Finland’s new regional welfare areas were established about two and a half years ago after a long and heated reform process. They came with promises of more equal and accessible services, as well as a more cost-effective system. Yet many citizens are now asking: what did we actually get in return?
Waiting lists are growing, local services are shrinking, moving online, or drifting farther away. Healthcare staff are being cut while cost-saving targets dominate public discussion. Meanwhile, unemployment, long-term sick leave, and disability within the sector are increasing – costs that, in the end, fall on society as a whole.
The situation is especially contradictory for staff. Just a few years ago, the talk was all about a shortage of nurses and how there weren’t enough skilled workers. The need has not disappeared. Yet under financial pressure, the very same workforce is now being reduced. There is still more work than there are hands to do it, but no money to pay for those hands. The result is that the remaining employees are overburdened, and many burn out. That helps no one: not the patients, not the workers, and not the economy.
From the outside looking in, the reform doesn’t seem to have streamlined administration at all – quite the opposite. Welfare areas have created new layers of hierarchy, additional governing bodies, and multiple tiers of management, all presented as a “light and agile structure.” In reality, it feels more like a sleight of hand. Resources increasingly flow into bureaucracy rather than to the people and services that need them most.
At the same time, decision-making has drifted further away from people’s everyday lives. In the past, a citizen knew who was responsible for their local services. Today, the regional council and its executive board make the calls, but the voice of any single municipality is drowned out. Nationally, the welfare areas are treated as one uniform mass, even though demographics and needs differ dramatically. South Savo is a prime example: an aging population and long distances create challenges that no national average can solve.
Short-sightedness has also shown up in specialized care. Transferring institutions like Vaalijala, a national center of expertise, under the responsibility of South Savo’s welfare area may prove to be a serious mistake. Its services have traditionally been provided nationwide. Now, under financial pressure, outsourcing is being cut, and expertise risks splintering across multiple regions. That is neither cost-effective nor sustainable for specialists or patients.
For the city of Pieksämäki, Vaalijala’s role as a national center is a matter of survival. It is a major employer and part of the city’s identity. If its role diminishes and jobs disappear, the impact could be as severe as if the paper mill were to close in the neighboring city of Varkaus.
The reform was supposed to eliminate overlap and bring savings. The real danger is that we also lose what was working: skilled staff, centers of expertise, local accountability, and a sense of human scale. As everything is merged into a massive, average-based funding machine, decision-making grows more distant and everyday problems get buried under reports, statistics, and austerity targets.
The central question is this: did the reform actually improve services, make the system more efficient, or streamline the organization? Or did we rush to reform for reform’s sake – and throw the baby out with the bathwater? So far, it looks like the gap between promises and reality is wider than ever.
And yes – for American readers who may stumble across this blog, I realize that the very existence of public healthcare services probably sounds like utopia. Sorry about that.