I am an American Documentary filmmaker/composer who has lived and worked here in Finland over 40 years. Previously, I always admired the Finnish Health system and often described it to people in the US as an example of how a National Health Service could function. .. Unfortunately, these past years have been very alarming to me, watching the healthcare service become less and less effective and economically weakened. I have written some thoughts on what appears to be many of the main reasons for the present-day situation of health care troubles in Finland.
The Finnish National Health Service (FNHS) is facing a growing crisis largely due to an unequal relationship with private medical companies. The government invests heavily in educating healthcare professionals, while private firms benefit from this taxpayerfunded system without contributing back. Medical education in Finland is rigorous, lengthy, and expensive. Yearly budgets for medical equipment, operating facilities, the annual price of the medical teaching staff and guest specialists participating in
educational programs for the 6-8 years and longer period of studies is all very costly. Stipends and grants are provided to medical students for the years of study. …Altogether, an immense cost.
The Finnish National Health Service, (i.e., the public tax-payer), finances this entire system towards medical education and the creation of medical personnel in Finland. All public education in Finland is free, supported by the Finnish state. However, there is no other profession that demands the sums necessary for the multi-year period to complete studies that even closely demands the sums needed towards educating the medical profession.
Historically the medical graduate worked for the Public Health Service, this same public system that educates the medical professional. Today the new doctor has free hands, without any responsibility towards the public funding of their education, to decide to either work for this National Health Service that educated him, or work for the salaries offered by private medical firms. Many newly qualified doctors opt for more lucrative positions in private companies, leaving the National health serive understaffed and struggling to meet public demand. These private firms offer much higher salaries, creating a brain drain from the public system.. The public is left paying twice—first through taxes that finance medical education and again out-of-pocket for private healthcare services that employ these same publicly trained doctors.
Does this make sense to anyone?
It would be the equivalent of Microsoft paying all expenses of training their personnel for a 6–10-year period and then simply, without contract restrictions, allowing them to walk over and work for Macintosh. Private medical firms play no part in educational expenses, on the contrary they only benefit from their medical staff’s education.
This imbalance has led to a mass exodus of healthcare professionals from the Public health service, further compounding the staffing crisis. The 3 largest private firms have expanded by acquiring smaller clinics and healthcare providers, driving up the cost of healthcare services. A 20-minute appointment
with a private general practitioner will be from 90 – 120 Euros, and a top specialist can cost up to 200 – 300 Euros for 30 minutes. This is the same medical specialist who will meet patients at a public institution via a health clinic referral for basically no charge to the patient
The questions arise, – where are reciprocal responsibilities of medical graduates after having been supported by public funds for 6,8, 10 years? And, is there any responsibility of these private medical companies towards the public funded educational costs of their staff?
In Britain there has been constant discussion in parliament concerning reciprocation for studies by medical personnel not working within the NHS, whether they move abroad or work for private firms. This issue is not discussed here in Finland, as if the taxpayer is obliged to pay costs for medical education without compensation from either doctor’s working for private firms or from these medical firms themselves.
In the US, there is a program entitled The National Health Service Corp. It can pay part or all of a person’s medical education expenses and in return, the doctor is obliged to work in a specific disadvantaged area for at least a three year period or repay their educational support. The National Health Service Corp had its budget reduced significantly under President Reagan, but was greatly
expanded as part of President Obama’s Affordable Care Act.
In France there was a period where special monetary support was given for people to study in professions urgently needed, then the graduate was obliged to work for 5 years in that profession within France. Today, publicly educated nurses are obliged to work for the public health system for a period of 5 years to reimburse their education.
In many countries the graduating medical student would have hundreds of thousands of euro debt after studies. In the US, costs of medical studies can easily go into many hundreds of thousands of dollars creating gigantic loans to be repaid.
