Finland spends less on health than other Scandinavian countries, growth in health spending remains a major problem.
Background
Finland has a socialized but decentralized system that is financed in a fragmented fashion, with municipalities, health insurers, employers, and families all paying for a portion of health care.
Out-of-pocket payments comprise over 20% of health expenditures. The four largest areas of health spending are outpatient care (33%), inpatient care (25%), long-term care (19%), and pharmaceuticals (12%). Three of these four categories — outpatient care, long-term care, and pharmaceuticals — comprise two-thirds of all out-of-pocket payments.
Most hospitals and health care facilities are publicly owned, with only a small number of privately or jointly owned hospitals. Finland’s public hospital network includes 15 central and five university hospitals owned by the 20 hospital districts (federations of municipalities). As in the United States, a wave of hospital closures and mergers has significantly reduced the number of facilities since 2000.
Quality
Finland’s overall quality ranked 22nd, with low rankings in patient-centered customer service (28th) and measures of preventable disease (23rd). However, Finland boasts a relatively modern hospital infrastructure, ranking it 4th overall.
Choice
Despite Finland’s successes in other realms, it ranked last in WIHI’s overall choice metric. Under its socialized model, the freedom to choose health care services was nearly nonexistent, rendering a 31 of 31 ranking, and largely contributing to its overall number. The affordability of health insurance and access to medical technology services ranked 18th and 15th in the WIHI analysis, respectively.
Science & Technology
Finland ranks within the top third for overall science and technological innovation at 9th. Most notably, Finland’s nationwide adoption of EHRs was outstanding, ranking 1st. What’s more, Finland’s medical and scientific innovation remained in the top third, at 10th and 9th, respectively. Of note, other Scandinavian countries — e.g. Sweden and Denmark — proved exceptional in implementing EHR adoption nationwide.
Fiscal Sustainability
Fiscal sustainability remains an issue for Finland’s health system, which is reflected in its ranking of 21st. While its debt-to-GDP ratio ranked it at the median (15th), its public health spending per capita ranked 21st, while Finland’s growth of health spending as a share of GDP over the last ten years ranked 18th.
