Læknablaðið - 01.04.1979, Side 91

LÆKNABLAÐIÐ
111
rent support categories. For primary care the
least affluent municipalities receive 70% of
their expenses (according to approved plans)
as government subsidy with the most affluent
municipalities receiving 39% and the rest are
somewhere in between. The national average
comes close to a 50—50 distribution between
municipalities and central government. For
1975 the health center cost was distributed as
follows for the whole nation: (in million
marks/1 U.S. dollar = approximately 4.3 mk).
Capital expend.:
Total of tliis:
cost Govt. Municip. Insur. yatients
153 90 63 — —
Running costs:
Total ofthis:
cost Govt. Municip. Insur. patients
1020 450 448 62 60
Of the total running costs in health centers,
68% was for outpatient care and 32% for in-
patient care in the health center wards.
The Primary Health Act of 1972 foresaw a
gradual decrease in the out-of-pocket fees paid
by patients attending health centers and by 1979
these fees would be abolished entirely. All pro-
motive and preventive health care services are
free and certain patient categories pay nothing
at all. Others pay a standard fee which at the
present is 6 mk (approximately U.S. dollars
I. 40) for the first visit and half of that for
subsequent visits. Due to the change in the
overall economic situation abolishing the fees
by 1979 may be reconsidered.
II. PROBLEMS AND PROGNOSIS
The present primary health care system in
Finland is built on a tradition of municipal
responsibility for the primary care of the popu-
lation. This system of care has developed
gradually over the past 100 years or so pro-
viding a foundation for the Primary Health Act
of 1972 which at present is being implemented.
Because of an overemphasis on medical care
and hospital with subsequent domination of
,,the medical model" in the 1950s and 1960s
there is a tendency both among the population
and some of the health personnel to underesti-
mate the role of the health center as provider
of primary medical care. This causes a tendency
to by-pass the health centers and go directly
to hospitals but this is now countered by hospi-
tals requiring a referral from the health
center.
Primary health care as provided through the
health center is only partly understood, but the
MCH services provide the backbone of these
functions in people’s minds and the entire
health center has been living off the capital of
goodwill created by decades of MCH-work.
Gradually the other promotive and preventive
services are being appreciated as new genera-
tions of health workers and consumers emerge.
Training of doctors and nurses in primary
health still leaves much to be desired. The same
can be said about continuous education of politi-
cians and decision makers at the municipal,
regional and national level.
As long as there is a strong emphasis on
medical care in the health center and in the
attitudes of the population there can only be
limited awareness regarding the need to in-
voive the community in primary care. This
awareness only grows with increasing emphasis
on health care, health promotion and health
education. Realizing that the reasons for health
are complex and to be found mainly in the
everyday life situations and decisions of people,
their attitude and life styles it becomes much
more important to involve people as individuals,
families and groups of citizens. This is already
evident in environmental health efforts but
these have been too separated from the rest
of the health center functions until now. With
increasing integration of environmental health
with the rest of the health center the com-
prehensiVeness of the total life environment
should become more evident to all and have
effect on the health center activities as a
whole.
New efforts to strengthen health promotion
and health education, e.g., implementation of
legislation on smoking and health, nutritional
programmes and preventing cardiovascular dis-
eases, have indicated the need for closer co-
operation between health workers/health cen-
ters and civic organizations and citizen groups
and the first administrative measures have
already been taken to enable an increase of
such cooperation, e.g., through the formation
of coordinating bodies in the municipality bet-
ween authorities and organizations of different
kind. Apart from health authorities, this also
involved, e.g., school boards and those working
against alcohol abuse, for youth, sport, recrea-
tion, etc.
The relationship of health care and social
services has been unclear and weak in the
past. The experience that social workers have
of the total life situation of people and patients
has not been brought to bear on the total
health center functions. Today’s and tomorrow’s
needs among the aged population in Finland
are already bringing social service and health
care together for mutual assistance and bene-
fit to the patient. Organizational changes are
taking place to integrate social welfare and
health services at the municipal level and the
first steps have already been taken to adjust
administrative, planning and financing mecha-
nisms accordingly.
CONCLUSION
Finland has a long tradition of local responsi-
bility for primary health care and the Primary
Health Act of 1972 provides a good legislative
framework for the development of primary