Health Care Services In Finland Research Articles

Healthy Finland survey as the latest uptake for 50 years of population health monitoring in Finland

Abstract In Finland, population-based health examination surveys (HESs) have been conducted in regularly since early 1960's to obtain information on population health and health determinants. These surveys have covered adult population living in the mainland Finland. Surveys have always been conducted by specially trained personnel using international standardized protocols such as WHO MONICA protocol or EHES protocol. The latest HES, Healthy Finland, is ongoing and will run until June 2023. The Finnish Institute for Health and Welfare (THL) had the responsibility of the coordination of the preparation phase as well as conducting the survey. Survey planning was started already in early 2021 with a multidisciplinary group including representatives from different stakeholders. Survey sample includes 66.000 randomly selected adults aged 18+ years living in Finland. In the 1st phase, they receive a questionnaire to be filled in. Questionnaire covers topics such as quality of life, health, use of health care services, lifestyles, background information, work ability and functional capacity, wellbeing, accidents, and sexual and reproductive health. In the 2nd phase, 10.000 of those selected to the survey were invited to health examination including for example anthropometric measurements, blood pressure, spirometry test, collection of biological samples and sub-studies. This from these national HESs has been widely used for policy making, planning and evaluation of the prevention programmes, as epidemiological background for clinical treatment guidelines of several diseases, and for research. Information obtained from the Healthy Finland survey will be used for the evaluation of wellbeing service counties which are responsible for the organization of social and health care services in Finland. Survey will generate new information about health inequalities by providing information not only by age and sex but also by education and other socio-economic indicators.

Towards a holistic customer value approach in managing public health care services: a developers' view

PurposeRecent literature within public service logic has called for more explicit conceptualisation of customer value in public services. This study aims to fill this gap by examining how the customer value approach can be applied in the management of public health care services.Design/methodology/approachThis study is a qualitative case study of management of public health care services in Finland. The authors interviewed 17 regional health care service developers and analyzed the interview data using thematic analysis.FindingsThe study suggests five propositions for applying customer value approach from the marketing literature in public health care service management. The study enables a deeper understanding of customer value creation in this context and improvement of public health care services.Originality/valueThis study contributes to the public management research in general and public service logic research in particular by suggesting what constitutes customer value in public health care services.

Effects of Vocational Rehabilitation on the Use of Health Care Services in Finland: A Propensity Score Analysis

Vocational rehabilitation may affect the frequency of health care use by improving the access or reducing the need for health care. We examined whether participation in rehabilitation effects the healthcare services use. Register-based data was utilized on all individuals aged 15-60 living in the city of Oulu, Finland, who started vocational rehabilitation in 2014-2015 (N = 784). We examined the use of outpatient health care services from 1.5 years before to 1.5 years after the start of rehabilitation and 1.5 years after the end of rehabilitation, and compared it to the propensity score matched controls. Rehabilitees had on average 1.5 visits to outpatient health care services in the 6th quarter before the start of rehabilitation. In the 4th quarter before the start of rehabilitation, that number increased to 1.8. After the rehabilitation period, the quarterly number of visits returned to the same level as at the beginning of the follow-up. The biggest changes were in the use of occupational health services. Compared to the propensity score matched controls, vocational rehabilitation did not appear to affect the use of health care services. Vocational rehabilitation seems to replace need for other services but not to affect the need to receive treatment for the underlying disease.

The effect of vocational rehabilitation on the use of health care services in Finland

