Directory of European Resources > Eurocleft Clinical Network > Registered Clinical Teams > Finland

Clinical Teams in FINLAND

• Helsinki
• Oulu

Population
Approximately 5.1 million.

Health Service
The Ministry of Social Affairs and Health has responsibility for national health policy, legislation and the state share of financing. Local authorities provide, organise and purchase the major part of health care services for their residents. 446 municipalities own and administer health centres providing primary care for populations of 10,000 - 20,000. Public health centres in Finland provide primary care services and free dental services to those under 19 years of age. The public hospitals are now service providers, selling their services to local authorities and primary care doctors.

Local authorities have the right to collect taxes from their residents. Local councils set the flat rate tax which on average is 17% of incomes. Additional financial support from the state is based on the principle of capitation however the local authorities themselves decide how much they actually will spend on health care. The Ministry covers only the costs of teaching and clinical research directly. The private health services are partly financed by compulsory Sickness Insurance schemes (40%) and partly by out-of-pocket payments. Tax financing covers 75.2% of the total financing of health care expenditure.

Irrespective of income, age, sex, race or area of residence all citizens are entitled to equal access to public health services. High quality of service is the goal and responsibility of all service providers, thus far without any compulsory quality assurance schemes. Quality is attained by observing the principles of ISO 9004, TQM and CQI. The National Board of Medico-Legal Affairs includes a committee for patient complaints.

Cleft Care Organisation
Finland has around 120* new cases of cleft lip and/or palate per year. In the late 1930’s there was an intention to build the first cleft centre but with the intervention of World War II plans were delayed until 1948 when the cleft centre in Helsinki was opened. During the war years in 1939-1945 however, 90% of patients were already receiving their primary cleft surgery from one surgeon in Helsinki. There has therefore been a long tradition of centralised care in Finland and since 1948 over 8000 cases have been operated in this system. In the 1970’s and 1980’s cleft care developed further with the creation of a multidisciplinary team, organised follow up and research studies. In the 1990’s the surgical protocol was simplified and the total number of operations per patient as well as the number of hospital stays, was halved. The national centre trains its own new members on the job. There is an active parent organisation “SUHUPO”. There is also a network of midwives, linked with the cleft centre, that in the majority of maternity hospitals provides information and advice for parents of newly born babies with clefts. A new centre was started in Oulu in the Northern part of Finland in 1998 with an annual caseload of 15 patients, mostly with isolated cleft palate. However the Ministy of Social Affairs and Health continues to recommend that primary cleft care should be centralised in the Helsinki centre only.

Challenges to Attaining the Eurocleft Consensus Recommendations
The Finnish model of care operates over a relatively small population in a large surface area with long distances, particularly in the north and east of the country. There is a single multidisciplinary cleft centre in Helsinki with a new small centre in the north. The majority of the population live in the southern and western parts of the country and the communication system is Helsinki oriented. However the medico-economic system requires vouchers from outside hospital districts for all operations and visits. The Helsinki centre has not as yet had any involvement in intercentre comparison studies but is currently taking part in a multicentre randomised control trial.

Future Plans
Efforts will be made to convince health care authorities and providers of the importance of the network’s recommendations in order to avoid fragmentation of cleft care.

* Number of clefts per annum reported by national representative for Finland