If one uses the services of the National Health System, (assuming there were the doctors and staff needed to function properly,) the cost to each individual no matter how often he visits the health clinic is 40 to 60 Euros a year. Now, not only does the system not function as designed, but also is progressively worsening with this movement of publicly educated doctors over to private medical firms. Municipalities and public health services are increasingly forced to turn to private firms to meet their staffing needs, hiring temporary or contract doctors at inflated rates. This creates a vicious cycle, draining public funds that could otherwise be used to improve public healthcare.
Recently, Dr Joona Kiili found an advertisement for a ‘temporary doctor’ to work in his same health clinic being offered 6000€ per month more than he earns. This salary, which doubled his own basic salary, didn’t even include the obligation to be on open call. With fewer doctors in full-time work in the public sector the workload increases, and is patched up by hiring ‘temporary doctors’ from private companies at extremely expensive pricing.
A district in South Karelia was charged 315,000 Euros a month for three ophthalmologists (eye surgeons) from the private sector. The district usually would pay these specialists 10 – 15,000 a month. The district received this bill from Mehilainen which justified its charge of 315,000€ a month by stating the tasks ordered by the district had been divided between 22 ophthalmologists. (source YLE 2.10.2023) . How much went to actual doctors’ salary and how much to ‘company services’ is the question here. This sounds completely outrageous.
Mikko Pietilä, Hospital Director of the Wellbeing Services County of Southwest Finland, stated doctors with public service positions are being recruited by temp agencies on social media for double or triple their present salaries to do the same jobs. He fears ‘unchecked privatisation’ in the form of a mass exodus of doctors from the public sector. “With this shortage of doctors, someone is trying to buy them up quickly and sell them back at a higher price,” Pietilä told Yle.
An added twist of absurdity to this system of ‘renting temporary doctors’ from private firms is a Latvian medical agency that has actually recruited Finnish graduates and 5th year medical students studying there, and hires them out to work to the Finnish national health system. (source YLE). .. This Latvian agency is paying their recruits salaries one third higher than in-house doctors, with free accommodation provided. One can image the charges being paid to this Latvian agency enabling them to pay these salaries and accommodations.
The Finnish National Health System temporary labor costs for the year 2023 were 600-700 million euros. (source Helsinki Sanomat 01,10,24) Hundreds of millions of Euros yearly are being spent by this present government to private medical clinics for, ‘rent of temporary medical staff’ instead in support of the National Health System itself.
This all illustrates how private firms are profiting at the expense of an underfunded public healthcare system. Mehilainen has more than doubled their size and income in the last 5 yrs. Since 2018 their overall revenue has grown from 915 million in 2018, to 1850 million in 2023. During this same period, the company has expanded into Estonia, Sweden, and Germany.
In May 2024, Director General Kirsi Leivo of the Finnish Competition and Consumer Authority stated: “The FCCA has no effective means to address this type of consolidation. There were almost 300 mergers where large operators acquired small local medical and dental clinics. Small and medium-sized enterprises operating in local markets may be taken over by large chains at will. The fact market
concentration may occur entirely outside regulatory control is the biggest drawback of Finnish competition policy. …This has led to price increases in the health care market.”
Where are regulatory controls on pricing by private medical firms? While the cost of public health clinic care is 60 Euros a year, the maximum yearly charges for all public health services, hospital stays, operations, etc., has an upper limit per calendar year of 692 Euros. Just one private clinic meeting with a specialist for 30 minutes can cost 300 Euros. All pointing towards no regulation.
