Finnish Reform Research Articles

Big bang in the middle of a storm: Lessons from implementing health system reform in Finland

Abstract Introduction Finland is often defined as a Nordic welfare state, characterised by universal access to healthcare and an emphasis on national and local politics in the governance of the system. In 2023, the Finnish health system was reformed by centralising organisation (purchasing and service delivery) to regional entities, as well as funding and overall governance to the state from 200 local organisations. The aims of the reform were to improve accessibility, decrease inequities, promote population health and curb growing costs. In the Finnish health system, as in other fields of society, we “find a huge number of very small changes, and a very small number of huge changes” (Cairney 2016). This makes the Finnish health system reform a rare opportunity to use a large-scale reform as a context for a study on reform implementation. Methods This research is based on document analysis and interview data collected from top regional managers. The data was analysed using a political determinants of health framework and thematic analysis. Findings The Finnish reforms were introduced by a left-centre government but implemented by a right-wing government with strong opposition to the reforms, which made full implementation challenging. The results highlight the importance of political commitment to implementation, demonstrate that reforms shape power relations at all levels of the health system and highlight how health system reforms are essentially about redistributions of power between different actors. The results also highlight the importance of contextual factors and suggest that large-scale reform should be treated as a system shock for which health systems need to prepare. Conclusions Understanding the political determinants of health and political commitment to reform is essential to implementation, as is the importance of resilience and preparedness to unexpected circumstances either due to reform-related factors or to external and contextual factors.

Representations of alcohol and drug use in the Finnish reform of social and health care service users’ rights

BackgroundA growing body of research has analysed the representations of alcohol and other drugs (AOD) in policy-making, but few studies have focused on the representations reproduced in law-making processes, especially in the context of the regulation of the rights of social and health care service users. This study examined what kind of representations of AOD use are reproduced in the legislative reform of social and health care service users’ rights in Finland. The purpose of the reform is to strengthen social and health care service users’ rights to self-determination and to reduce the use of restrictive measures. MethodsAs its data, the study used a draft of the bill and stakeholder opinions regarding the reform. ‘What's the problem represented to be?’ approach as a methodological framework. ResultsThe study discovered three AOD-related discourses: the Control, Welfare, and Rights and Legality discourses. The Control discourse represented people who use AOD as risky individuals and called for ways to manage risks in treatment situations. The Welfare discourse portrayed people who use AOD as a vulnerable group whose problems should be addressed by the welfare system. The Rights and Legality discourse represented the vague legal definitions of AOD use as the main regulatory problem. The discourses differed in terms of their definitions of self-determination. ConclusionsThe study illustrated how the right to self-determination as a legal concept is contested and can be interpreted in different ways depending on the representations of AOD use. The differing representations highlight the tensions involved in improving the rights of people who use AOD.

The Renewal of the Finnish Planning Legislation as a Strategy of Urban Planning and Development

Due to global eco-social and technological challenges, a new strategy of planning adopted as the Land Use and Building Act in Finland (2000) will be renewed after 23 years of implementation. Will the forthcoming law recognise the complex relationships and consequences of self-organised processes, the digital empowerment of citizens, and the eco-social content of planning and development? This article examines and discusses the renewal of the Finnish Land Use and Building Act and the forthcoming planning system from an ontological perspective. Methodologically it is based on an assessment of the draft of and comments on the new Act, as well as on a comparative analysis of two case studies that illustrate the potential consequences of the renewal in the Finnish context. The results reveal that the planning system will become more complex. Despite the adoption of a new digital methodology, the Act ignores civil society’s self-organisation and digital empowerment; also, the definition of the eco-social substance is vague. However, the Finnish reform serves as an example of the difficulties that planning systems encounter in the current context of complex problems concerning sustainability transitions all over the world.

The role and position of the third sector in social and health care system? Reflections from Finnish Reform

The role and position of the third sector in social and health care system? Reflections from Finnish Reform

Impact of a Finnish reform adding new sickness absence checkpoints on rehabilitation and labor market outcomes: an interrupted time series analysis.

In 2012, new checkpoints were introduced in the Finnish sickness absence system to improve early detection of long-term work disability and hasten return to work after illness. We examined whether the reform affected participation in rehabilitation and labor market outcomes over a one-year period. We used interrupted time series analysis among persons who started receiving sickness allowance up to three years before and up to two years after the reform. Separate analyses were conducted among those who passed 30, 60, and 90 sickness allowance days. Poisson regression analysis was used, controlling for seasonal variation, gender, age, and educational level. After the reform, participation in rehabilitation within one year of passing 30 sickness allowance days increased by 5.1% [incidence rate ratio (IRR) 1.051, 95% confidence interval (CI) 1.015-1.086]. The increase after 60 and 90 sickness allowance days was slightly larger. Looking at the type of rehabilitation, vocational rehabilitation from the earnings-related pension scheme increased most. Regarding the rehabilitation provided by the Social Insurance Institution of Finland (Kela), vocational rehabilitation, medical rehabilitation, and discretionary rehabilitation increased, but the increase was statistically significant only in the last case. Post-reform changes in employment, unemployment, sickness absence and disability retirement were negligible. The introduction of new sickness absence checkpoints was associated with an increase in participation in rehabilitation but did not affect labor market outcomes one year later. The reform thus was only partially successful in achieving its objectives. Future research should focus on identifying the most effective approaches for utilizing rehabilitation to enhance labor market participation after sickness absence.

