title: Expanding choice of primary care in Finland: much debate but little change so far.
abstract: "Putting the patient in the driver's seat" is one of the top issues on the health policy agenda in Finland. One of the means believed to promote patient empowerment and patient centeredness is the introduction and further expansion of choice policies with accompanying competition between public and private service providers. However, the Finnish health care system has a highly decentralized administration with multiple funding sources and three different types of providers that people can seek primary care from (municipal health centers, occupational health care services, and private sector providers). This complicates the implementation of choice at the level of primary health care. In this paper, we describe the current policy debates and initiatives promoting the expansion of the choice of primary care provider in Finland. We examine the legislation and policies that have contributed to the current, complex service system in Finland. In light of this examination, we critically discuss the current debate on choice policies as well as the introduction of choice in the context of primary health care.
authors.affiliation: University of Tampere, School of Health Sciences, FI-33014 Tampere, Finland; National Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland. Electronic address: liina-kaisa.tynkkynen@staff.uta.fi.
authors.forename: Liina-Kaisa
authors.initials: LK
authors.lastname: Tynkkynen
authors.affiliation: University of Tampere, School of Health Sciences, FI-33014 Tampere, Finland.
authors.forename: Miisa
authors.initials: M
authors.lastname: Chydenius
authors.affiliation: University of Tampere, School of Health Sciences, FI-33014 Tampere, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Saloranta
authors.affiliation: University of Tampere, School of Health Sciences, FI-33014 Tampere, Finland; National Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland.
authors.forename: Ilmo
authors.initials: I
authors.lastname: Keskimäki
mesh_terms: D003258:Consumer Behavior; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration; D005387:Finland; D018166:Health Care Reform / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D011057:Politics; D011320:Primary Health Care / Q000458:organization & administration*
keywords: Choice; Competition; Family medicine; Finland; General practice; Health care reform; Primary health care