Læknablaðið - 01.04.1979, Blaðsíða 88

108
LÆKNABLAÐIÐ
primary health care was one of supervision and
secondary referral. Those doctors more interes-
ted were actively involved and played an im-
portant role not only as municipal medical
officers and providing the prescribed doctor
contacts within the MCH framework but also
as members of the municipal health boards and
leaders of civic organizations in the community.
Others left the development of these services
largely to the public health nurses and mid-
wives and it is important to realize their central
role in both planning and provision of services.
From the base of MCH work they were also
involved in school health and primary medical
care for the adult population especially in large
rural municipalities and more remote rural
areas. Many public health nurses functioned
in practice as „assistant medical officers".
Municipal responsibility for environmental
health, occupational health and food hygiene
also developed during the early decades of this
century. Leadership in environmental health
at the municipal level has in Finland traditio-
nally been provided by the veterinary surgeon
and this is still true in most areas. The reason
lies in the fact that milk control was the
earliest responsibility and this was supervised
by the municipally employed veterinarian.
Health inspectors carried out the field activi-
ties. Gradually, other environmental health
funetions were added and municipal environ-
mental health and hygiene laboratories estab-
lished but the total function remained under
the Leadership of the veterinarian.
3. DEVELOPMENT OF MEDICAL SERVICES
INFLUENCING PRIMARY HEALTH CARE
Also in the field of medieal care and hospital
services the municipalities have played an im-
portant role. The earliest regional hospitals
were established by the central government, but
very soon large municipalities built their own
hospitals. The next step was for municipalities
to join together into municipal leagues and
build and run their hospitals together. A model
of central government support was developed
similar to that for the basic health service and
later the system was rationalized through
appropriate legislation. In this way, through
special acts, a national hospital ðystem for
tuberculosis was established in 1948, for general
medical care through regional hospitals in 1950
and for mental hospitals in 1952. These hospi-
tals are run by groups of munieipalities through
appropriate organizations and are financed
through an approximately 50—50 model of
local and central funds.
During the intensive development of the
hospital network in the 1950s and 1960s most of
the resources went into this area with the pri-
mary care sector receiving less attention and
continuing to function along the lines outlined
above. This led to an overemphasis both in the
minds of the public, their elected legislators
and other decision makers on hospitals and a
preoccupation with the „medical model“. This
development also led to a strong emphasis on
training of doctors to staff the hospitals with
little emphasis in their training on the needs
of the basic health service or of primary health
care. The same was true also to some extent
of the training of nurses although there conti-
nued to be good training programmes for
community health nurses.
Another reform during the 1960s was the
introduction of compulsory national sickness
insurance to assist with the rising cost of medi-
cal care, support people through illness and
convalescence and with transport cost to seek
care. This legislation is referred to as sickness
insurance as it does not basically promote
health care as such.
The attempts during the 1970s to develop
comphrehensive primary health care should be
seen against the background of the 1950s and
1960s.
k. PRIMARY HEALTH ACT OF 1912
Among the background factors to this act
the following ones were evident around 1970:
— of the health resources 90% went into specia-
lized medical care and only 10% for primary
health care
— total health expenditure rose twice as fast
during the 1960s as he GNP
— apart from favourable indicators for infants
and children all other health indicators for
the population showed no improvement and
in some cases even negative development
— increasing awareness that there had been
one-sided development of the health service
system leading to a lack of primary care
services
— a realization that changes could only be
achieved politically through a determined
and planned development of health policy
affecting the distribution of available re-
sources to both primary care and hospital
services as well as developing those service
functions based on nationally decided priori-
ties.
It was therefore decided to put the main
emphasis on health care and primary care and
to provide the necessary administrative and
financial structures for the rapid and planned
development of the municipal primary care
system. The Act gives the general outlines but
the details are provided through:
— rolling five-year plans approved annually by
Cabinet
— corresponding plans at the level of munici-
palities
— directives and regulations given by health
authorities
— funds provided annually by parliament and
municipal political bodies.
Similar five-year plans were introduced also
for the hospital system.