The impact of periodic interviews on unemployment duration: Evidence from the 2017 Finnish reform

AbstractIn 2017, a Finnish policy reform intensified the Public Employment Services' practice of periodically interviewing unemployed jobseekers. This study used high‐quality administrative data to analyse the effect of interviews on unemployment duration. We used a difference‐in‐differences approach that exploited regional variations in treatment intensity. Our results show that a 10 percentage point increase in interview probability increased the monthly hazard rate of employment by 3.1 per cent, with the effect being strongest among jobseekers aged 25–34 and jobseekers with a low education level. Also, our results demonstrate a strong effect on participation in active labour market programmes.

INTEGRATING POLLUTION REGULATION REGIMES: A COMPARATIVE SURVEY OF THE FINNISH AND SOUTH AFRICAN LEGAL SYSTEMS

The South African environmental governance, particularly the pollution regulation regime, is fragmented. Fragmentation ultimately leads to an unsustainable governance effort which negatively impacts on the environment and development in general. In 2000, Finland comprehensively revised the legal structure on which its pollution regulation regime is based. This new regime provides for an integrated environmental authorisation for polluting activities, integrated authorisation procedures and institutions, which result in a more integrated and efficient governance regime. The integrated Finnish approach is based on an European Union framework directive that provides for Integrated Pollution Prevention and Control (IPPC). The Finnish reforms may suggest strategies to integrate the fragmented South African regime. This article commences by investigating the nature and extent of fragmentation in South Africa. It then proceeds to analyse the European framework directive on IPPC, and then to reflect in detail on the new Finnish approach. It concludes by providing some comparative suggestions to achieve integration in South Africa.

Constructing Narrative Identity and Capabilities of Finnish Reform School Adolescents

Most studies of adolescents placed in foster care due to severe conduct problems have focused on their problems, while adolescents with healthy adulthood condition remain understudied. In Finland, adolescents with severe conduct problems are placed in reform schools (RS). The purpose of this study was to examine how former RS adolescents’ narrative identity and capability construction interact in different phases of their life-stories. Semi-structured life-story interviews were conducted with 13 former RS adolescents with healthy adulthood condition. Data were analyzed using a narrative constructivist method. We found a story in which the theoretical elements found from the research material were especially rich and thick and decided to present it as a case example of our findings—Anna’s story. The analysis showed that capabilities were closely related to RS adolescents’ identity construction and well-being. Strengthened capabilities provided material for identity construction, such as identities of meaning making, agency, redemption, and communion. The findings of the study point out that out-of-home care adolescents’ stable and trusting relationships should be supported as they may strengthen capabilities and help develop feelings of meaningfulness, belonging, experienced parity of participation and senses of coherence.

The Impact of Periodic Interviews on Unemployment Duration: Evidence from the 2017 Finnish Reform

The Impact of Periodic Interviews on Unemployment Duration: Evidence from the 2017 Finnish Reform

Inclusion in American and Finnish Schools: The Neglect of Youth with Emotional and Behavioral Disorders

ABSTRACT Youth with emotional and behavioural disorders (EBD) are guaranteed the same right to inclusive education as other students with and without disabilities. While Finland and the United States (U.S.) are committed to the ideals of inclusion, evidence suggests that these students are often excluded. This paper discusses Finnish and U.S policies and practices that identify and ‘push out’ youth with EBD. Additionally, the quality of education in exclusive settings, including Finnish reform schools, U.S. alternative schools and day treatment/residential psychiatric facility schools, as well as (juvenile) correctional facilities in both countries, are discussed. Recommendations are provided for policy and practice that will promote access to inclusive education for these troubled youth.

Science policy meets post-New Public Management: Estonian and Finnish reforms 2012–2015

ABSTRACT The study compares recent Estonian and Finnish research steering reforms. Both cases exhibit post- New Public Management (post-NPM)-style policy ideas that seek to enhance coordination over institutional boundaries but diverge in their horizontal and vertical configurations for coordination. This study combines perspectives on coordination from science policy and public administration with a historical institutionalist approach for understanding case divergence. This article argues that post-NPM reforms can involve rather diverse forms of coordination, which are affected by institutional legacies. We also argue that coordination efforts in science policy can involve a strengthened instrumentalization of research for policy-making, and, in such cases, they should be studied in close conjunction with public administration and its policy trends.

