Finnish solutions and experiences for integrated primary health care

PhD Simo Kokko. National Institute for Health and Welfare, Kuopio, Finland.

Background: Finland has since 1972 had a primary health care system based on health centres run and funded by the local public authorities called ‘municipalities’. On the world map of primary health care systems, the Finnish solution claims to be the most health centre oriented and also the widest, both in terms of the numbers of staff and also of different professions employed. Offering integrated care through multi- professional health centres has been overshadowed by exceptional diffculties in guaranteeing a reasonable access to the population at times when they need primary medical or dental services. Solutions to the problems of access have been found, but they do not seem durable.

Description of policy practice: During the past 10 years, the health centres have become a ground of active development structural change, for which no end is in sight. Broader issues of municipal and public administration structures are being solved through rearrang- ing primary health services. In these rearrangements, integration with specialist services and with social services together with mergers of health centres and municipalities are occurring at an accelerated pace. This leads into fundamental questions of the benefts of integration, especially if extensive integration leads into the threat of the loss of identity for primary health care.

Discussion: This article ends with some lessons to be learned from the situation in Finland for other countries.

Key Words: primary health care system, social services, Finnish solution

Kokko S. Finnish solutions and experiences for integrated primary health care. Shidnoevr. z. vnutr. simejnoi med. 2016;1:87-94.


1. Vuorenkoski L, Mladovsky P, Mossialos E. [Finland: health system review]. Health Systems in Transformation. 2008; 10 (4): 1–168. Available from the European Observatory on Health Systems and Policies website: yInputSubmit.
2. OECD Reviews of Health Systems: Finland. Paris: OECD; 2005. (OECD Reviews of Health Systems 2005; (21): 1–110).
3. Oulasvirta L. [Doctoral thesis]. Tampere: University of Tampere; 1996. Kuntien valtionapujärjestelmä (Series A: 494). [in Finnish, with English summary]
4. Moisio A. Spend and tax or tax and spend? Panel data evidence from Finnish municipalities during 1985–1999. Helsinki: Government Institute for Economic Research; 2000.
5. Aro S, Liukko M. VPK väestövastuisen perusterveydenhuollon kokeilut 1989–1992. [Pilot projects on list based primary health care in 1989–1992]. Helsinki: Stakes; 1993. (Report 105). Finnish, English.
6. Mäkelä M, Åström M, Bergström M, Sainio S. Alueellinen väestövastuu terveyskeskuksissa: toiminta ja kustannukset. [Principle of local residency based responsibility in primary health care; activities and costs]. Helsinki: Stakes; 1993. (Report 107). Finnish, English.
7. Kangas M. Väestövastuujärjestelmä 10 vuotta: edut ja mahdolliset haitat. [10 years of list-based personal doctoring in primary health care; advantages and potential disadvantages]. Suomen Lääkäril. 1999; 54: 21-61. Finnish, English.
8. Kokko S., author; Uusitalo H, Staff M, editors. Kunnallisten sosiaali- ja terveyspalveluiden muuttuvat organisointitavat. [The municipal social and health services are changing the organization]. In: Sosiaali- ja terveydenhuollon palvelukatsaus. Gummerus Oy, Jyväskylä; 1997. Helsinki: Stakes; 1997; 49–71. Kirjassa. (Report 214). Finnish.
9. Allen J, Gay B, Crebolder H, Heyrman J, Svab I, Ram P. The 2005 edition. WONCA; 2005. The European Definition of General Practice/Family Medicine. Available from: http://
10. Huttunen J. [Unpublished presentation material used in regional consultative meetings in Finland] in 2001.
11. Finnish Ministry of Social Affairs and Health. Sosiaali- ja terveysministeriö [Ministry of Social Affairs and Health] In: National project to ensure sustainability of health services. Helsinki: Finnish Ministry of Social Affairs and Health; 2002. Available from:
12. Association of Finnish Local and Regional Authorities. [Project to restructure local government and services]. Helsinki: Association of Finnish Local and Regional Authorities; 2008. Available from: asp?path=1;161;279;280;105989.
13. Suomen Lääkäriliitto [Finnish Medical Association] Kunnat ulkoistavat kokonaisten terveysasemien toimintaa. Lääkärityövoimakatsaus lokakuu. [Municipalities contracting out the operations of entire health centres, overview of employment of physicians]. Helsinki: Finnish Medical Association; 2008. Finnish
14. Statistics Finland. Population projection 2007–2040. Helsinki: Statistics Finland; 2007. Available from:
15. Hukkanen E, Vallimies-Patomäki M. Yhteistyö ja työnjako hoitoon pääsyn turvaamisessa. Selvitys kansallisen terveyshankkeen työnjakopiloteista. [Co-operation and division of tasks in ensuring access to care. Report on the pilot projects on division of tasks in the national health project]. Helsinki: Ministry of Social Affairs and Health; 2005. (Selvityksiä 2005:21). Finnish.
16. Sosiaali- ja terveysministeriö [Ministry of Social Affairs and Health] Sosiaali- ja terveydenhuollon kansallinen kehittämisohjelma Kaste 2008–2011. [Governmental development project KASTE for social and health services in 2008–2011]. Helsinki: Ministry of Social Affairs and Health; 2008:6. Finnish.
17. Kokko S, Peltonen E, Honkanen V, editors. Perusterveydenhuollon kehittämisen suuntaviivoja. Raportti perusterveydenhuollon vahvistamistoimien suunnittelutyöstä. [Development of primary health care. Report of a process of planning for measures aimed at strengthening primary health care]. Helsinki: Institute for Health and Welfare; 2009: 13. Finnish.