Regional integrated care in Finland: a case study on two counties with comprehensive integration of primary and specialised health care and social services

Abstract

Introduction: Since the early 2000s, Government policies in Finland have supported administrative and operative integration of health and social care to create larger authorities for organising services and to strengthen coordination of primary and specialised care, and social services. Nationally, the policies have led to attempts to reform the service system to support integration. At the local level, municipal collaboration has been launched to create regional joint health and social care authorities to boost administrative integration and to facilitate the implementation of innovative forms of integrated care. Of these local initiatives, we address two county level joint authorities which have established comprehensive integrated care organisations merging primary and specialised health care and social services under one management. Our aim is to evaluate the success and transferability of these initiatives. Methods: We focus on two vanguard counties, South and North Karelia, which have established joint health and social care authorities in Finland. In South Karelia the authority has operated since 2010 and in North Karelia since 2017. For the multimethod study, we collected intensively data on the operation of the joint authorities and health and social services provided particularly for client groups benefiting from integration. We compiled county policy and evaluation documents on health and social care, run an online survey among employees, and carried out individual and group interviews of management and employees. Results: The two counties have several common features including the population of 130,000-169,000 inhabitants, regions of a larger town with a specialised hospital and several rural municipalities. While both counties have intensively supported to care integration, they display differences in their approaches. South Karelia has gradually developed integrated services for focused client groups, such as homebased rehabilitation services for the elderly, integrated services for children and young people, and integrated psychosocial services for adults. In North Karelia, reorganised recently, integration has focused on integrated health and welfare centres bringing earlier separate primary and mental health care, and social and substance abuse services on the same premises. In both counties, preliminary experiences on adopting integrated care models are positive. Efficiency has improved and waiting time and costs decreased without deteriorating patient satisfaction. The early experiences also underline the importance of strengthened shared management to address smooth work processes between different professional groups. Discussion and conclusions: The establishment of the joint health and social care authorities with a strong emphasis on integrated care seems to be successful. The early experiences suggest a positive impact in terms of efficiency. Transferability particularly to larger urban municipalities is challenging to assess. The national health and social system reform currently prepared in Finland may include features, such as increasing privatisation and market-based services, which request changes in the integrated care models. Limitations: The study was based only on two county-based health and social care authorities with relatively similar integrated care models. Suggestions for future research: Due to limitations in case-studies, long-term broader follow-up studies are needed for assessing and comparing the impact and outcomes of different integrated care models.

Keywords

• integrated care
• case study
• health care
• social services