Abstract Background Because vocational rehabilitation is a separate service from other health services, there may be interruptions at their interface. We examined whether the use of health services changes before and after rehabilitation. Methods Longitudinal individual-level register-based data was utilized on all individuals aged 15-60 living in the city of Oulu, Finland and starting vocational rehabilitation in 2014-2015 (N = 792). We compared their use of outpatient health care services in 3-month periods from 1.5 years before to 1.5 after the rehabilitation period to the total population of the same age and to the propensity score matched controls. Several socio-demographic factors and sickness and employment histories were used for matching. Results According to the preliminary results, rehabilitees had on average 1.5 visits to outpatient health care services in the 6th quarter before the start of rehabilitation, twice that of the total population. In the 4th quarter before the start of rehabilitation, the number increased to 1.8. After the rehabilitation period, the quarterly number of visits were at the same level as in the beginning of the follow-up. The biggest changes took place in the use of occupational health services. Changes were modest in public health care services. In other services changes were minimal. Compared to the propensity score matched controls, vocational rehabilitation did not appear to have an effect on the use of health care services. Conclusions The use of health care services is more common before vocational rehabilitation than after it. The effect of rehabilitation on the use of health care needs further analysis. Key messages • The pattern of the use of health care services changes in the course of vocational rehabilitation. The changes are mainly due to visits in occupational health care services. • The use of health care services is most common before rehabilitation. However, vocational rehabilitation does not appear to have an effect on the use of outpatient and inpatient health care services.

How do individuals with alcohol problems use social and healthcare services in Finland? Comparison of service use patterns between two high-need patient groups

Aims:Alcohol use disorders (AUDs) are associated with high risk of comorbidities and excess use of social and healthcare services. We examined health service use (HSU) frequencies of patients with AUD in comparison to those with type 2 diabetes mellitus (T2DM).Design:A random sample of individuals with AUD (n = 396) were identified based on ICD-10 codes and HSU patterns, morbidity and mortality were compared with age- and gender-matched T2DM controls (n = 792) using logistic regression analysis. Six years (2011–2016) of electronic health record (EHR) data from the North Karelia district in Finland were used.Results:Similarities in comorbidity patterns existed, although mental health comorbidity (odds ratio [OR] 1.86) was more prevalent in the AUD group. The average annual HSU varied according to the groups: T2DM patients had more continuous contact with public health nurses in primary care, whereas AUD patients were more likely to experience somatic specialised care hospitalisations (OR 11.30) and have frequent somatic primary healthcare doctor visits (OR 3.30) and frequent emergency room doctor visits in specialised care (OR 8.89). Furthermore, patients with AUD had a 7.5 times higher risk of death compared with T2DM patients.Conclusions:This study identified rather similar comorbidity status for the AUD and T2DM patients, but their HSU patterns differed noticeably. AUD patients had higher frequencies of hospitalisation periods and emergency service use and were at a higher risk of death compared with T2DM patients, indicating greater challenges in the organisation of care for AUD patients compared with those having T2DM.

Screening University Students for Health Checks With an Electronic Health Questionnaire in Finland: Protocol for a Retrospective, Register-Based Cohort Study.

BackgroundHealth questionnaires and health checks are an established part of preventive health care services in Finland. However, only very limited research of these has been conducted. The Finnish Student Health Service (FSHS) provides primary health care services to all bachelor’s and master’s degree university students (approximately 134,500 students) in Finland. FSHS’s statutory health examination process of university entrants includes an electronic health questionnaire (eHQ) and, based on the students’ eHQ responses, a subsequent health check if necessary. To our knowledge, no previous studies have been published on the use of questionnaires for screening students for general health checks.ObjectiveThe general aim of the study is to evaluate the health examination process of university entrants. The objectives are to determine how students’ self-reported health in the eHQ and participation in the health examination process are associated with graduation, mental health problems, and the use of student health care services.MethodsThis is an ongoing, nationwide, retrospective, register-based cohort study with a 6-year follow-up. The study population is the cohort of university entrants (N=15,723) from the 2011-2012 academic year. These students were sent the eHQ, which consisted of 26 questions about health, health habits, social relations, and studying. Based on the eHQ responses, students were referred to one of the following interventions: (1) a health check, (2) an appointment other than a health check (eg, physiotherapy), or (3) electronic feedback to support a healthy lifestyle, when the other interventions were not necessary. Multiple comparisons will be made within these groups using logistic regression. The primary outcome variables are graduation, having a mental health problem, and attending a health check. The use of FSHS health care services will be studied with the cluster analysis method. The data have been obtained from three nationwide registers: the eHQ register, the medical records of FSHS, and the Higher education achievement register. The data have been linked using personal identity codes.ResultsAs of August 2019, the data collection and processing are complete and the statistical analyses are in progress. Preliminary results are expected in autumn 2019. Further publications are expected in 2020, and two PhD theses are expected to be completed by the end of 2022.ConclusionsStudying practical procedures in primary health care is highly important for resource allocation and the development of evidence-based processes. This study will be the first to assess the usage of a health questionnaire in screening students for health checks. The findings of this study will contribute to the field of preventive health care. The main practical implication is the development of the FSHS’s health examination process. We hypothesize that participation in the health examination process enhances academic achievement and the detection of university students’ mental health problems early on in their studies.International Registered Report Identifier (IRRID)DERR1-10.2196/14535

