Municipalities In Finland Research Articles

Characteristics, treatment and disease burden among stage 3-4 chronic kidney disease patients with and without type 2 diabetes in Finland during 2016-2022.

Real-world evidence on the management of chronic kidney disease (CKD) with and without type 2 diabetes (T2D) is limited. This study described the characteristics, treatment, and disease burdenin patients with stage 3-4 CKD with and without T2D in Finland. This cohort study used data from primary and hospital care in five municipalities in Finland to identify adults with stage 3-4 CKD, defined as having either one estimated glomerular filtration rate (eGFR) measurement of 15-59ml/min/1.73m2 followed by a second measurement taken≥90 days apart, or a registered CKD diagnosis. Prevalence was determined on 31 December 2022, and a cohort of incident stage 3-4 CKD patients was followed from the first date fulfilling eligibility criteria since 01 January 2016 (index) until death or 31 December 2022, and analyzed by T2D status. The prevalence of stage 3-4 CKD was 6.3%. Among the 12 474 incident stage 3-4 CKD patients, the majority were non-T2D (73%). The median age was similar for non-T2D and T2D CKD patients, respectively. Baseline albuminuria screening was 9% among non-T2D and 53% among T2D. The use of kidney-protective treatments at index was also lower in non-T2D patients (47%), compared with T2D patients (69%). The use of kidney-protective treatments remained unchanged during 12 months after index. Healthcare resource utilization was high, and CKD or heart failure contributed considerably more to the all-cause healthcare costs than atherosclerotic diseases, regardless of T2D status. In both CKD subgroups, 10% had died within one year. In Finland, CKD is highly prevalent and associated with high risks and low use of albuminuria testing and kidney-protective medications. Most CKD patients were non-T2D, which showed lower use of preventive management and similar risks compared with T2D patients. These findings call for an urgent need for improved awareness and risk management, especially in non-T2D CKD patients.

Variation in patient-sharing network characteristics of health care professionals treating different mental and substance use disorder patient sub-groups in primary care.

Providing efficient and targeted services for patients with mental health problems requires efficient collaboration and coordination within healthcare providers, but measuring collaboration using traditional methods is challenging. To explore the patient-sharing networks of professionals taking care of different groups of patients with mental or substance use disorders. We used data that covered adult patients' visits to the primary care service providers of seven municipalities in Finland during year 2021. Data included 8,217 patients (147,430 visits) with mental or substance use disorders who were treated by 1,566 health care professionals. We calculated descriptive network metrics to examine the connectivity of professionals in three different patient groups (patients with substance use disorders, psychotic disorders, and depressive disorders) and compared these characteristics to a network based on all patients. We also analyzed whether patient sharing was associated with the health care professionals' attributes (occupational group, municipality) using Exponential Random Graph Models (ERGM). Diagnosis-specific networks were denser and more connected compared to the all-patients network. Nurses were the most central occupation in all the diagnosis-specific networks and especially in the substance use disorder patients network. When examining all patients, two professionals were more likely to share patients when they belonged to the same occupational group. However, in the network with depressive disorder patients we found the opposite: professionals were more likely to share patients if they were of different occupational groups. Patient-sharing networks within patients with a specific mental or substance use disorders are denser and more connected than networks based on all patients with mental or substance use disorders. In the substance use disorder patients network particularly, nurses were the most central occupation. Multi-professional connections were more likely in depressive disorder networks than in the all-patients network.

Embodied with data: Early childhood education and care centre director's stories about living with datafication

This article presents autoethnographic short stories that describe an early childhood education and care (ECEC) centre director's work for one year in a municipality in Finland. The purpose of this article is to provide a glimpse into what it is like to enter into an ECEC director position and live everyday ECEC life with economic data that are produced by frequently fluctuating child–staff ratios. This study contributes to a better understanding of the transformational implications of datafication by providing insight into affective interrelations held together by economic aspirations. It shows that datafication is a powerful tool to affect and to be affected in the female-dominated care work of ECEC. The study highlights the possibilities of using an autoethnographic analysis to recognise how data affect the body in data dominated ECEC and how to utilise this very recognition as resistance.