Additionally, budget cuts have further strained the Public Health System. The Hospital District of Helsinki and Uusimaa (HUS), the largest hospital district in the country, faced a 44 million Euro budget reduction, leading to longer wait times for medical services, reduced access to care, and even facility closures. The administration at HUS has made it clear that many life-threatening operations will have to be put off indefinitely. This is contrary to the central concept of Nordic welfare, where: ‘the entire population has an equal possibility for medical care without any relationship to economic status.’ When more and more people cannot get into the National Health Service for their medical needs, then more people go without health care entirely due to prices they cannot afford at the private clinics. Taking care of one’s health is the number one priority. This is precisely why the Finnish state pays so much of taxpayer’s money towards this health service, to give future doctors the best possible educational facilities and teachers’ possible. This well constructed system is unraveling. How is it possible for the Public Heath Service in Finland to be short 1000 medical personnel when every year there are between 600 – 800 medical graduates? Thou Finland’s has less graduates than the EU average, ‘doctors per population’ is similar to many other European countries. When one contacts the local health clinic for medical assistance, the wait for a doctor’s appointment can be a month or months. However, a general practitioner at a private medical clinic is found within hours. While the number of doctors has increased by a third in the past two decades, the public sector has an ever-increasing shortage of personnel while the private sector expands. The present role of the private sector has become detrimental for the National Health Service.
In summer 2021, closures of health centers due to staff shortages was first seen in Finland. Six (6) health centers in North Karelia were temporarily closed when no workforce could be found during the holiday season. In the summer of 2024, staffing shortages have caused temporary closure of 120 health centers across the country. Where do people go for treatment? Also, 5 of Finland’s maternity wards have plans to close because they have fewer than 1000 births a year. Does this make sense that a maternity ward must have a minimum of 3 births a day to remain open? Where are these mothers-to-be supposed to find other maternity wards to give birth?
Private health care is partly subsidized via KELA by reimbursements of patient expenses. This sum was raised from 8 to 30 euros per appointment in 2024 in an attempt to shorten waiting times in the public sector. After 6 months, the result was a 260% increase of reimbursements to companies with basically no effect on patients, while shifting 31 million more euros of public funds to private firms.
Why should KELA, a public funded government organization, pay the private sector when that same private sector entices doctors away from working in the public health system, weakening it? When the government ‘rents’ surgical procedures, an average knee operation at private care is 8,000 euros, and a hip operation is 15,000€, money paid directly from public funds that could go to support of the national health system. It is as if this system is paying to strengthen private health care at the expense of the national health service.
The pricing of private firms should be regulated and discussed publicly. How is it when the percentage of KELA payments to private medical care went up in 2024, so did prices at private firms rise by 10%.
The entire question of charges and pricing of ‘rented medical staff’ from private firms should be publicly discussed and resolved in regulations, as the previous examples demonstrate a complete ‘wild capitalist’ approach in terms of the incredible sums charged to public funding.
When Finnish society finances a doctor’s medical education, medical graduates could reciprocate by working in the public sector for a certain required period, as a form of reimbursement for education. This could be discussed towards resolving shortages of personnel in public health similar to
the discussions concerning the NHS in Britain.
Also, an approach might be to require private healthcare companies to contribute to the cost of medical education, acknowledging their reliance on a publicly funded workforce, a form of compensation for ‘educational expenses’ paid by the public for their medical staff. The raising of the amount of yearly medical students is also a question to be studied and an obvious plus towards health care. This discussion is now ongoing in terms of educational capacity, cost, etc.
In Finland, 78 percent of the entire health and social services sector is funded through public expenditure, and similarly 95% of hospitals budgets are financed by the public. Of the nation’s 15,286 hospital beds in 2021, 14,723 were in public care. When the public pays the overwhelming expenditures for health care, the priority should be to economically support that public health care system. The Finnish National Health Service is the last place the Finnish public should allow to be economically drained or exploited by a private profit interest.
As more healthcare workers leave for private practice, the National Health Service is increasingly at risk of failing to deliver the level of care expected by the Finnish population. The system’s sustainability is now in serious question, and without significant reforms, Public Health Service will continue to deteriorate. The consequences will be longer waiting times, understaffed facilities, and diminished healthcare access, for all but the population that can afford private care. Without reforms, the imbalance between the National Health System and the private sector will continue to grow, threatening the entire future of public healthcare in Finland.