Recipes for Systemic Change - Helsinki Design Lab

The Primary Healthcare actof the 1970’s is a significantattempt at shifting attentionto preventive and outpatientcare.Municipalities (or groupsof) are required to establishhealth centresMunicipal care is centralizedCosts are shared betweencentral and local governmentsCentral and local groupsmust submit annual 5-yearaction plansThe number of doctors workingin primary health triplesin a few years1984 reforms of the SocialWelfare Act, together withthe earlier Primary Healthcareand Children’s Day-CareActs, were the foundationsfor the growing Finnishwelfare state.Elder care is particularlyeffected by the creation ofinformal care allowancesand the strengthening ofoutpatient services for theelderly.In 1993, the recession hitFinland at the same time asthe government launcheda major effort to decentralizethe health and socialservices systems.Though there were cuts inexpenditures in some healthand social services areas- notably for the elderly,disabled, and families withchildren - as a result of therecession, by the end ofthe decade numbers hadreturned.To deal with the recession,geriatric care is transitionedfrom a health issue to aprimarily social one, and isreduced in both scope andcontent.The decentralization effort isnot hindered dramatically bythe recession, and goes onto define the contemporarystate of the Finnish welfaresystem.1971 Labour market organizationssign an agreement on workplacehealthcare services1972 Primary Healthcare Act passed,it becomes a significant attemptat shifting attention to preventiveand outpatient care1973 Children’s Day-Care Act1974 Free-trade agreement with theEEC1975 Bed spaces are transferred frommental hospitals to mentalhealth clinics, which increasetheir capacity by 89% (initiatedin 1975, completed in 1987)1978 Occupational Health Care Actpassed1980-85 National pension reform1984 Reform of Social Welfare Act-Increased cooperation betweenpublic health and social welfare# Creation of informal care allowancesystem for elderly care #Social assistance is replacedby income support # New statesubsidy system1985 Child Home Care Allowance Act1986 Health for All by 2000Programme#Develop primaryhealthcare # Expand dentalservices#strengthenoutpatient services for theelderly#modernize psychiatrichealthcare#intensify rehabilitation1990 Survivor’s pension reformed toinclude widowers1991 Major reorganization into21 hospital districts withcompulsory membership for allmunicipalities1991 Reform of rehabilitation legislation1993 Decentralizing reform of thestate subsidy system#Statedistributes funds through aneeds-based estimating formularather than expenditures#Centralhealth administration isrestructured#Move from statutoryguidance to informationguidance#STAKES is formed1995 State and local governmentretirement ages raised from 63to 651999 Finland joins the EU1999 Finland joins the EMU Sweden introduces a newpension system to replacethe old, which was experiencingrising costs in the face ofan ageing population2000 Basic social rights are writteninto the new Finnish constitution305