health – SULONORTH

Finland’s healthcare has a pretty good reputation globally. Medical journal Lancet’s study The Global Burden of Disease ranked the country’s healthcare among the best in the world in 2018. Still there is always room for improvement.

Local health centres vs big hospitals

In fact, Finland’s new government aims to reshape the country’s health sector. According to the government, the Northern European country’s weakest link when it comes to healthcare is primary care at local health centres which are often underfunded compared to big hospitals and don’t attract the best medical talent.

Currently, for non-urgent care, these health centres are by law required to give an appointment within three months. The new government plans to decrease the waiting time to only seven days. The government’s programme reads: “The maximum waiting times for access to primary healthcare will be shortened so that access to non-emergency care must be arranged within a week (7 days) of the assessment of need for care.” This is yet another ambitious goal that the new government has on their agenda. You can read more about their other ambitious goals on our previous blog post.

The National Institute for Health and Welfare has estimated that bringing down the maximum appointment waiting times in Finland would require 1,600–2 ,600 more health centre doctors. The government is hoping that 1,000 will be adequate enough and estimates the cost for this to be €50 million. Apparently 1,000 new GPs will suffice since the newly improved health centres will be better managed and use more digitalisation (will going digital be the answer to every problem?). In the government’s own words, they plan to create “multidisciplinary health and social services centres that harness the possibilities of digitalisation and modernise division of work to make better use of different professionals’ skills and of specialist consultations.”

Counties to receive more funding

Another big step the government is going to make in terms of the health sector is the health and social service reform that seems quite similar to the one that the previous government had set the groundwork for. This means that the responsibility for health services will be moved from municipalities to 18 autonomous counties. The counties will be run by elected councillors and there will be five collaboration areas for specialist healthcare between the counties. Citizens are free to choose which county’s healthcare they want to use. The public sector will dominate in providing the care but private healthcare will also be used when needed.

“The counties will receive most of their funding from the central government. We will reform the system for financing health and social services so that it is structured on needs based criteria” the government programme reads.

Making an appointment

I have experience with healthcare in five different countries and I have given birth in both Finland and UK. My experiences with Finnish public healthcare has been mostly positive. Having two small children I usually have gotten care pretty fast and haven’t had to queue for long. The longest I ever had to queue when visiting a health centre without an appointment was for about an hour and 30 minutes. But usually I have only had to wait for about 15 minutes.

In Helsinki, if you need to visit the doctor on a weekday you ring a callback service for your local health centre to make an appointment. The nurse will call you back the same day usually within two hours and assess the urgency of the situation. Is he/she thinks you should be seen the same day they will first try to make an appointment for an exact time. If all appointment times are taken then you will have to go to the health centre for a walk-in appointment which requires some waiting, depending on how many people are there on that particular day. It works on a ‘first come, first served’ basis. I usually ask the nurse on the phone to tell me what the walk-in situation is so I can estimate if it is worth it to go and wait or if I can hold off and make an appointment for next day.

If you are lucky you might only have to wait for 5 minutes for your walk-in appointment, but some days it can be closer to two hours. This is how it works on a regular week day, on weekend you would have to go to your closest hospital’s emergency care unit.

These appointments at the health centre and the hospital have always been completely free*. However, prescription medicines are not free. They are subsidised by Kela but you still pay some out of pocket. What also costs money is giving birth which I will go into in the next segment of the article.

Giving Birth in Finland – the cost

I have given birth in Finland and in the UK. Both times I received high quality care but at what cost?

In Finland, giving birth in a public hospital is not completely free. This came as a surprise to me since I had never had to pay for any public health services in Finland before this. The cost varies depending on how long you have to stay in the hospital. I stayed only one night and the total cost came to €130.50. On top of the care this included meals, diapers, formula milk and hospital clothes for me and the baby.