#1432 Prevalence, risks and treatment of incident chronic kidney disease stage 3-4: an observational study in Finland between 2016-2022

Abstract Background and Aims The rising burden of chronic kidney disease (CKD) calls for early detection and targeted interventions. Kidney-protective treatments (renin–angiotensin system inhibitors [RASis] and sodium-glucose co-transporter-2 inhibitors [SGLT2is]) can delay chronic kidney disease (CKD) progression, cardiovascular events and death. However, contemporary differences between CKD patients with and without type 2 diabetes (T2D) is limited. This study aimed to describe the prevalence, patient characteristics, the use of kidney protective treatments (RASi or SGLT2i) and event risks among patients with incident stage 3-4 CKD in Finland. Method We used comprehensive real-world clinical data from electronic health records from primary and hospital care in five municipalities in Finland between 1st January 2016 to 31st December 2022 to identify stage 3-4 CKD patients aged ≥18 years, defined as having either one estimated glomerular filtration rate (eGFR) measurement between 15 to 60 ml/min/1.73 m2 followed by a second one ≥90 days apart, or a registered CKD diagnosis. Two cohorts from primary care were identified: a prevalent cohort indexed at a fixed date, 1st Jan 2022 and an incident cohort indexed at the date of new CKD. The incident CKD patients were followed from CKD incident index date until death, emigration, or end of study on 31 December 2022. Analyses were also stratified by CKD patients with T2D and non-diabetes (T1D and gestational diabetes excluded), respectively. Risks were estimated as event rates per 1000 patient-years. The proportion of patients on/off treatment were estimates as a function of time and divided into pre- vs. post-index. Results In 2022 the prevalent cohort of 16,380 CKD stage 3-4 patients, represented a prevalence of 6.2% in the total background population of 263,383 individuals. The 12,129 incident Stage 3-4 CKD patients had a median eGFR of 55 ml/min/1.73 m2, similar in both non-T2D and T2D. Most patients were non-T2D; 73% (n = 8859). At index, 1.7% had a CKD diagnosis, lower in non-T2D (1.0%) vs T2D (3.5%) patients. The use of urine albumin creatinine ratio (UACR) was generally very low (21% had a measurement), 9% in the non-T2D and 53% in the T2D patients. Non-T2D, compared to T2D patients, were similar in age (76 vs 75 years) and had slightly less comorbidities like HF (12% vs 18%), myocardial infarction (9% vs 14%), stroke (15% vs 16%), atrial fibrillation (21% vs 25%) and less treated with statins (38% vs 64%). During follow-up, 10% had died within 1-year (97 deaths per 1000 patient years), similar in non-T2D (95 deaths per 1000 patient years) and T2D patients (104 deaths per 1000 patient years). One year risk of any hospitalization was also high, 49% and 64%, respectively. The use of kidney-protective treatments (renin angiotensin system inhibitor [RASi] or SGLT2i) at index (date of incident CKD) was lower in patients without T2D (47%) compared to those with T2D (69%). No change was observed in their use in the 12 months after incident CKD (Fig.). Finally, when studying the proportion of all non-T2D patients receiving SGLT2i after approval for CKD treatment, less than 1% of all CKD patients in the study group were treated with SGLT2i on 31st December 2022. Conclusion This study shows that CKD stage 3-4 is highly prevalent in Finland. Newly detected CKD stage 3-4 patients were little diagnosed and the use of UACR was low, especially among those who were non-diabetic. More than 2 out of 3 CKD patients were non-diabetic. Importantly, these non-diabetic CKD patients had similarly high disease burden, similar high risk of dying and had less kidney/cardiovascular prevention compared to those with T2D. The high mortality risks, substantial kidney-protective treatment inertia and UACR underutilization in stage 3-4 CKD patients all call for an urgent need for improved awareness and risk management, especially in the larger group of non-T2D.

Registered nurses' perceptions of healthy lifestyle counselling for immigrants in primary healthcare: A focus group study.

The use of primary healthcare and health promotion services is low among immigrants compared with native citizens. Immigrants are at risk of developing chronic diseases due to genetics, nutrition and a sedentary lifestyle. Registered nurses play an integral role in teaching, counselling for a healthy lifestyle and care coordination in primary healthcare. We aimed to explore the perceptions of registered nurses on healthy lifestyle counselling for preventing type 2 diabetes and other chronic diseases among immigrants in the primary healthcare setting. We performed a qualitative descriptive study using focus group interviews. Data were collected with semi-structured focus group interviews with a total of 23 registered nurses working in primary healthcare. We recruited the participants by using the purposive sampling method in the primary healthcare setting of four municipalities in Finland. Interviews were audio-recorded, transcribed verbatim and analysed with qualitative inductive content analysis. The participants' perceptions were related to (1) uniform counselling practice for both immigrants and native citizens, (2) challenges in counselling immigrants, (3) understanding cultural factors influencing immigrant counselling, (4) the need to improve immigrant counselling and (5) utilizing insights from practical experience to improve the counselling service. Developing a culturally sensitive health promotion service is suggested to support the health of immigrants. Moreover, both migrant communities and healthcare professionals should be involved in co-designing and implementing health promotion projects through a community-based participatory approach. Our study contributes to healthcare practice and management by underscoring the need for culturally tailored health promotion services for the at-risk group of immigrants in primary healthcare. Cultural competence in nursing education needs to be reinforced. The provided recommendations inform researchers and policymakers about the health disparities and health needs of immigrants. Healthcare professionals were consulted in the study design.