The transposition of the Patients’ Rights Directive in Finland—Difficulties encountered

The Directive on the application on patient rights’ in cross-border healthcare (2011/24/EC) was transposed in Finland by the Act on Cross-Border Health Care (1201/2013), which entered into force on 1 January 2014.A new reimbursement model for cross-border health care costs was designed. The Finnish legislator considered the chosen reimbursement model to correspond both with the aims of the Directive as well as to the functioning of the national health care scheme. The European Commission, however, initiated the first infringement procedure against Finland already in January 2014.In spring 2015, the Government launched a Regional government, health and social services reform, which would fundamentally transform the organizing, production and financing of health care services in Finland. Consequently a Government bill (HE 68/2017 vp) to change the existing reimbursement model for cross-border health care costs was delivered to the Parliament on 1 June 2017.In this article, Finland’s implementation process of the Directive is reviewed. Special attention is drawn to the argumentation concerning the reimbursements of cross-border health care costs. The differences of views on reimbursements can generally illustrate the conflicting objectives to expand access to cross-border health care services and to ensure financial sustainability of states thereof.

Sense of community, organizational commitment and quality of services

PurposeThe purpose of this paper is to examine how factors associated with a sense of community in the workplace are connected with organizational commitment and the quality of services among frontline managers and middle managers in social and health care services in Finland.Design/methodology/approachA questionnaire designed specifically for this research was sent to 241 lower-level and middle-level managers in social and health care services in central Finland. A total of 136 managers completed the questionnaire (response rate 56 per cent). The results were analyzed using descriptive statistics, exploratory factor analysis, Spearman’s rank-order correlation coefficient and multiple linear regression analyses.FindingsThe study showed that feeling a sense of belonging, mutual trust and appreciation, and open interaction among colleagues were connected to organizational commitment for frontline managers and middle managers in social and health care services in Finland. Correspondingly, an open flow of information in the organization, job meaningfulness and appreciation received from managers’ superiors were connected to the quality of services.Originality/valueThis study provides information on the factors that influence social and health care managers’ organizational commitment and on items connected to their experience of the quality of services.

Need for medication and stuffy nose predict the severity of allergic rhinitis.

Need for medication and stuffy nose predict the severity of allergic rhinitis.

Sense of community and job satisfaction among social and health care managers.

The purpose of this paper is to identify how the factors associated with sense of community at work are connected with job satisfaction among the front-line managers and middle managers in social and health-care services in Finland. A questionnaire prepared for this study was sent to 241 social and health-care managers (front line and middle managers) in Finland. A total of 136 of managers responded to the survey (response rate was 56 per cent). Data were analyzed by using descriptive statistics, exploratory factor analysis and multiple linear regression analysis. Alongside job meaningfulness, open communication and good flow of information within the organization, sense of security provided by close relationships at work and managers' own superiors' appreciation of their leadership skills all are related to managers' job satisfaction. The study adds to our understanding of factors which are connected to the job satisfaction among social and health-care managers'. The findings of this study can be used in the development of leadership to support managers in coping at work.

Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women

Objective. To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.Design. Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.Participants. A total of 70 married Somali women aged 18–50 and mother of 2–10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.Settings. Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.Results. Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.Conclusions. The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.

