1. Public Health Care and Globalization - Finland
Eeva Ollila

2. Globalization and Health care --Some common features
Increasing commercial interests in the production of health services
Increasing (multinational) for-profit service actors
Problems with equity of access, increasing inequities in health
Challenges in regulation
Increasing health care costs and problems in public financing
Increasing prices of pharmaceuticals, emphases on high technology
Taxation capacities decreasing
Deficit of health care workers
Flow of workers from public to private, from South to North

3. Finnish health care system
Decentralized health care system with municipalities responsible for organising health care
Multi-channel financing with non-ear marked state subsidies, municipal taxes, social insurance and user fees
Primary health care mostly produced by the municipalities, specialised care by hospital districts, private provision with social insurance subsidies especially in cities in open care/ occupational health

4. Globalization and its implications for the national health care
National trends
New public management (NPM), preparing for outsourcing: Bureaucratic commercialization, purchaser- provider split, contract steering, pricing according to DRGs, private sector management techniques, decentralization
Outsourcing ( and privatisation) likely to increase
(procurement law and the project on municipal and service delivery restructuring, pressures to decrease the size of the public sector)
Maintenance of public financing (tax or insurance based)

5. Globalization and its implications for the national health care
Regional and global pressures
Neo-liberal political atmosphere
EU: the four freedoms, internal markets, competition, procurement directive, services directive, directive on health services, financial policies (EMU criteria), ECJ decisions
OECD (public governance and management): NPM
WTO (TRIPS, services)

6. Globalization and its implications for the national health care
Financing
Pressure to lower taxes, lowered state subsidies put pressures on municipal tax- based financing, increased user fees on services and on pharmaceuticals: as a result regressive financing
Pressures for increased funding: Commercialization, new expensive technologies, increased expectations, aging

7. Production of health services
Outsourcing and privatisation increasing
Fragmentation of the service delivery system
Competition practices increasingly taking production decisions to court
Responsibilities remain with the municipalities

8. Globalization and its implications for the national health care
Governance - “Steer more - row less”
Information steering, project steering, laws, regulations, monitoring, financing
The framework of regulation is changing
Regulation from the Ministries of Health to the Courts