Finland: #21 in the 2021 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 21st overall in the 2021 WIHI Analysis — up two spots from its inaugural 2020 ranking. Like last year, Finland performed best in the WIHI Dimension for Science & Technology (9th), mainly due to its (near) world-leading adoption of electronic health records (calculated in the WIHI Element “IT”). Nevertheless, Finland ranked last in the WIHI Dimension 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 health care. Out-of-pocket payments comprise over 20 percent of health expenditures, and the four most significant areas of health spending are outpatient care (33 percent), inpatient care (25 percent), long-term care (19 percent), and pharmaceuticals (12 percent). 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 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 17th, with low rankings in the WIHI Elements for Patient-centered Care (28th) and measures of preventable disease (22nd). However, Finland boasts a modern hospital infrastructure, ranking 4th in the corresponding WIHI Element.
Choice
Despite Finland’s successes in other realms, it ranked last in WIHI’s Dimension for Choice. Under its socialized health care system, the freedom to choose health care services was nearly nonexistent, and in effect, rendered a 31st ranking in the WIHI Element for the “Freedom to Choose Health Care Services.” Furthermore, Finland ranked 11th and 17th, respectively, in the Elements “Affordability of Health Insurance” and “Access to New Treatments.”
Science & Technology
Finland ranked 9th in the WIHI Dimension for Science & Technology. Notably, Finland’s national adoption of EHRs was outstanding, ranking 2nd in the WIHI Element “IT.” What’s more, Finland’s medical and scientific innovation remained above the median, with 12th and 11th place standings in the Elements “Medical Advances” and “Scientific Discoveries,” respectively. Interestingly, other Scandinavian countries — e.g., Sweden and Denmark — also excelled in EHR adoption. Overall, Finland ranked in the top third for global contributions to scientific and technological innovations.
Fiscal Sustainability
Fiscal sustainability remained an issue for Finland’s health care system, as it ranked 22nd in the WIHI Dimension. While its debt-to-GDP ratio ranked at the median (calculated in the WIHI Element “National Solvency” at 16th), its public health spending per capita stood near the bottom third of countries (assessed in the Element “Public Health Care Spending” at 21st). Moreover, Finland’s growth of health spending as a share of GDP over the last ten years ranked it below the median at 18th (accounted for in the Element “Growth in Public Health Spending).