Results of archival appraisal: a study of a Finnish City

The study investigates which information is chosen for long-term retention in a municipality in Finland. The municipal Records Management Plan of the City of Helsinki was analyzed quantitatively to provide the research data. The results show that information pertaining to permanent or long-standing objects and phenomena, as well as those with long-lasting consequences (such as high-level decision-making, environmental factors, constructions, land use, and people), are more likely to have extended retention periods and may even be preserved permanently. According to archival literature, archival appraisal is a process influenced by theoretical considerations. However, the findings suggest that practical factors tend to guide the appraisal process more significantly. This raises the question of how appraisal decisions are made. The perceived value of information may depend on the level of detail provided about the functions and processes, as well as the knowledge possessed by the appraisers. However, the role that archival theory and other factors play cannot be understood without additional research.

The Role of In-House Procurement According to Finnish Municipalities' Purchase Invoice Data

Public sector is a large consumer for ICT systems and services development used for various public services. Tendering for such systems is governed by laws aimed at eliminating unfair advantages and offering all possible parties equal opportunities to participate in the tendering process. In this article, we study in-house procurement, where the acquiring organization is an owner of the subcontractor that delivers the system. Municipalities purchase invoice data is used to determine how greatly municipalities in Finland depend on in-house procurement. In conclusion, the understanding if included municipalities have ICT service and development units within the organizations needs closer examination, as in-house companies may offer municipalities with limited resources divided costs in the public procurement process.

O.5.3-1 Implementation of an online group model for work-related well-being among sport instructors

Abstract Purpose Sports instructors, who work in small and mid-sized municipalities and the public sector, provide physical activity counselling and group guidance for municipality residents of all age groups. Sport instructors execute a variety of physical activity and well-being promotion activities. Many of them are working independently, having only little collegial or community support. Additionally, only little is known about work-related well-being of their own as well as methods on how to improve it. Project description Within research and development project TOGETHER -Towards an online community among sport instructors, an online group for work-related well-being was created and piloted. There were 32 participants who were working as sport instructor in small or mid-size municipalities in Finland. Before the start of the group meeting process, the participants were interviewed about their perceptions about work-related well-being. The group process consisted of six online small group meetings with four to six participants and the facilitator in a group. Each of the biweekly group meetings took 1,5 hours. The themes of group meetings were pre-stated, nevertheless, the participants' own reflections and discussions were highlighted. The main themes focusing on work-related well-being were sense of community, autonomy, capability and social support. The participants were instructed to set their own aims for their individual work-related well-being process. Between the group meetings the participants have made written reflections about the themes and the process. After the last group meeting, group interviews will be made to find out the outcomes and reflections of the process. They will be shown in the presentation. Conclusions Based on the reflections and findings of the implemented online group meeting process, the model will be further modified. The final outcome of the project will be a tested online model for increasing work-related well-being among sport instructors working in municipalities, which will be presented. The research has been funded by the Finnish Work Environment Fund.

O.3.1-6 Work-related well-being of sport professional at public sector

Abstract Sports instructors, who work in small and mid-sized municipalities and the public sector, provide physical activity counselling and group guidance for municipality residents of all age groups. Over the last decade, the work has expanded from group guidance to promote the well-being of residents. Many of them are working independently, having only little collegial or community support. Additionally, only little is known about work-related well-being of their own as well as methods on how to improve it. The aim of this study was to investigate the experiences of a sport professional’s work-related well-being and what factors increase or decrease it. The study was carried out using qualitative methods. In the study, there were 32 participants who were working as sport instructors in small or mid-size municipalities in Finland. On average, the interviewees were 42 years old and had work experience in the municipality’s sport instructor work for an average of seven years. The data was collected with thematic interviews during the autumn and winter 2022-2023 and it was analyzed using content analysis. The results showed that work-related well-being was confirmed by the relevance of the work, and by the customers and their success in their own goals. The study also found that the appreciation and sense of community experience also played a significant role in the well-being experienced at work. Work-related well-being is also strengthened by supporting autonomy. Work-related well-being was weakened by the fragmentation of work and hurry at work. Clients were a strength resource for sport instructors, but they could also increase mental stress. The clients may tell sport instructors about their own illness and loneliness, but workers did not have enough tools to help them. The results also showed that physical problems can affect well-being at work. The study provides a broader understanding about the art of sports instructors’ work. It makes visible which are the main elements that increase and decrease sport instructors’ work-related well-being. The results can be utilized when implementing activities of sport instructors’ well-being promotion. The research has been funded by the Finnish Work Environment Fund.

