In this slideshow, Professor Erkki Vauramo, Researcher and Professor, Aalto University, Finland, explores the issues facing Finland’s primary care and asks if they need a new network model for organising regional care. Professor Vauramo spoke at the Nuffield Trust European Summit 2014, which was supported by KPMG.

1. New Paradigm for organizing
regional care –
a network model?
Erkki Vauramo
Professor
Aalto University,
Department of Architecture
Research Institute for Health Care Facilities

2. OECD Health data 2013
Total social and healthcare employment and
hospital beds /1 000 inhabitants
Orientation: Open care
Orientation: Institutional care
Norway
Employees / 1000 inhabitants
97
Denmark
87
Netherlands
Sweden
77
Iceland
United Kingdom
67
United States
57
Finland
Switzerland
Australia
Luxembourg
Germany
Belgium
Ireland
47
Austria
Israel
37
France
Portugal
Spain
Italy
27
Estonia
Greece
Chile
17
Czech Republic
Slovak Republik
Hungary
Korea
Slovenia
Mexico
Turkey
7
1.5
2.5
3.5
4.5
5.5
6.5
Hospital beds / 1 000 inhabitants
7.5
8.5
9.5

3. Ageing population and available resources
Finland 2014 -2040
250
Population 75+
Maximum taxation
200
Number of
Number od deaths
Year 2014 =100
Need of Social Care
Taxation per one 75
Taxatio per one 75+ +
150
Need of Health Care
Taxation per one death
100
50
0
2014
2020
2025
2030
2035
2040

4. Driving force: difficulties in Primary care
Planned in 1972
To day
Perspective
Primary care hospital: 3
beds/1000 inhabitants
Acute 1 bed, long term 2 beds
/ 1000
Long term beds will closed, system
under evaluation
Local ambulance service
Organized by Central Hospital Acute patient flow and triage
controlled by special care hospital
Emergency 24 h local
24h/7d in central hospitals,
only easy cases during office
hours in primary care
Imaging, local
Controlled by central hospital
Laboratory, local
Controlled by central hospital
Adult open care; 2-2,5
doctor visits per person
Lack of physicians, from 1,8
visits to 1,3 per person
Competition of MDs with insurance
based adult clinics
Acute care, Disease
management
Children and elderly care
Chronic disease management
Increasing consultations from
special care
Preventive medicine
Realization by primary care
Planning is coordinated by central
hospital district
No acute cases in primary care,
focus on children and elderly
Is special care all-embracing primary care close to death ?

5. New Health Care Act
Objective:
To integrate special care, primary care and social care services under
one regional management and create one funding mechanism
New structure for 5,5 million people and 330 000 km2:
Social and Health Care integrated into 65 districts
Districts with Acute Care Hospitals 18, over 80 000 inhabits
Districts with limited Special Care Hospital (geriatric,
rehabilitation), over 50 000 inhabitants
Districts with local Open Care Services at primary level, care homes
over 20 000 inhabitant
Content is under development
One channel funding is under discussion
Testing:
Tested during 6 years with highly positive results by Eksote
Time table:
Parliament will discuss 2014, in force late 2010’s

6. NEW SOCIAL AND HEALTH CARE REGION
ACUTE CARE HOSPITAL
Typically 200 000 inhabitants
Local service facilities some 230
for 200 000 inhabitants
NEAR-BY-SERVICE CENTRE
SERVICE BLOCK
CETRALISED SOCIAL
SERVICES
LOCAL HOSPITAL
REHABILITAION,
GERIATICS
Minimum 50 000
inhabitants
NEAR-BY SERVICE CENTRE
WITH HEALTH AND SOCIAL
CARE
Minimum 20 000
inhabitants
MOBILE HOME SERVICES
MOBILE HOME SERVICES
SERVICE HOMES
Jarmo Suominen | Aalto Yliopisto | Arkkitehtuurin laitos 2014

7. New Health Care Act – open issues
Administration of Social and Health care district:
Regional organization or “Capital City” of county
New structure for 5,5 million people:
Acute care hospitals; 18 still too high, 11-15 might be better
Role of University Hospital is not defined
Primary care hospitals, now 150, will be closed towards 45,
difficult to accept by municipalities
Programme of new near-by-services undefined
Funding:
Several governmental funding channels treat citizens unequal
but one channel funding hurts the interest of adult population

8. Questions
Is WHO three level principle of care (primary, special,
third level) overcame by IT–era networking?
Role of primary care?
Do we need a new service paradigm?
NHS? WHO?