Læknablaðið - 01.04.1979, Page 89

LÆKNABLAÐIÐ
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In the primary care sector the new act
brought together the piecemeal legislation
developed at different stages and in different
ways over the previous decades to form a uni-
fied system of primary care based on a unified
model for the whole country of administration,
planning and central government subsidies. The
basic principles involved are coverage of the
entire population, eqaality in the distribution
of resources, free service provided to the indi-
vidual and close social contact between con-
sumers and providers. These are the very
principles successfully employed in the develop-
ment of the MCH services described above and
without the experience and baekground of
these services it would not have been possible
to introduce the new Primary Health Act in
1972 .
The health care concepts built into the Act
are promotion of health, prevention of illness,
appropriate treatment and rehabilitation. This
is carried out through a network of municipal
health centers whose staffing patterns, func-
tions and financing are guided by a system of
five-years plans adjusted annually.
5. THE HEALTH GENTER CONCEPT IN
FINLAND
Primary care is provided through municipal
health centers. This health center is a functio-
nal unit that may include several buildings and
service units situated in different parts of the
municipality or within different municipalities
that have joined together to form one health
center district. Finland has over 470 primary
municipalities, many of which are small with
a population varying from a few hundred to a
few thousand peopel. An optimal population
base for a health center is considered to be
10.000—15.000 people and it should not be
smaller than 8.000. This has made it necessary
to join several primary municipalities together
which has led to a national total of 220 health
centers. About 100 of these are based on a
single municipality and the rest on groups of
several municipalities. Generally, a health
center has 4—6 doctors and none should have
less than three medical officers. Due to finan-
cial, geographic and demographic circumstances
in a large country with a small (4.7 miilion)
population, of course these and other norms
cannot always be dogmatically applied. For the
same reasons one has allowed for gradual
implementation of the Primary Health Act.
The structural and functional basis for the
primary care provided is formed by the munici-
pal basic health services as developed earlier.
Among the health eenter ser\úce units there
may be old MCH units in different locations,
facilities used by the former municipal medical
officers for diagnosis and treatment and also
small municipal impatient units now referred
to as health center wards. As new health center
facilities are built, attempts are made to bring
together under one roof several of the different
functions, but most health centers will also in
the future function with several geographically
separated service units.
6. ADMINISTRATION OF PRIMARY CARE
The responsibility for primary care services
lies with the municipality and its Health Board
which consists of members nominated by the
politically elected Municipal Council. The
Health Board has two subsections: 1) General
section dealing with primary care and health
centers, and 2) Health surveillance section
dealing with environmental health. When seve-
rai municipalities have joined to support a
health center they form a Joint Health Council,
which then nominates a Health Board for the
group. The place of the health boards in the
national administrative structure is as follows:
MINISTRY OF SOCIAL AFFAIRS AND
HEALTH
National Board of Health
(there is also a National Board of Social
Welfare)
Regional Departments of Social Affairs and
Health
(12 regions)
Health Boards
(107 comprising a single municipality and 115
formed by group of municipalities)
The Health Boards employ the health center
staff and are responsible for planning, functions
and development. This includes primary health
care, primary medical care and environmental
health. Within the health center there is an
Administrator, a Chief Medical Officer and a
Nursing Superintendent, with the rest of the
health center staff and organization depending
much on its size, location, etc.
7. PLANNING AND PRIMARY CARE
The rotating five-year plans in use since 1972
are indicative in nature and reviewed and ad-
justed annually. Early in each year, guidelines
are provided by the National Board of Health
regarding resources and functions on the basis
of which the municipal health boards develop
their detailed plans. These are forwarded to the
regions for scrutiny and comments and from
there to the National Board of Health. The
plans are further reviewed, corrected, adjusted
and finally approved. By this time the next
annual planning round has already started with
the Ministry of Social Affairs and Health
agreeing with the Ministry of Finance on the
general resource framework within which the
indicative national plan is prepared and ap-
proved by Cabinet. This plan then again forms
the frame for the municipalities in their
planning process etc., etc.
8. HEALTH CENTER FUNCTIONS
An outline is given of the main functional
areas together with some indicative figures
concernig quality and quantity of the services.
The data are from 1975. The population of
Finland was then 4.7 million people.