Gp in Europe

                                       
Finland

Organisation and objectives: 
Financing of the healthcare is based on taxation:

    • the target is equality;

    • the availability of services should be equal;

    • not depending on domicile;

    • not depending on social status of solvency.

Based on legislation and statutes and degrees
The communities and local authorities have the main responsibility for organising the services. The decision-making is based mostly on the local self-government, which, however, is directed and guided by laws and statutes, considering the resources available.

Legislation
The Common healthcare Act from 1972 defines the services of primary and basic healthcare. The act of specialised healthcare decides on the hospital system, which includes 21 central hospital districts and the Helsinki University teaching hospital. The act of specialised care defines also to which hospital district every community has to belong.

Basic organisations
In Finland there are about 450 communities. There are 258 health centres as organisations of one or more communities. About 3,400 doctors, 58 per cent of whom are women, are working there. They are mainly employed as health centre general practitioners (GPs), 1,060 of them have the speciality of general medicine. One thousand, three hundred doctors are working as family doctors meaning that they have their own population responsibility additionally to other health centre functions. The patient pays to the community as fee for service 0-150 FM a year depending on the decision of the community.

Definition of tasks
The community can produce the basic services itself by employing the personnel, or together with other communities. The health centres financed by the communities or federations of communities are producing the health services.According to the Common healthcare Act 1972 the communities are responsible for producing the following services.According to the Common healthcare Act 1972 the communities are responsible for producing the following services:

• the preventive functions are basic in the primary healthcare and that is provided by our guidance centres or clinics together with the consulting and surgery functions of the GPs. We have special clinics for the maternity care, childcare and contraceptive clinics. Also many kinds of health inspections belong to the field of basic healthcare. In the health clinics the specialised nurses work together with GPs;

• the health centre provides the inhabitants of the community with medical nursing services including the surgery of GP,lab and x-ray. In the health centres there are also beds mainly for geriatric care. Mainly it is GP level, although in part of the country the basic healthcare also produces some special hospital care. The care can also be provided for the people as home care, when there is a home care nurse helping the GP;

•the rehabilitation services and the providing rehabilitation instruments belong to the functions of basic healthcare;

•mental health services can also be included in the functions of the GPs, the medical director of the health centre has the responsibility of compulsory care of the mentally ill patients;

• the medical rescue functions are also included in the ambulance services of the communities. They can produce these services themselves or buying them by any private providers;

•the health centre organises the school healthcare and the student healthcare;

•the health centre organises mass screening and mass health inspections;the health centre organises the GP level acute services around the clock.

 

Relations to specialised care
The specialised care usually needs a referral from the doctor, either from the public GP or a private doctor. But in fact many patients go to the specialised hospital care without a referral through the first aid clinic or just phoning. The healthcare GP can refer the patient to his or her own area's central hospital or in special cases to other hospitals if the patient has made or arranged financial obligation agreement with the community.

Future
The basic or primary healthcare will be strengthened and it has been seen also at the political level as a possibility to control the economic situation. There are trends emphasising the scaling and the differentiation of the care and agreement of healthcare systems within districts. It is also allowed to buy a special are consultations from private doctors and the aspect of competition has been emphasised recently. There have been attempts to prohibit the increasing costs of healthcare and the trend is recently more towards open care. The family doctors have been seen as an answer to this. On every level the co-operation between basic healthcare, specialised care and the social workers will be clarified and in future the family doctor has better possibilities to follow up the patient also while in specialised care and also to influence the money flow which is going with the patient.

 

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