Hospital.Help

Berlin – In order to ensure healthcare in structurally weak regions in the future, Germany could take a leaf out of the Finnish healthcare system’s book: the expansion of digitization has progressed there, new medical professions have been established, and budget responsibility was transferred to the regional level at the beginning of 2023.

Franziska Beckebans, Head of Care at Siemens Company Health Insurance Fund (SBK), and Sven Preusker, a freelance journalist and author living in Finland, recently discussed these and other approaches in a specialist discussion.

Demographic developments, the shortage of skilled workers and changing expectations in terms of work-life balance will bring with them new needs and place new demands on healthcare in Germany, particularly in rural areas, stressed Beckebans. In some regions, the healthcare landscape has already become a patchwork.

Care takes place locally, which is why we need more room for maneuver for regional stakeholders, flexible solutions across sector boundaries and freedom in contractual arrangements, says Beckebans. In Finland, budget responsibility has been in the region since the SOTE reform in 2023 – this may also be a way for the German health system to strengthen the financial basis of care.

The SOTE reform also brought together social and health care, explained Preusker. The aim was, among other things, to ensure equal access to care for the entire population and to reduce inequalities in social and health care.

In sparsely populated Finland – there are 18 people per square kilometre, compared to 240 people in Germany – the SOTE reform made it possible to create a regionally organised system in larger units. “Local, outpatient and inpatient healthcare was thus ensured, above all, in rural areas,” said Preusker.

A total of 21 regions as well as the city of Helsinki and the autonomous region of Åland are now responsible for organizing health, social and emergency services, explained Preusker. The services are financed through state grants, which are based on, among other things, the population size and disease burden in the regions.

Primary care via health centers

Health centres are the main providers of primary medical care in Finland. Consultations offered by doctors of various specialties, dentists, nurses and physiotherapists ensure basic care for patients with chronic and acute illnesses.

Health consultations, vaccinations, preventive examinations, dental care and basic diagnostics are other key tasks of the health centers, explained Preusker. In larger centers, there are also inpatient departments available. Here, acutely ill patients can be observed and chronically ill patients can be cared for for a short period of time.

According to Beckebans, an important approach for Germany would be to include nurses, therapists and new professions such as e-nurses, physician assistants or VERAH/NAPa in the care in order to relieve the burden on doctors. “In Finland, this is already widespread. Nursing professionals play a central role in primary care,” explained Preusker.

Their training takes place exclusively at universities. With certain further training courses, they are qualified to prescribe certain medications or extend certain prescriptions from doctors, explained Preusker.

In case management, they take on important tasks in Finnish health care facilities, such as deciding whether a medical examination or medical advice is necessary. The cooperation between the disciplines and professional groups in hospitals is characterized by multi-professional teams, says Preusker.

Beckebans pointed out that there is still a clear focus on doctors in Germany and that doctors have often been skeptical about delegating tasks. However, this must change in order to ensure that care can continue to be provided in the future and to relieve the burden on doctors. As an example, she cited the fact that in Finland, nursing staff take over triage in health centers.

Digitization has also long served as a key tool in Finland to improve healthcare, explained Preusker. Electronic prescriptions have been available since 2008 and can now also be redeemed in Sweden and Estonia. In addition, electronic admissions, referrals and discharges as well as digital consultations and special e-health services for patients also help to relieve the burden on the healthcare system, said Preusker.

Since 2010, a nationwide electronic patient record has also enabled Finnish patients to access their doctor’s letters, laboratory results, medication prescriptions and the like at any time. It serves as a link between the actors involved and the insured person, Beckebans emphasized.

She therefore also called for stronger digital networking in Germany. Digitalization is a “game changer” that offers completely different conditions and can improve intersectoral cooperation, she said.

“Providing healthcare across the region is a future task for all stakeholders,” says Beckebans. “In Finland, we see that regional concepts, a new division of tasks between health professions and consistent digitalization, among other things, make an important contribution to making healthcare across the region humane and efficient at the same time.” © nfs/aerzteblatt.de