The Roles of Various Sources of Funding in Social and Healthcare Services in Oulu
Abstract
Background
The social and healthcare system in Finland, both the production and the financing of the services, is currently being reformed. One goal of the reform is the integration of different services. This study focused on how the costs of social and healthcare services for the citizens of the city of Oulu are distributed between different sources of funding: the municipality, the Social Insurance Institution of Finland (Kela) and occupational healthcare. Special attention was given to those citizens who need a lot of services.
Methods
The study was a retrospective registry study. Data were compiled from different electronic patient records and registries and consisted of patient level information on service usage and costs. The data included both healthcare and social care services as well as benefits related to health needs and were from the year 2013. The population under study consisted of 201 788 individuals.
Results
The 10% of the population that need the most services use 73% of social and healthcare funding coming from the different sources. Within this 10% of the population 67% receive funding from both the municipality and Kela, while within the rest of the population only 39% receive funding from both sources. Citizens who need a lot of services typically get funding from Kela for medical and travel expenses, rehabilitation services and benefits for the disabled. The rest of the population receive relatively more funding from Kela as reimbursements for private physician and dentist visits, private diagnostics and privately provided care, for all of which Kela covers a share of the fees. Also, occupational healthcare constitutes a significant share of the healthcare costs of the rest of the population. Taking all the sources of funding together changes the relative costs of services that are potential substitutes for each other – the costs of which are usually compared from the perspective of one funding source alone. We used living arrangements for the elderly as an example of the phenomenon: the cost difference between nursing homes and assisted living decreases from 22% to 9%, when the social and healthcare costs from all funding sources are combined.
Conclusions
In order to slow down the increase of social and healthcare costs on the level of society as a whole, improving the coordination of services for those in need of a lot of services, on the one hand, and prevention of the increased need for services on the other become crucial. The problems related to multiple sources of funding may be exacerbated within the segment of the population who are most in need of services, who need funding for medical and travel expenses, rehabilitation services and disability benefits in addition to the social and healthcare services provided by the municipality. What makes the coordination of the services complicated today is the dispersed decision making and the lack of information across funding sources. The reform of the social and healthcare system should aim at supporting the comprehensive planning and coordination of services and benefits for those most in need of them.
Authors
Riikka-Leena Leskelä, Vesa Komssi, Saana Sandström, Hennamari Mikkola, Elina Ahola, Sirkku Pikkujämsä, Sirkka-Liisa Olli, Anna Haverinen, Kirsti Ylitalo-Katajisto, Eveliina Huurre
Additional Information
- Peer-Reviewed: yes.
- Open Access: yes.
- Cite as: Leskelä, R., Komssi, V., Sandström, S., Mikkola, H., Ahola, E., Pikkujämsä, S., Olli, S., Haverinen, A., Ylitalo-Katajisto, K., & Huurre, E. (2016). Eri rahoituskanavien rooli oululaisten sosiaali- ja terveyspalveluissa. Suomen lääkärilehti, 71(11), 809–815. https://www.laakarilehti.fi/tieteessa/terveydenhuoltoartikkelit/eri-rahoituskanavien-rooli-oululaisten-sosiaali-ja-terveyspalveluissa/