Meal time at Helsinki’s Naistenklinikka Hospital

In the UK I stayed at the hospital for five days and the total cost of labour was €0. You read that right. In the UK giving birth at a public hospital is completely free. This also included meals. However, you were supposed to provide the diapers, formula milk, clothes for baby and yourself.

Meal time at John Radcliffe Hospital in Oxford, UK

If I had stayed five day in the public hospital in Helsinki it would have cost €244.5. The daily fee for the hospital stay is €48.90 in Finland. The fee is double if your spouse stays with you but he/she will also get meals and a bed included in that fee. The maximum you would ever have to pay is €683 even if you have to stay in the hospital for a longer time due to serious complications. My fee came down to €130.51 because I also had to bring the baby for an additional check-up due to my early release. The check-up cost was €32.70.

The bottom-line on giving birth (in Finland)

The bottom-line is that giving birth in Finland and UK is not going to make much of a dent in your wallet. Another story is all those American parents. On average giving birth is US costs about €8,900. Parents who are blessed enough to have insurance are usually left with a bill of about €2,700 for vaginal birth. This doesn’t include pre- or post-natal care.

How about safety then? UNICEF’s report on infant mortality rates published in 2018 ranked Finland as the fourth safest place to give birth globally. According to the report Finland’s newborn mortality rate is 1.2, the UK’s stands at 2.5 and in the US the rate is 3.7.

*Free means that these services are paid with tax income and no private insurance is needed to receive care.

Finland has been ranked the happiest country in the world for the past two years. Yet how many jovial Finns have you met? Let me explain what happiness means in Finland…

World Happiness Report

First of all, can happiness be measured? Yes, if you ask the United Nations Sustainable Development Solutions Network. According to their annual Happiness Report: “…the quality of people’s lives can be coherently, reliably, and validly assessed by a variety of subjective well-being measures, collectively referred to then and in subsequent reports as ‘happiness’.” The report takes into consideration these key aspects of life: income, healthy life expectancy, social support, freedom, trust and generosity.

Top 10 happiest countries, according to the report:

Finland
Denmark
Norway
Iceland
Netherlands
Switzerland
Sweden
New Zealand
Canada
Austria

What is happiness?

If happiness can be calculated then we need to define what equals happiness. Finland seems to have discovered the formula.

Yet, Finland’s ranking surprised many, especially Finns themselves. After the release of the report many Finns expressed disbelief on social media. Finland, after all, is a country known for its melancholia and lack of small talk. Also, the PR sets a rather high standard. What if Finland doesn’t live up to the hype?

Happiness in Finland is not what one might think. It doesn’t mean you walk smiling like somebody just cracked a super joke. In Finland you don’t need to feel great all the time to consider yourself content. In fact, Finland has high levels of depression, which is the number one cause of early retirement in the country according to a recent study done by the Finnish Centre For Pensions. The country also has relatively high rates of suicide.

So what is happiness? In Finland, it means not necessarily feeling very joyful all the time. Instead, it means feeling OK and that even if life gets tough you’ll stay OK. And that is the key.

No Worry, No Cry

Happiness is not about feeling extreme highs all the time. Of course, you also don’t want to feel extreme lows all the time. Happiness is about having your emotions somewhere in the centre most of the time. To attain this, Finns rely on a safety net provided by the state. Finns know that that the state is where they can get help if it all becomes less bearable.

In Finland, happiness means that when you lose your job the state gives you a decent unemployment income that gets you through the temporary rough period. Happiness in Finland is when you injure yourself you can go to a hospital and get high quality care without worrying about breaking the bank. Happiness in Finland is that when you find out you are expecting a child you don’t have to start calculating pennies to make sure you can afford it.

Simply put: Happiness in Finland is not having to worry when, pardon my french, shit hits the fan. A future post will get into the ‘nanny state’, though that type of mentality is, sensibly, not widely expressed in Finland.

Everyone wants to be happy. But let me suggest we stop calling Finns happy altogether. A better word to describe them would be to say they are carefree. On a happiness scale of 1-10, most Finns stand in the middle.