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Primary Care Trends in Finland (2010–2012): Insights from Arto Virtanen

Explore the evolution of primary care in Finland from 2010 to 2012, with a focus on health care reform, privatization, and positive developments in general medicine. Learn about the changing responsibilities of municipalities and the impact of outsourcing on health centers. Discover salary trends and work satisfaction among general practitioners.

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Primary Care Trends in Finland (2010–2012): Insights from Arto Virtanen

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  1. Primarycare in Finland Trends 2010 – 2012 In Särö 6.9.2012 Arto Virtanen

  2. Topics • Health carereform • Privatisation • Positivetrends for general medicine • Salaries

  3. Arto Virtanen • GP in Nurmijärvi Countysince 1985 • Rajamäki Health station in Nurmijärvi: • Nurmijärvi has 41000 inhabitants, • 40km north of Helsinki • Rajamäki has 6000 inhabitants, 3 GP:s • Non-specialist • GPF Board since 2002 • GPF Chair since 2011

  4. Municipalitiesresponsabilitiesarechanging • Soon? • Municipalities • organizeprimary and areresponsoble for secondarycare • Universityhospitaldistricts (5) • Organizetertiarycare • Before • Municipalities • OrganizePrimaryCare • Hospitaldistricts • Municipalities as members • Organizesecondarycare • Organizetertiarycare

  5. Reasonings for systemchange • primary and secondarycareshouldworktogether, in the sameorganisation • The social sectorshouldbealsoincluded in this • Manymunicipalitiesaretoosmallto arrangelocalhealthcarebythemselves. • In the sametime a big politicalissue • A separatecentralgovernmentplan to reduce the number of municipalitiesmoreorlessdrastically • Nowover 300, plan: 50?

  6. Size and numbers of municipalities 2011

  7. Privatisation • Holehealthcentersoutsourcedsince 2004 • City of Lahti started with itscentral - region • At peaktherewere 40 outsourcedcenters, now 38, soon 40 again (Samaria/Espoo and Hakunila/Vantaa as new ones) • Lack of GP:s • Monetarysavings • Organisationalchanges • Ideologicalreasons (private = moreefficient) • HiredGP:sthroughcompanies • Since 2000, first in out of hourswork • Nowalso long lastingcontracts

  8. PrivateCompanies (revenue 2011) • Attendo-Medone 250 mill € • Mediverkko 65 mill € • Pihlajalinna 30 mill € • Coronaria 20 mill € • MediRadix 12 mill€ • Doctagon 11 mill € • MAST Data 4 mill € • MediVida 2 mill € • Puumedi • Terveydenhuolto.com

  9. How much of the healthproduction-labour is outsourced? • In primarycare 7% • In secondary and tetiarycare 1,7 % • In both: verywidegeographicaldifferences

  10. General medicine is improvingitsbrand • Lack of GP:s is lessening (partlyevengone) • General practice as a speciality is gainingpopularity • 1.1.2012 specialists in differentfields: • General medicine: 2882 • Internalmedicine 1659, psychiatry 1340, General surgery 1266, occupationalhealthcare 1007

  11. Work-happiness(Lääkärilehti: Harri Haimakainen, Arto Vehviläinen, Esko KumpusaloVsk. 66 • Nr: 42 / 2011 • s. 3133 - 3138) • ”I wouldsuggestworking in a health-center as a career for my children” • 2002 39% • 2006 52% • 2010 60% • ”Working in a health-centertakesall my powers” • 2002 60% • 2006 48% • 2010 44% • ”I willbeable to work in a health center up the retirementage” • 2002 47% • 2006 60% • 2010 66%

  12. Workingpart-time: • 1996 5% and 2010 20% of GP:s • Of these: women 2/3 and 1/3 men, the samepercentage in allagegroups • ICPC vs ICD 10 in Finland: • Physiciansuse ICD 10 (except a couple of municipalities) • Nursesuse ICPC • National data collection of eitherone

  13. Officially 2 paymentsystems • Own GP • Responsibility to takecare of a namedpopulation • Populationsusually 1800-2700 • Workingtimenotmeasured • 25-40% of paymentdepending on the workload (fee for service) • Traditional • 37 hours/week • 10% of paymentdepends on the workload (fees for service)

  14. Many-manylocalagreements • Now the majority of GP:sworkunderdifferentlocallyagreedwork/paymentsystems • Everyhealth center hasdifferentagreements • Listmodels • List of patients (somepatientsorallpatients) • Fee for service: 30-60% of totalincome • Worries:Motivates to serveshortlymanysimplepatients • Fixedwages • Allinclusive • Worries: Motivates to spendtimepeacefully in the office

  15. Salariesdevelopments • 2012-2013 centralagreement: 2,4% • 2010-2011 development • Normalhourswages +3,6% for physicians • Communal-sectoralltogether 2,5% • Total wages the difference 4,3% vs 2,5% • Since 2000 (index 100) wageshaverisen • Physicians in the communalsector to 160 • others in the average to 150

  16. Wages • In Regularhours 2011 • 6500 € / monthGP:s • 5800 € / monthhospitaldoctors • GP:sgetbetterpayed in start of theircareerbuthospitaldoctorsarecomingslower to theirpeak • Wagedevelopment 2009 -2011 amongGP:shasbeenpositive • nonspecialists+ 12,8 % • specialists+ 6,5% • Differencenowabout 600€/month

  17. Let´skeep us fitIthelps in keepingothersfit

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