Voters in Finland will later this month cast their ballots in the country's first regional elections that will revolutionise the way the Nordic nation provides health and social care.
The county elections will be held on 23 January but advance voting opens on Wednesday.
It's the result of the biggest reform to the country’s public health system for decades and transfers responsibility for social, healthcare and emergency services from an unwieldy 294 individual municipalities — half of them with fewer than 6,000 residents — to a more streamlined 21 new regional authorities whose boards are directly elected.
Voting takes place in all parts of Finland except the capital Helsinki, and the semi-autonomous Åland Islands.
The reforms are a flagship policy for prime minister Sanna Marin’s Social Democrat-lead coalition, and usher in sweeping and difficult changes that have eluded previous governments: former prime minister Juha Sipilä staked his administration’s whole legacy on overhauling Finland’s health system, but resigned in spring 2019 when a deal could not be reached.
Demographics are biggest drivers of change
But the problems facing the current healthcare setup, aside from individual municipalities all potentially making their own local policies, are more to do with shifting demographics.
Finland has one of the oldest populations in Europe, with the share of over-65s projected to increase from the current 22% to 26% by 2030, and then to 29% per cent by 2060.
This, coupled with the rising age of first-time mothers and a low birth rate, sets up a problem where rural areas become disadvantaged in terms of healthcare provision - with municipalities becoming too sparsely populated or too tax-poor to properly care for elderly local residents or even recruit the right staff.
The new regional system aims to redress that balance going forward.
Reforms don't set pulses racing
While the provision of social services and healthcare, and emergency rescue services, impacts everyone living in Finland, the upcoming elections have not exactly sparked a lot of enthusiasm.
A recent poll suggests turnout could be lower than 40% with the centre-right National Coalition Party on track to win the biggest percentage of votes; followed by Sanna Marin’s Social Democrats and the right-wing Finns Party.
“The major political faultline is between privatisation, and the public organisation of these services,” Markku Jokisipilä, Assistant Professor at the University of Turku’s Centre for Parliamentary Studies, explained to Euronews.
“These new regions have real power, the power to choose between public providers and then private providers. But how radical the changes or the decisions made by these new councils will be, that remains to be seen” he said.
In theory one region dominated by the National Coalition Party could open up a lot of its health services to private providers, while the region next door run by left-wing parties might provide everything with their own resources. However, Jokisipilä thinks that’s not likely to happen in reality.
“There might be some differences between these 21 regions but the differences in the end won’t be that big, because all of the big parties will have a say in that. It’s all about bargaining. Everybody gets to say something and the more votes you get, the more you can say.”
Candidates discuss their motivation to run for office
In southern Finland’s Uusimaa region, Karin Cederlöf is worried about the possible low voter turn-out.
She’s running on the ballot for the Swedish People’s Party, one of the five parties in the ruling government coalition, and currently also serves on the Espoo city council, Finland’s second-largest city.
“Unfortunately during the past weeks it’s become quite apparent that there are many people who don’t know what these elections are all about,” she told Euronews.
“For people who don’t follow politics, I think it’s hard to visualise what is happening, and what parts of the administration are moving from the municipalities to this new regional level.”
Cederlöf also notes that differences in healthcare provisions between municipalities can be quite stark, but the new, bigger regions should be able to guarantee that everyone receives the same level of service.
In the Central Finland region, Dr Ville Väyrynen is running on the National Coalition Party ticket, and as a surgeon who comes from a small municipality, he reckons he’s got some unique insight into the issues facing the country’s healthcare system.
“For a medical doctor to be in these kinds of elections, well there’s no way for me to miss it. We’re going to build a totally new healthcare system in Finland,” he said.
While some senior members of his party have been outspoken about how the new funding arrangements can be a disadvantage for big cities, like Helsinki, Dr Väyrynen thinks there are pros and cons for his part of the country, even as some services become more centralised.
“I think in Jyväskylä [the main city in the area] we will benefit from this kind of new system. Personally, I’m from Muurame which is a small town and I think we’re going to suffer somewhat, but if you think about the whole region I think this is a giant step forward.”
In the south of Finland, Sara Peltola is running on the Green electoral list and says cost savings for procurement will be a major benefit of the new system, to make budgets more efficient.
“This is one of the reasons why some municipalities have already been moving in that direction, pooling their resources, and the good experiences that have come from those areas are the reason now the government wants to accelerate their development,” she argued.
Language rights and healthcare for immigrants
As Finland’s population ages, and more immigration is needed to fill jobs, the issue of how to provide health and social care for people who don’t speak Finnish as their first language also looms large.
This is tied in with language rights in Finland, where a Swedish-speaking minority of around 5% are constitutionally guaranteed to receive services in their mother tongue - which might not always be practical or affordable in different parts of the country.
In Lapland too, Finland’s indigenous Sámi population are also guaranteed services in their own language, a genuine challenge in a vast wilderness area.
Karin Cederlöf thinks technology could be a good solution for all of these issues - and that foreigners should also be able to access medical help in their own language.
“In practice, one solution could be to have more digital services and if a Swedish-speaking person wants to have services in Swedish you could have an appointment with a Swedish-speaking doctor in another region," she said.
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