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HELSINKI, Finland: A healthcare reform will replace present healthcare and social services in Finland, which are centred on public provision, with a market-oriented system which will enhance competition between public and private sectors. A recent study aims at ascertaining what public dental service (PDS) changes are anticipated by personnel and how dental services in the new county-owned public undertakings could be made more cost-efficient.
According to a government proposal, the former health administrative offices in the old system will become purchasers. Also, freedom of choice between public and private services is planned. Hospitals and primary health services may become semi-autonomous trusts that sell their services and compete with the private sector for contracts with purchasers. This will also apply to dental care.
To find out whether the personnel working in the PDS were aware of coming changes in their work environment and what kind of changes they anticipated, 12 PDS units out of an existing 90 in northern and southern Finland were randomly selected. A total of 438 personnel were contacted in the autumn of 2016. The 311 respondents included 129 dentists, 61 dental hygienists and 121 dental assistants. This was 71 per cent of the total number of personnel in the 12 clinics.
All categories of personnel in the health services anticipate great changes in their work in the future. Results from a questionnaire study conducted by the Finnish Nurses Association among their members showed that few respondents believed that the reform would fulfil its goals. Only 21 per cent felt the changes would improve access to care, and 17 per cent believed the proposed changes would inhibit cost increases. Most respondents (87 per cent) thought that free choice between public and private treatment providers would create new problems and 58 per cent believed that the reform would lead to fewer job openings.
Overall, dental personnel expected major changes in their working conditions, especially in southern Finland, where the private sector has a greater market share than in the northern parts of the country. Dentists and dental hygienists seemed to be more aware of possible market-oriented changes than dental assistants were. Public sector employees seemed to have little understanding of how the work could be made more cost-efficient and were thus poorly prepared for increased competition with the private sector.
Historically, a municipal school dental service offering free, tax-financed dental service for schoolchildren started the PDS in Finland in 1956. In 2002, all age groups were given access to the PDS. Alternatively, adults could use the more expensive private sector dental services partially reimbursed by the Social Insurance Institution.
The planned reform is the most extensive to take place in Finnish healthcare in 50 years, and it follows the international policy movement towards marketing and competition as a way of challenging the public services, which today are often regarded as inefficient, unresponsive and politically outdated. In 2015, the government proposed the establishment of 18 counties and the transfer of responsibility for the organisation of healthcare and social services from the almost 200 existing municipalities to the new counties. This change was planned to commence in July 2017 and to be finalised by 1 January 2019. However, both the establishment of the county councils and the change of responsibility for providing service have been postponed to January 2021.
Of the personnel presently working in the PDS, 47 per cent of the 4,200 dentists and 60 per cent of the 1,700 dental hygienists and 3,000 dental assistants are currently working as a salaried workforce. In the reform, their work contracts will be cancelled, and they will have to find new employment in the regional county council limited companies or in private companies, or they will have to start their own businesses. This means that thousands of dental professionals are at risk and need to prepare themselves for a changed work environment.
Reasons for the reform include rural–urban migration and many of the municipalities having become too small to administer health and social services. In addition, care and service needs have changed as the proportion of the elderly in the population has increased.
The study, titled “Public Dental Service personnel facing a major health care reform in Finland”, was published online on 11 April 2019 in BDJ Open.
Editorial note: Finland's entire government has resigned over its failure to achieve a key policy goal on social welfare and healthcare reform. The announcement was made by Prime Minister Juha Sipila on Friday 3 May 2019, as reported by the BBC.
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