Sote reform debacle comes back to haunt new government

Fewer, larger administrative regions, optional private sector involvement and special arrangements for the capital city region seem to have won over political critics.

Leaders of 5 parties in government coalition negotiations, Wednesday 8th May 2019 / Credit. Laura Kotila, Valtioneuvoston kanslia

Plans to reform Finland’s social and health care, and regions, known as sote, are causing problems for the new government before it’s even taken office.

Politicians and party officials from the Social Democrats, Centre Party, Greens, Left Alliance and Swedish People’s Party have been locked in weeks of talks to hammer out policy positions for the next coalition government.

Today, they announced that responsibility for organising health and social services would be transferred to 18 regions, larger than municipalities. There will be special provisions made for Helsinki and the capital city region.

A similar plan from the last government, pushed hard by Juha Sipilä‘s Centre Party, was mired in negotiations, and couldn’t win parliament approval. Ultimately it brought down the government in March.

File picture showing detail outside House of the Estates in Helsinki / Credit: News Now Finland

What is sote reform? 

Politicians broadly agree there’s a need to modernise and reform the way Finland provides social and health care for its citizens, especially with an ageing population.

However, there are differences of opinion between the various parties, and between central government and big cities, on how it should happen.

The last government also wanted to reduce the number of Finnish regions, so that health care services could be managed on a larger, central scale, rather than at dozens of smaller municipalities.

Experts repeatedly told the last government that there shouldn’t be any more than 12 regions.

The last government also wanted to introduce more options for patients which in practice meant opening the market up to private operators. Fans of this proposal said similar moves have worked well in Sweden, introducing cost savings and welcome competition. Critics said that inevitably costs will rise for Finns and lead to more inequality.

Clarifying the new proposals, special capital considerations 

It looks as if a balance has been struck between opening the market fully to privatisation, and allowing some elements of choice to be controlled more at local level.

On Thursday afternoon Left Alliance chair Li Andersson said the new proposals from the fledgling coalition government have “nothing to do with privatisation, it allows for the strengthening of service chains”.

Green party chief Pekka Haavisto also told reporters that “third sector and private services can be used, but this will be left to the self-governing areas to decide how much”.

Last year, both the Left Alliance and the Greens were staunchly against Sipilä’s government’s plans to open the market up to more privatisation. They have now signed up to this modified proposal.

There will be some special arrangements worked out for Helsinki and the cities of the capital region, but critics say that all large cities should have their own bespoke deal.

Previously, a coalition of Finland’s largest cities lead by Helsinki mayor Jan Vapaavuori (NCP) argued that reforms to healthcare funding would place an unfair financial burden on bigger cities, compared with the current system.

Cities also argue that they know best when it comes to caring for their own residents, rather than leaving things to a larger regional body.

Today Jan Vapaavuori called the plans a “nightmare”. There was also criticism in the Finnish media from senior officials in Turku, Tampere and Vaasa.

“It’s a bad start for cooperation between the Government and the cities” Vapaavuori wrote on Twitter.