Food consumption and nutrient intake of Finnish preschool children according to parental educational level.

We examined the association between parental educational level (PEL) and children's food consumption and nutrient intake in a sample of Finnish 3- to 6-year-old preschoolers (n 811). The data were obtained from the cross-sectional DAGIS project, conducted in eight municipalities in Finland during 2015-2016. The food consumption and nutrient intake were assessed using food records. The highest educational level of the family was used as the indicator of socio-economic status. Differences in diet by PEL were analysed using a hierarchical linear model adjusted for energy intake. Compared with high PEL, low PEL was associated with a child's lower consumption of fresh vegetables and salads, vegetarian dishes, berries, white bread, blended spread, skimmed milk and ice cream but higher consumption of milk with 1-1·5 % fat content, dairy-based desserts and sugar-sweetened soft drinks. Food consumption was also examined after disaggregating dishes into their ingredients. Low PEL was associated with lower consumption of vegetables, nuts and seeds, berries and fish but higher consumption of red meat. Children in the low PEL, compared with the high PEL group, had a lower intake of protein, fibre, EPA, DHA, vitamin D, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, potassium, phosphorous, Ca, Mg, Zn and iodine but a higher intake of fat and saturated, trans and MUFA. The observed diet-related disparities highlight the need for policy actions and interventions supporting healthy eating patterns such as high consumption of vegetables, nuts and berries in childhood, paying special attention to those with low PEL.

Miles’ law in Finnish municipalities: where decision-makers stand depends on where they sit

ABSTRACT Miles’ Law, i.e., the notion that institutional position affects attitudes, is considered a truism, but not much attention has been given to properly test or develop it. Here, we argue that Miles’ Law is effective not only for civil servants but among municipal decision-makers in different positions. We examine how well institutional position can explain differences in attitudes to welfare service provision among decision-makers on different levels. Differences in opinion depending on institutional position are usually overlooked when attitudes on welfare are explained. Using survey data (N = 1,578) from 42 municipalities in Finland, our analyses show that institutional position does affect attitudes to service provision. However, the differences are contingent on the mode of service provision under consideration and are moderated by the size of the municipality and the economic status. This shows that it is important to consider the position of local government decision-makers to understand their attitudes.

Governing education, governing early childhood education and care practitioners’ profession?

Neo-liberal values affect early childhood education through the production of specific teacher subjectivities. These subjectivities are connected not only to the logic of competition, but also to competing definitions of worth, trust and values, as demonstrated by data. Neo-liberal values of accountability are also intertwined with the traditional discourse of child-centred learning. This study contributes to research concerning early childhood education and care staff’s professionalism by focusing on the effects of the commercialization of early childhood education and care teachers’ understanding of their work. With survey data (161 responses) collected from the five largest municipalities in Finland, the authors examine the reasoning that early childhood education and care staff provide for choosing commercial as well as non-commercial digital applications, licensed programmes and ready-made learning materials. The research is highly topical since the number of innovations targeted at early childhood education and care is increasing. Digitalization opens new ways for the privatization and marketization of education by introducing appealing commercially produced programmes and materials. In this study, the authors show how the advertising of these innovations as providing ‘easy solutions’ to improve either children's learning or early childhood education and care practitioners’ working time has become a discourse through which teachers and other staff members evaluate their work and their professionalism. In addition, the authors suggest that Finnish early childhood education and care practitioners seem to have internalized the pressure to enhance efficiency and accountability in early childhood education and care.

The impact of wildlife and environmental factors on hantavirus infection in the host and its translation into human risk.

