Finland: #16 in the 2022 World Index of Healthcare Innovation
Finland aggressively restricts patient access and choice but ranks among the better socialized systems in quality.
By Gregg Girvan, Grant Rigney, and Avik Roy
Introduction
Finland ranked 16th overall in the 2022 World Index of Healthcare Innovation, up from 21st in 2021 and 23rd in 2020. Finland’s strongest performance came in Quality (7th), mainly due to improvements in multiple measures of patient-centered care (1st). Nevertheless, Finland ranked second-to-last for Choice (31st), owing to its stringent restrictions on patient access to providers. Subsequently, long wait times and high levels of cost-sharing are common in the Finnish health system.
Background
Finland has a socialized but decentralized system financed in a fragmented manner — with municipalities, health insurers, employers, and families each paying for a portion of healthcare. Out-of-pocket payments comprise over 20 percent of health expenditures, and the four most significant areas of health spending are outpatient care (35 percent), inpatient care (21 percent), long-term care (17 percent), and pharmaceuticals (12 percent). Outpatient care, long-term care, and pharmaceuticals comprise two-thirds of all out-of-pocket payments.
Most hospitals and healthcare facilities are publicly owned, with only a small number of privately or jointly owned hospitals. Finland’s public hospital network includes 16 central and five university hospitals owned by 20 hospital districts (i.e., federations of municipalities). As in the United States, a wave of hospital closures and mergers has significantly reduced the number of facilities since 2000.
Over the last three decades, life expectancy in Finland increased by five 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 significant problem.
Quality
Finland’s overall quality ranked 7th, with low rankings in the elements for measures of preventable disease (17th) and infrastructure (19th). However, Finland’s scores rose significantly in patient-centered care, soaring to 1st from 28th in 2021. This dramatic improvement stems mainly from decreased waiting times to see doctors, increased levels of patient-provider transparency, and higher levels of patient safety.
Choice
Despite Finland’s successes in other realms, it ranked second-to-last in Choice. Under its socialized healthcare system, the freedom to choose healthcare services was nearly nonexistent and resulted in a 32nd ranking in freedom to choose healthcare services. Furthermore, Finland ranked 9th and 18th, respectively, in the elements affordability of health insurance and access to new treatments.
Science & Technology
Finland ranked 12th for Science and Technology. Notably, Finland’s national adoption of electronic health records (EHR) was laudable, ranking 5th in health digitization. Scandinavian neighbors Sweden and Denmark also excelled in EHR adoption. Moreover, Finland’s innovation remained above the median, ranking 11th in medical advances despite ranking 17th in scientific discoveries.
Fiscal Sustainability
Fiscal Sustainability remained a difficult dimension for Finland’s healthcare system, ranking 20th. While its debt-to-GDP ratio ranked slightly above the median — coming in at 18th in national solvency — its Public Healthcare Spending was near the bottom third of countries (22nd). However, Finland’s growth of public health spending improved in 2022 and ranked in the top third of countries at 10th.
