Centralization of health services: Implementation of division of work in specialized medical care and of joint emergency services

Joint emergency services providing both primary and specialized 24-hour service suffer from congestion and the costs of specialized medical care increase as reception services for urgent cases are not effective and enough places for follow-up treatment are not available. Insufficiency of places for follow-up treatment also hampers the operation of hospitals and patients’ access to treatment.

Directed by the Health Care Act together with decrees on centralisation of services and 24-hour services, a reorganisation of the hospital and 24-hour service network has been on-going in Finland since 2018. Its objective was to secure equal access to services, sufficient expertise, quality of services as well as client and patient safety. The reform aimed for savings of up to EUR 350 million in general government finances between 2017 and 2020.

The audit examined the national and regional implementation of the reforms of centralisation and joint emergency services, achievement of the objectives set for the reforms, and the consequences of the reforms for different types of hospitals, units providing extensive 24-hour services, and units providing 24-hour joint emergency services. At the time of publication of the audit, the Government is preparing a proposal for the reorganisation of the hospital and emergency service network to improve fiscal balance and respond to a shortage of healthcare personnel.

In joint emergency services, the extensive range of examination and testing options of specialized medical care are also used to treat primary healthcare level patients. The 24-hour services also treat patients who need care rather than treatment. As the hospital and 24-hour service network is reformed, the Ministry of Social Affairs and Health should ensure effective reception services for urgent cases to avoid patients ending up in costly specialized medical care unnecessarily.

Providing primary and specialized 24-hour services in the same unit has not made it easier to find on-call general medicine physicians, and 24-hour services still have to resort to agency physicians. Due to a trend of physicians specializing directly in narrowly defined specialties and the large number of specialties that units with 24-hour services are expected to offer, more and more physician’s expertise and physicians are needed in primary and specialized 24-hour services. From the perspective of labour availability, specialists’ fields of expertise should not be allowed to get any narrower.

The implementation of the centralisation and 24-hour service decrees has progressed to varying degrees in different areas. A management model of special catchment areas based on cooperation between hospital districts has not always worked smoothly. The current wellbeing services counties’ collaborative areas are afflicted by the same problems relating to competence that hindered the development of activities in the special catchment areas.

The audit found that the Ministry of Social Affairs and Health has been unable to monitor the operational and financial consequences of centralising specialized medical care. In the future, indicators for monitoring their achievement should be defined for objectives of healthcare reforms.