Prison-based drug treatment in Finland: History, shifts in policy making and current status

Aim The article outlines, at the level of political discourse, changes in drug and criminal policy that may have influenced the penal system as a backdrop to the rise of prison-based drug treatment programmes (PBDT) in Finland. Methods and Data Our perspective is historical. The article is based on historical and political documents, scholarly research and white papers. Results The history of PBDT in Finland is characterised by an absence of drug treatment programmes until the 1980s, first initiatives at the end of the 1980s, enthusiastic programme development from the mid-1990s, and decreasing interest during recent years. Unlike the National Drug Strategy, the Prison Drug Strategy aimed at a drug-free environment (zero tolerance) and implemented harm-reduction measures only to a limited extent. Conclusion The development of PBDT represents the new way of performing treatment in prisons, with features of managerialism. PBDT is also affected by an organisational segregation of rehabilitation and medical treatment, which prevents integration of harm-reduction measures with rehabilitative treatment, and is in conflict with general aims of integrating substance abuse treatment to mental and healthcare services in Finland. In the spirit of a new kind of Penal Welfarism, the role of documented individual risk and needs assessment in defining an offender's sentence has increased.

Depression-Focused Interpersonal Counseling and the Use of Healthcare Services After Myocardial Infarction

The purpose for this study was to evaluate the association between depression-focused interpersonal counseling (IPC) and the use of healthcare services in Finland after myocardial infarction (MI). The measures were done at 6 and 18 months after MI in the randomized intervention (n= 51) and the control group (n= 52). There was less use of somatic specialized healthcare services in the intervention group from 6 to 18 months after hospital discharge, and with intervention patients who had no other long-term disease during 6 months. Confirmation of possible benefits of IPC for practice calls for more specific studies.

Developing the formula for state subsidies for health care in Finland.

The aim was to generate a research-based proposal for a new subsidy formula for municipal healthcare services in Finland. Small-area data on potential need variables, supply of and access to services, and age-, sex- and case-mix-standardised service utilisation per capita were used. Utilisation was regressed in order to identify need variables and the cost weights for the selected need variables were subsequently derived using various multilevel models and structural equation methods. The variables selected for the subsidy formula were as follows: age- and sex-standardised mortality (age under 65 years) and income for outpatient primary health services; age- and sex-standardised mortality (all ages) and index of overcrowded housing for elderly care and long-term inpatient care; index of disability pensions for those aged 15-55 years and migration for specialised non-psychiatric care; and index of living alone and income for psychiatric care. Decisions on the amount of state subsidies can be divided into three stages, of which the first two are mainly political and the third is based on the results of this study.

Both endurance training and strength training reduced disability and pain in chronic non-specific neck pain in women

(2003) JAMA 289, 2509. Ylinen J, Takala EP, Nykänen M, et al. . Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial....

Local Heroes Beat National Champions: Quality Improvement in Finnish Health Care

FINNISH HEALTH CARE: Although health care services in Finland are organized uniformly throughout the country, they, along with the application of total quality management (TQM)/continuous quality improvement (CQI), are the responsibility of municipalities. CASE 1: At the Helsinki City Health Organization, top management launched an organizationwide quality improvement (QI) initiative in 1993, entailing 150 CQI projects. Yet top and middle managers were not sufficiently dedicated to the initiative to provide adequate support to many of the quality projects. Only "islands of activity" were spotted. CASE 2: A physician in the pediatrics department of a hospital helped initiate CQI projects--for improvements in administration of x-rays for patients with antebrachium fractures, transport of samples to the microbiology laboratory, and admissions of patients with acute infectious disease. Successes led senior management in the hospital federation to issue a quality policy based on CQI management, showing the power of the good example. CASE 3: The first launch of CQI at the Helsinki University Central hospital was part of a management development project that did not have the full support of senior management and that, consequently, failed. A second initiative undertaken a year later, the quality council, was more successful. CASE 4: At a local center for social services and primary care, quality projects have strengthened the organization's team and network structures across two professional cultures. The four cases provide insight into the diffusion of TQM/QI and implementation strategies on the local level.

