Finnish parliament kills government plan to incorporate public primary care providers

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Public health experts in Finland have welcomed the surprise decision of the parliamentary constitutional committee to dismiss a government plan to transform public primary health care providers into commercial companies.

In a unanimous decision on Thursday, the constitutional committee asked the government to find another way to arrange “freedom of choice” for patients.

However, the committee did not cancel the principle that patients could in the future choose between private and public services providers, at public expense and with the same rates.

The denied government bill had been based on the idea that public services would compete on a equal basis with private health care, and should therefore be turned into companies for reasons of transparency. As independent legal entities, they could have gone bankrupt if their business did not go well.

Local experts warned that public health centers with no experience in commercial operations would have become an easy victim to major commercial health companies. The commercial health sector has attracted capital investors in recent years and has been largely consolidated into a few companies.

The National Institute for Health and Welfare welcomed the committee decision. Deputy director general Marina Erhola said the agency had always been concerned about the incorporation intention.

Strongest criticism came from the Confederation Industries known as a defender of business interests. Director Ilkka Oksala said incorporation would have brought financial savings that were lost now.

Both the centrist Prime Minister Juha Sipila and conservative leader Petteri Orpo disassociated from the original plan some days before the constitutional committee decision. Sipila had been a strong defender of incorporation earlier, but now said he had had doubts about it.

LOBBYIST IMPACT QUESTIONED

The death of the health care bill raised again the debate of poor legal preparation of bills submitted to the parliament.

Kaarlo Tuori, professor emeritus at Helsinki University Law Faculty and one of the key experts heard at the constitutional committee, blamed the current lobbyist culture as a reason for the bill getting this far in parliament until it was stopped.

He said in an interview with national broadcaster Yle that “lobbyists have increasingly entered the corridors of power in Finland, and views from professional experts are not listened to”.

Over the last year, several conservative party aides and parliamentarians have left politics to work for the commercial health care industry or in public relations agencies. Tuori said this would amount to “political corruption” in some other countries.

Velipekka Viljanen, a professor of constitutional law at Turku University, told Yle that the committee decision offered a major definition of the scope of public service in Finland.

The killed plan “meant ousting the public sector. The whole primary care would have been transferred out of public control”, he said.

The committee decision has reopened the political give-and-take deal of the center and the conservatives in November 2015. In the deal, the center got the provincial autonomy and the conservatives the “freedom of choice” in health care.

The constitutional committee had no complaints about the provincial reform, but the conservatives may not accept its implementation until their health sector goals have been reached as well.

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