Identifying factors that drive infection dynamics in reservoir host populations is essential in understanding human risk from wildlife-originated zoonoses. We studied zoonotic Puumala orthohantavirus (PUUV) in the host, the bank vole (Myodes glareolus), populations in relation to the host population, rodent and predator community and environment-related factors and whether these processes are translated into human infection incidence. We used 5-year rodent trapping and bank vole PUUV serology data collected from 30 sites located in 24 municipalities in Finland. We found that PUUV seroprevalence in the host was negatively associated with the abundance of red foxes, but this process did not translate into human disease incidence, which showed no association with PUUV seroprevalence. The abundance of weasels, the proportion of juvenile bank voles in the host populations and rodent species diversity were negatively associated with the abundance index of PUUV positive bank voles, which, in turn, showed a positive association with human disease incidence. Our results suggest certain predators, a high proportion of young bank vole individuals, and a diverse rodent community, may reduce PUUV risk for humans through their negative impacts on the abundance of infected bank voles.

Unemployment and Mental Health: An Instrumental Variable Analysis Using Municipal-level Data for Finland for 2002–2019

We explore the effect of unemployment on mental health, using data from Finnish municipalities for the period 2002–2019. We measure mental illness using a mental morbidity index, as well as mental health care utilization and the use of antidepressants. There are significant differences across municipalities in Finland in both prevalence of mental health issues and illnesses, along with unemployment. Establishing a causal link between these two variables is challenging because of their reverse causality and joint determination. Using instrumental variable estimation, we establish a causal effect from unemployment to mental health. We present a strong connection between unemployment and mental health, especially for males between 25 and 64 years of age. Similar connection is not found among younger or older males, nor among females. Our findings are robust, since the results hold for various mental health measures. Our results reflect the possibility of differing mental health effects across the sources of unemployment.

Smart shrinkage and multi-locality – The appeal of hope, illustrated through Puolanka, a rural municipality in Finland

ABSTRACT Our contribution discusses two phenomena – shrinkage and multilocality – in relation to the big picture of urbanisation and to the prevailing regional policy discourse that is very growth oriented in nature. Empirical material from Puolanka is used to illustrate the key tensions of this constellation. We ask: Does the concept of ‘smart shrinkage’ resonate in the context of a shrinking municipality? Is it possible to operationalise shrinkage at the local level? A group of artists has been experimenting with a very peculiar approach by branding their local pessimism (!) and thereby sympathetically ridiculing the growth orientation of a locality that shrinks fast by numbers. What about ‘multilocality’? Is it a true opportunity to increase the quality of life in depopulating regions? Like many rural municipalities, Puolanka hopes that the holiday homes and e-work will contribute to local vitality. We propose that other somewhat surprising forms of multilocality may be even more significant. Those include the global multilocalities of the entrepreneurs with immigration background that keep the last restaurant business up and running, as well as the seasonal workers in agriculture and tourism. Also, the pessimistic artists can be seen as multilocals. The peculiar connectedness that these young people have with Puolanka is of high symbolic value.

Second-home owners as local developers: Roles and influencing factors

This study analysed the variety of pro-development roles of second-home owners in their host municipalities in Finland. The roles had not been identified previously, despite the policy expectations concerning the economic and social advantages of second-home owners for rural development. Moreover, this article examined how factors such as place attachment explained the roles. The data was collected from the postal survey (N = 2500). The roles and the place attachment constructs were defined by exploratory factor analysis (EFA), while the roles were explained by multivariate regression analysis (MRA). Five roles were identified: Potential Developer, Aware Consumer, Ordinary Member of association, Responsible Member of association, and Developer outside associations. The key components of second-home owners’ place attachment were identified as Community belonging, Rootedness, Place dependence, Family history at the second home, Rural leisure roots, Second-home community belonging and Economic embeddedness. Most roles were shaped to some extent by Community belonging, thus emphasising the co-operative nature of local development processes. The importance of Rootedness as well as of personal agency was proven. In addition, some features of the local context encouraged second-home owners to assume these roles.

Municipal climate communication as a tool in amplifying local climate action and developing a place brand

Both climate communication and place branding are familiar concepts, whose potentials have been recognized. Cities have engaged in communication and climate work for several years, yet studies linking municipal climate action and communication are scarce. We conducted targeted interviews and a broader survey of climate workers and communicators of forerunner municipalities in Finland and found gaps between climate action and communication. Synergies could be achieved if the two functioned in synchronicity rather than separate tasks, as words require actions, but full impacts of actions fall short without communication. Municipalities have progressed on both fronts but are hindered by lacking time and human resources. Results revealed several opportunities of climate communication in amplifying local climate action and strengthening municipal brand image, but many remain underexploited. Sufficient resources and stronger legitimacy are still needed for climate matters to be better integrated into everything the municipality does and communicates.