Vibration exposure and prevention in Finland.

The number of annually compensated occupational diseases due to exposure to hand-arm vibration (HAV) has decreased during the last 15 years. The number of exposed workers has been declining in Finland, especially in forestry work, as harvesters have increasingly replaced manual chain saw operations. During the entire 1970s, forest work caused more cases of vibration-induced occupational diseases than all industrial branches together. The decrease is mainly due to the technical development of chain saws, but also to the effective health care services in Finland. Other factors such as warm transport, warm rest cabins in which to take pauses at work, warm meals, adequate protective clothing, and vocationally adjusted early medical rehabilitation have helped to cut down health hazards, especially in forest work. The number of new cases has been decreasing in Finland not only in forestry but also in other industries. In Finland a considerable amount of research has been conducted to hand-arm vibration, resulting in the increased awareness of the health risks related to certain occupations. This has helped to carry out the Primary Health Care Act (1972) followed by the Occupational Health Care Act (1979) which obligates employers to arrange occupational health care for their employees. We believe that the research activity has contributed significantly to achieving the present health in Finnish work places. The purpose of the present paper is to describe the cases of occupational exposure to HAV, and the effectiveness of different preventive measures in Finland.

Women's satisfaction with maternity health care services in Finland

The purpose of this study was to describe the Finnish maternity health care system and to determine the level of satisfaction in general with maternity health care services and specifically with hospital clinic visits in Helsinki, Finland. Information was collected using both interviews ( N = 63) and questionnaires ( N = 408). Care during pregnancy takes place in maternity centers, and risk pregnancies are referred to hospital clinics for consultation. The maternity hralth care system in Finland is regarded internationally as effective and well functioning. In recent years, however, increasingly more prenatal visits have taken place in hospital clinics. This change may lead to a system similar to Great Britain's where a large part of prenatal care takes place in hospital clinics. Although the women in this study are satisfied in general with the content of maternity health care services and regard them necessary for their well-being during pregnancy, data also indicated that women are more satisfied with visits to maternity centers than with visits to hospital clinics. The factors women complained most about in hospital clinic visits, were long waiting times, unsatisfactory doctor-patient communication, the ‘assembly-line’ routine of the clinic, and seeing a different doctor at each visit. The lack of social and psychological support involved in the care given at hospital clinics was also evident. In planning and evaluating maternity health care, it is important to consider women's views and experiences.

Family Resources and Children's Use of Primary Health Care Services in Finland in 1979

The purpose of the study was to determine how children's use of primary health care services was related to family resources (socio-economic status, marital and residential stability of the family, and core/periphery dichotomy). The population consisted of a random sample of 3201 children from 15 municipalities in the province of Uudenmaan lääni in Southern Finland in 1979. Among two-parent families in the core regions total utilization of primary health care services was significantly higher among the children of workers and upper white-collar employees. Children of farmers and lower white-collar employees in the periphery exhibited low primary health care utilization. Children in upper white-collar employees' families (both two- and one-parent) in core regions frequently used private services. Among children of one-parent families, exceptionally high users of private services were children of upper white-collar mothers in core regions, and of municipal health services the children of working-class mothers in the periphery. Non-migrated children had a slight tendency to use health services more than migrated children. Differences in family resources thus cannot be ignored when children's utilization of primary health care services is studied.

Use of mental health care services in Finland by students in different fields of study.

Abstract The purpose of this study was to investigate the degree of utilization of mental health care services by students in different fields of study and to look into the reasons for any differences found. The material consisted of the records of all the students who used the mental health care services of the Finnish Student Health Service Health Center in Helsinki during the period from September 1, 1980 to August 31, 1981. This basic population was divided into two groups: humanists (students of the arts, theology, and art) and scientists (students of technology, science, human and veterinary medicine, and commerce). There were a total of 672 students in the two groups. The degree of utilization of mental health care services was higher in humanists than in scientists. Similarly, it was higher in female than in male students in both groups.