The background to the occupational health system is one of the key terms in Finnishness, such as labor market organizations and the benefits achieved.
“Speciala semi-public system that is insanely inefficient, although it should probably not be said so, ”said THL Mika Salminen directly in Yle’s Korona-period financial statements.
Public money goes through a detour to provide occupational health services, and Salminen thinks that such parallel maintenance of occupational health care and public primary health care is stupid.
It came as no surprise that Salminen slipped into a sensitive place. Roihahti’s debate, in which the labor market organizations on both sides, both at the mouth of the trade union movement and employers, condemned Salminen’s view.
Wage earners are attached to a system where they receive medical care immediately with little or no hassle. Even if the employer cuts down on services from time to time, there is a bypass in the bypass rather than in the queues on the public side.
The model is also popular with employers. Employees have faster access to treatment and return to work after receiving treatment.
The responsible occupational health doctor Elis Heikkilä at Medivire’s premises in 1999. Terveystalo later bought the company.
Finland even behind the internationally unique model are the post-war health situation and inadequate public services. In the 1960s, Finland was at the forefront of coronary heart disease mortality in working-age men in the world.
The most significant health care reform of that era was the Public Health Act of 1972. The municipal medical system was dismantled and municipalities were required to establish health centers.
The private medical activities that had been created until then were not dismantled, but on the contrary, the largest Kela reimbursements were supported for a long time to come.
Originally, the idea was that people could use private services with state support because there were not enough municipal doctors everywhere.
The connection between the public and the private has also been sought to be maintained by the medical profession. The model has enabled physicians to practice in the private sector and earn more.
On occupational health was enacted by law in 1979 and was entrusted with the maintenance of working capacity. Even before the law, big employers provided services for themselves – there was a factory doctor and a mine hospital. They handled both preventive examinations and medical care.
“The system had long been evolving around occupational health care. It was the health insurance thinking that was born around large companies, ”says THL’s chief physician. Anu Niemi.
In recent decades, occupational health has become more and more general care. This has happened even though the state has tried to steer operations in a preventive direction by changing Kela compensation.
Attempts have been made to steer occupational health care in a preventive direction. The Footbalance device was tested in 2011.
Multi The health care expert has long been of the opinion that the Finnish model is problematic. Thanks to the model, Finland is among the most unequal EU countries when comparing the number of doctor visits with the income level.
Already in 2009, our health care was the fourth most unequal in the OEDC countries, after Poland, the United States and Spain. Not everyone in Finland gets the care they need.
The Finnish system, which is divided into public health centers, occupational health care and private health care supported by Kela, is unique in Europe.
The new welfare areas do not bring any fundamental changes to the model. The fort of occupational health remains intact.
How Did this happen in Finland?
“It was drifted gradually,” says the docent Liina-Kaisa Tynkkynen From the University of Tampere.
According to Tynkkynen, the distribution was not made consciously, but the system has moved to a situation where a large part of those who work receive their basic medical care services through occupational health care.
“Personally, I can’t see that a system where different groups of people are covered by different systems could be from a fair point of view. In that sense, I agree with Mika Salminen, ”says Tynkkynen.
As Finland drifted on two tracks, a vicious circle emerged. Improving services in occupational health contributed to the deterioration of public services. According to Statistics Finland, the number of doctor visits to health centers has collapsed in 20 years.
As public service deteriorates, occupational health has become increasingly responsible.
“Primary public health care is under-resourced. This has partly led to an increase in the number of employers purchasing medical care for their employees. Thus, occupational health care is also one big part of the system, for example, doctors are employed instead of being employed in primary health care, ”Tynkkynen describes.
On occupational health came as if not noticing his own institution. Chief Physician Anu Niemi points out that although the SOTE reform was delayed for a long time, the government’s programs never took a position on starting to change occupational health.
“Wage solutions are currently being considered and are said to be issues between social partners that cannot be addressed. Occupational health is in a similar position, ”Niemi describes.
The Finnish healthcare model became such largely thanks to the trade union movement and employers’ organizations.
“When development started for these gangs, it has been thought that a solution has been made. There has been a lack of courage to change direction, ”says Niemi.
There has been no political will to dismantle the system. The majority of voters have been satisfied users of occupational health services, so no party should take the risk of annoying them.
“Because a large portion of the working population, which is often also healthier than average, uses occupational health care services, there is no political pressure to rehabilitate primary health care resources. Many decision-makers also enjoy the health care services of occupational health care, ”says Liina-Kaisa Tynkkynen.
At the same time, there has been a lack of political pressure on public services. Resourcing them has not been seen as important enough – however, for the majority of the population, basic services are in order on the side of occupational health.
Health examinations are part of occupational health care.
By Europeans The special system is one of the reasons why Finland has drifted into public services. In Finland as a whole, less money is spent on health care than in the other Nordic countries.
The price of cheapness has been inequality. How has elsewhere been more successful in this regard?
“Of course, other countries have an occupational health care system, but the Finnish model differs in that occupational health care includes this outpatient care block,” says Tynkkynen.
For example, in the other Nordic countries, medical care has not been provided in the same way as in Finland. However, there have been recent developments in the direction of the Finnish model, as the number of private insurance policies taken out by employers for their employees has increased. According to Tynkkynen, development has still been rather slow.
In Germany, health care is covered by social insurance. An insurance premium is paid on the salary, which finances a scheme that covers all citizens. In the United States, the employer decides what health services an employee can receive.
In Denmark, Norway and England, doctors are self-employed with a contract with a funder. The doctor is often familiar and knows the patients and their families well.
Exercise may be part of occupational health services.
The Finnish health center model is in itself advanced in EU comparison. However, the weakness of the system is precisely in the health centers.
Occupational health care is largely funded by employers. The employer applies to Kela for part of the costs, which are financed by employment income insurance. It is paid for by both employees and employers.
Employees pay for their unpaid visits in the form of their pay and perhaps also in the form of lower pay. If there were no benefit, wages could be higher.
Although the state pays little directly, it is a question of national resources and their rational use. The contradiction is that in occupational health, a basic runny nose is shown to a doctor when a similar ailment at a public health center is treated at the nurse’s office.
“One may ask if it adds value to public health. Could we think of partnerships so that the public side has common doctors with occupational health care, ”Niemi ponders.
Tynkkynen emphasizes that at the moment, dismantling the model would be impossible. Lack of resources in public primary health care.
In principle, just as Finland drifted into its current model, it could drift away from it.
“However, there are strong interests and gains in the background for both employers and employees, as well as for a wide range of voters,” says Tynkkynen.
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