Prevalence of Erosive Tooth Wear and Associated Dietary Factors among a Group of Finnish Adolescents

The aim of this study was to investigate the prevalence and severity of erosive tooth wear (ETW) among Finnish adolescents and to evaluate how frequency as well as amount of the use of erosive products is associated with ETW. The study population consisted of 328 voluntary, >15-year-old secondary school students (males 49.1%, females 50.9%) in three municipalities in Finland. Clinical examination to measure ETW (BEWE index) was carried out by trained and calibrated dentists. Piloted questionnaires included questions on consumption of drinks, fruits and berries, as well as tooth brushing frequency. Means and medians of frequencies and amounts of consumed erosive products were calculated and associations with ETW severity were analysed by logistic regression models. One-third (36.9%) of the participants were in need of at least preventive measures for ETW (BEWE sum score ≥3), but severe ETW (BEWE sum score >9) was rare (2.1%). Boys had severe ETW significantly more frequently than girls (p < 0.001). Habitual consumption of erosive drinks was common especially among boys compared to girls (p = 0.001). ETW was significantly associated with the amount of consumed erosive drinks, fruits, or berries. The prevalence of ETW among adolescences in Finland seems to be at the same level as in other Nordic and European countries. Consumption of erosive products is common and thus, the risk for tooth erosion is high, especially in boys. In addition to erosive drinks, also berries and fruits are associated with ETW and should be included in individual dietary counselling when early signs of ETW are clinically detected.

The 'Tasty School' model is feasible for food education in primary schools.

The 'Tasty School' is a tailored teacher-delivered food education model for primary schools in Finland. The aim of the current study was to investigate the feasibility of the Tasty School model in primary schools. Furthermore, the aim was to assess changes during the intervention in the class teachers' perspectives and experiences related to food education and school dining. The method involved a quasi-experimental study with intervention and control groups. A total of 130 class teachers from 15 intervention and 10 control schools from five municipalities in Finland participated in the study during one school year. The theoretical framework of acceptability was utilised to evaluate feasibility using frequencies. The comparison data were analysed using a mixed-effects model for repeated measures to account for the intervention effects and selected standardising effects. Teachers reported that the model was highly acceptable and easily integrated into the school environment. Support from principals and colleagues was the most important facilitator of food education, and lack of time was the barrier. Teachers in the intervention schools were more likely to consider school meals healthy after the intervention, and they reported having sufficient materials and supplies for food education. The Tasty School was shown to be a feasible model for food education in primary schools. The current study especially found that the commitment of the whole school and principals' role are crucial in the implementation of food education. The factors that support the implementation must be strengthened, and efforts must be made to reduce the barriers.

Virtual Joint Companies as a Means of Incentivizing SMEs to Use Occupational Health Services—A Trial in Two Municipalities in Finland From 2009 to 2011

Employees of Small and Medium-sized Enterprises (SMEs) can benefit from occupational health services (OHS) in the same way that employees of large organizations do. The aim of this 3-year trial was to investigate whether integrating multiple SMEs into virtual joint companies may result in incentive structures like those of large companies concerning access to Occupational Health Services (OHS), which can improve wellbeing and reduce the number of sickness visits to clinics. Several SMEs were grouped together to form virtual organizations to enter into agreements with OHS providers. Two groups were created, each with a somewhat different price structure: one with a fixed annual fee and the other with a cost-dependent fee. The number of sickness visits to clinics increased among those who worked under the cost-dependent fee system, whereas it decreased among those who worked under the fixed-fee system. The findings on the work climate were inconclusive because there was no discernible difference. The improved productive time was particularly appealing to SME businesses, since employees could rapidly schedule sickness visit and they were able to spend less time dealing with sickness-related paperwork. It also raised their awareness of their employees' health. When OHS providers could address SMEs as a group, their desire to collaborate with them improved. Furthermore, the local entrepreneur organizations, which served as the virtual headquarters for the SME groups, stated that they would be willing to continue with the work for a rather moderate compensation. The ability of SMEs to create legal organizations in the form of virtual joint companies appears to address, at least partially, the issues related with the conflict between their small sizes and Occupational Safety and Health (OSH) incentive systems to address work accidents and disease incidences. Using the proposed approach would allow for differential fee systems, as well as economic incentive systems, which presently apply predominantly to large firms, might be extended to SMEs.