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Eeva Ollila. Public Health Care and Globalization - Finland. Globalization and Health care --Some common features. Increasing commercial interests in the production of health services Increasing (multinational) for-profit service actors

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Public Health Care and Globalization - Finland

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Eeva ollila

Eeva Ollila

Public Health Care and Globalization - Finland


Globalization and health care some common features

Globalization and Health care--Some common features

Increasing commercial interests in the production of health services

Increasing (multinational) for-profit service actors

Problems with equity of access, increasing inequities in health

Challenges in regulation

Increasing health care costs and problems in public financing

Increasing prices of pharmaceuticals, emphases on high technology

Taxation capacities decreasing

Deficit of health care workers

Flow of workers from public to private, from South to North


Finnish health care system

Finnish health care system

Decentralized health care system with municipalities responsible for organising health care

Multi-channel financing with non-ear marked state subsidies, municipal taxes, social insurance and user fees

Primary health care mostly produced by the municipalities, specialised care by hospital districts, private provision with social insurance subsidies especially in cities in open care/ occupational health


Globalization and its implications for the national health care

Globalization and its implications for the national health care

National trends

New public management (NPM), preparing for outsourcing: Bureaucratic commercialization, purchaser-provider split, contract steering, pricing according to DRGs, private sector management techniques, decentralization

Outsourcing ( and privatisation) likely to increase

(procurement law and the project on municipal and service delivery restructuring, pressures to decrease the size of the public sector)

Maintenance of public financing (tax or insurance based)


Globalization and its implications for the national health care1

Globalization and its implications for the national health care

Regional and global pressures

Neo-liberal political atmosphere

EU: the four freedoms, internal markets, competition, procurement directive, services directive, directive on health services, financial policies (EMU criteria), ECJ decisions

OECD (public governance and management): NPM

WTO (TRIPS, services)


Globalization and its implications for the national health care2

Globalization and its implications for the national health care

Financing

Pressure to lower taxes, lowered state subsidies put pressures on municipal tax-based financing, increased user fees on services and on pharmaceuticals: as a result regressive financing

Pressures for increased funding: Commercialization, new expensive technologies, increased expectations, aging


Production of health services

Production of health services

Outsourcing and privatisation increasing

Fragmentation of the service delivery system

Competition practices increasingly taking production decisions to court

Responsibilities remain with the municipalities


Globalization and its implications for the national health care3

Globalization and its implications for the national health care

Governance - “Steer more - row less”

Information steering, project steering, laws, regulations, monitoring, financing

The framework of regulation is changing

Regulation from the Ministries of Health to the Courts


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