It looks like the governmental coalition is really fighting over the number of regions planned in the SOTE reform (it stands for Social (Sosiaali) and Health Terveys) reform. Maybe they should consider instead discussing the question of inequalities, which is more serious for the citizens…
Why do they fight
.Kokoomus, the Finnish conservatives lead by Alexander Stubb, wanted to limit the number of regions after the reform to 5, and Keskusta, the Centre party of Prime Minister Sipilä, wanted 18 regions. An expert group has proposed 12 regions, and everybody was expecting that a compromise would be agreed on this basis. But M. Sipilä and his party disagreed, and said to Kokoomus: “if you don’t accept, we will put you out of the government”.
Politically, we cannot, at Finland Politics judge if Juha Sipilä is right to use regularly the method of ultimatum in order to get what he wants. After all, as stressed by some other media, President Kekkonen has been very successful in using the same type of method to lead Finland in difficult times, and he seems to have been quite successful. Certainly, M. Sipilä knows the recent Finnish history, and may be tempted to have the same attitude, even if circumstances seem different. It is certainly risky, but until now he and his party have kept quite high their level of popularity.
However, it is quite clear for the observers that the fight in the coalition is about the political influence between the different parties: with a large number of small regions, Keskusta will be alone in the leading seat in a large number of regions. If the number of regions is more limited, then there will be a large influence of the other parties in all regions, and Keskusta would not be alone in the driving seat. So this fight is about the political influence of the parties in the new system, not about the interest of the citizen.
Anyway, when we observe the situation in other countries, one can note that there is a tendency to increase the size of regions and transfer to them some of the responsibilities from the central level, which is decentralisation. In the Finnish system, we observe a movement towards centralisation from municipalities to the regions. But there is no correlation between the size of the public authorities responsible for health care and the efficiency of the system: Denmark, with 5 regions managing health care, is clearly less efficient than Sweden, with 20 regions. In the social field, it is more difficult to measure, but transferring the responsibility of the social affairs far away from the municipalities who are in charge of education and social housing may be risky.
Some serious topics that would need the attention of the government
If fact, we would have expected some fight on more serious topics for all of us. As indicated by Juho Saari, Professor at the Eastern Finland University, in an interview on Finland Politics in April 2015, “today if you are working, and you have a steady work contract, you never use municipality services for health care, but private service providers (in some cases, municipalities’ health services may act as an occupational health unit). So, we have two different systems. On the one hand, we have the services provided by municipalities, and then we have occupational health. And this system is exceptionally unequal, in the way that people with less resources are using these services from the municipalities, provided by municipalities, and everybody else is using occupational health, with the exception of specialized health services that are provided at the regional level, and they cover both sides”. So we would expect to hear about strong discussions on this topic, with Keskusta pushing for the public service, and Kokoomus for more privatisation, and not about how many position of chair of the board of regional boards each party will get.
The funny point is that, except for the inequality indicated by Professor Saari, the situation of the health system in Finland is not so bad: it is among the most efficient in the world, with costs significantly lower than those of the other Nordic countries such as Sweden, Denmark and Norway, and quite satisfying health indicators (see here Bloomberg ranking 2014). The main problem, as stressed by the Finnish National Institute of Health, is the increase in the last 15 years of health inequalities, and that is what we would expect to discuss in the government and the Parliament, definitely not the number of regions…