Exploring the Relationship between Law Students’ Prior Performance and Academic Achievement at University

As Finnish university admissions are reformed, more information is needed on the relationship between performance in prior education and later academic achievement. Transition to university is a critical period, and low performance in prior education is associated with challenges in later study. In the present study, law students’ (n = 426) performance in the National Matriculation Examination was investigated in relation to later academic achievement at university. Quantitative methods were used. Findings showed that prior performance was not only associated with study success but also with study progress. The results also showed that law students who had grades in the advanced mathematics course were faster and more successful at university. This work contributes to the existing knowledge of university admissions ahead of the Finnish reform by providing new insights into prior performance and how it is related to academic achievement at university.

Knowledge as a critical success factor in the Finnish social and health-care reform

ABSTRACTThe social and health-care reform in Finland is a major governance reform and – together with aims to promote using of knowledge along with it – it opens a unique window to observe development of knowledge management in societal reforms and in renewing services. This article offers an overlook to the ambitious knowledge management goals set to the reform and to the new regions that are currently planning the implementation of the reform and knowledge management in practice. It focuses on the needs, interests and barriers related to knowledge management as they appear in the regions. Building this kind of overall view is of high relevance in Finland while the implementation phase of the reform is beginning. The findings are useful to the international audience too when it comes to using knowledge in governance reforms and in multi-actor social and health-care models.

Presenting the status of project SIFT – Research of the patient flows and structures in health and social services in three Finnish cities in 2009–2015

The date of Finnish health and social services reform is fast approaching. The reform, planned to step into force on 1 January 2020, includes transferring responsibility of these services from municipalities to newly formed, autonomous regions. In addition to coordination, the regions shall form effective service and care chains. To carry out this task successfully, more information is needed about the critical points of integration of different services. We have for a while been working with a project called SIFT, which focuses on the heavy users of health and social services. We have obtained register-based data from three cities (Lohja, Karkkila, Vihti) in Southern Finland, with a total of approximately 85 000 inhabitants. Based on this data, we are studying the distribution of services used by those clients that occur in three registers: primary care, secondary care and social services. Interest is laid especially on the service processes. What kind of links are there within and between the health and social services? Are there certain phenomena to be found concerning the combinations, timelines etc? What is the level of health and social care integration before the reform? The study design is extraordinary in many respects. All sub-sets of data – also the social services sub-set – are large and numerical, allowing a quantitative research approach, as well as an integrated analysis concerning the co-occurrence of different services. Data includes some information on the family members of the clients, which is important from the point of view of child protection and family work services. Furthermore, the time span is relatively long, from the beginning of 2009 to the end of June 2015. Analysis methods include e.g. decision trees, SOM (a neural network), genetic algorithms, K-nearest neighbours and Markov chains, applied in various steps of the process. Spatial analyses can be carried out based on the postal number of the customers. It is already clear that the heavy users of health and social services can be classified into groups based on some factors, e.g. the dominant services and frequency of the service use. Certain dependencies can be pointed out in the service processes. Furthermore, spatial differences can be seen even in this relatively small geographical area. Using information of the family members has also proven to be useful and brings new perspectives into the client processes of social work. Because of the ambitious aim of combining observations from several branches, there have been plenty of issues related to completeness and internal integrity of the data. The operations situated at the interfaces of health and social services seem to be problematic from the point of view of our data collection. We do not have access to services given by the private sector. However, the heavy users of the health and social services mainly rely on the public sector in Finnish conditions. During 2018, a tool will be built, with which a person’s probability to become a heavy user of different health and social services can be predicted.

Principals’ views on changes in the provision of support for learning and schooling in Finland after educational reform

Recently, the large-scale reforms of special education have been carried out in many countries. This study focuses on the latest Finnish reform of special education in compulsory education. As principals lead educational reforms in schools, their role in the implementation of reform is significant. The study explores principals’ views on the changes in support arrangements after the educational reform. We used latent class analysis to identify the subgroups of principals who share similar views. In addition, we examined the relationship between the subgroups and individual, school, and municipal level factors using multinomial logistic regression analysis. Four subgroups were identified: improved pedagogical support (19% of principals), stability of support (54%), increased administrative support (14%), and weakened support (13%). Work experience as a principal, school size, schools’ resources for special education, and region differentiated these subgroups from one another. Despite nationwide reform, the support arrangements and their changes differed among schools in the opinion of principals. We discuss the implications for the planning and implementation of the educational reforms.

A distributed leadership perspective on the Finnish curriculum reform 2014

ABSTRACTBridging curriculum research with educational leadership, we examined the 2014 Finnish curriculum reform compilation and enactment process through the lens of distributed leadership.As a tool for the examination, we used the resource–agency duality model of distributed leadership. It explicates how organizational members create resources and enact agency to achieve organizational and individual goals. This mixed-methods study had three phases. First, we conducted document analysis to position the 2014 curriculum in a series of curriculum reforms. Second, we analyzed how distributed leadership was interpreted and incorporated in the goals and instructions of the 2014 national core curriculum document. Finally, we surveyed 21 key actors for their insights of distributed leadership in the curriculum compilation and enactment process.The findings revealed a trend of deepening and expanding distributed leadership in curriculum work over the past decades. This trend mirrored the general societal development in Finland. The 2014 curriculum explicated goals and instructions to use distributed leadership for inclusion, multidisciplinary learning, student-centred assessment and operational culture. The key actors regarded the leadership for the 2014 curriculum work as distributive which enabled resource creation and agentic participation on both national and local levels.

Reshaping local borders in Europe today. A critical reflection founded on an analysis of the case of Finland

Abstract In Europe, the amalgamation of local authorities is currently used to optimize public resources. Although amalgamation involves several advantages, it needs to fulfil three conditions to be considered successful. First, address local preferences and needs; second, be fair, transparent and accessible to citizens; and third, be a compromise between central and local political elites. In the current paper the fulfilling of these three conditions is analysed using the comprehensive, bottom-up, Finnish reform introduced during the period of 2008-2013. The findings conclude that while the Finnish local reform plan has been successful in reaching a compromise between local and central governments, it has failed insofar as it has not fulfilled the condition of making the process fair, transparent and accessible to citizens. Furthermore, whether the amalgamation has allowed local government to address citizens’ preferences and needs in a meaningful and responsive way has yet to be demonstrated.

‘Walking a fine line’: teachers’ perception of curricular autonomy in Estonia, Finland and Germany

The purpose of this paper is to comparatively investigate the professional autonomy of upper secondary school teachers in three European countries in interpreting and implementing curricula. The paper focuses on teachers’ experiences, and their perceptions of their autonomy and the control exercised over them in the global era of neoliberal education reforms. Semi-structured teacher interviews from Estonia, Finland and Germany (n = 33) were used to ascertain teachers’ professional roles in different political contexts. Despite the common economically motivated pressures on school systems and teachers, the responses of nation-states and teachers vary. While German education reforms have been aimed mainly at increased standardization of education, Estonian and Finnish reforms have also emphasized school autonomy and the empowerment of teachers through school curriculum development. Even the Bavarian curriculum for gymnasia, one of the most prescriptive curricula in Germany, since 2008, has promised increased autonomy to teachers. Nevertheless, as the cases of Bavarian and Estonian curricula show, the autonomy-stressing rhetoric of a curriculum can be accompanied by teachers’ perceived lack of autonomy. Moreover, teachers’ willingness to endorse and enact curricula depends on their perceived social status and involvement in educational decision-making.

Finnish reform of the funding and provision of special education: the views of principals and municipal education administrators

This study examines the current state of special education provision and resources in Finland after the extensive reform of the government transfer system and Basic Education Act implemented in 2010–2011. Data were collected from a survey of compulsory school principals and from interviews with the highest-ranking officials in municipal education administration. The results show that participants viewed the Basic Education Act as having a more significant impact on the provision of special education than the reform of the government transfer system. Partly due to the reforms, local authorities have targeted the resources of special education differently and used resources more effectively. Continued efforts are needed to ensure the provision of resources for part-time special education and the use of other forms of early intervention in general education classrooms.

The ‘Golden Age of Legislation’ in Finland 1863–79: Judicial Reforms in a Societal Context

Finland was part of Russia’s multi-national empire from 1809–1917. This period of autonomy witnessed several different phases. The phase that started from the ascent of Alexander II to the throne and ended some decades later is known as the ‘Golden Age of Legislation.’ The Finnish Diet could convene from 1863 after a moratorium of a half a Century. This dynamic period witnessed a huge amount of legislative changes. Legislative structures typical to Estate society were dismantled and a legislative basis suitable for a capitalist economy was established. There were not only changes in private law; major changes were also made in other fields of law. For example, principles of criminal law were discussed in the Diet of 1863–64, and changes that modernized and made criminal punishments were enacted in 1866 even though a total reform of the Criminal Code was not realized before 1889. It is important to put these reforms in a societal context. These reforms can be explained by connecting them to the changing power structures of the Empire. Alexander II’s policy aimed at modernizing society and he set about doing this by maintaining an autocratic rule. This allowed Finland to carry out societal reforms; reforms which served the interests of a new commercial class recruited partly from the nobility and partly from the bourgeoisie. In comparison, it is clear that Finnish reforms and Russian reforms of 1864 had a common societal basis in their aim of serving the interests of the economy. However, this led to legal reforms in different fields of law reflecting the economic, societal and political conditions in Finland and in the Empire.