Enacting integrated care in the system-wide social and health care reform in Finland

摘要

Introduction : This research in progress studies the enactment of integrated care in the system-wide social and health care reform suggested by the government of Finland. In the new model the responsibility for organising social and health care will be transferred from the municipalities to the eighteen new counties, while the service delivery will be the responsibility of public, private and third sector organisations. The counties will have the responsibility for defining the service packages and chains on the basis of the needs of different client groups. The challenge for integrated care is that there will be multiple service providers from whose services a client’s service package or chain can be composed of. The preparation of the implementation of the model has started in the preliminary county organisations, while the new counties are planned to start their activity in January 2021. Theory and Methods : This research studies the social and health care system as systemic practices that constitute and mold each other. A model is studied as a script that defines the elements of a practice and their relations. A model is locally translated and adapted into practice. This research is based on a multi-case study setting which studies the implementation process in five counties. This first part of the research analysed during 2018 the strategies and means for defining the service packages and chains within five county organizations..Official public documents were analysed and thematic dialogues with the temporary county organisations were carried out. Results and discussion : There was uncertainty among the counties concerning what the government means by the service packages and chains. Every county had chosen the life span model as a ground for defining the service packages and chains: children and families, adults of working age, and elderly. Within this model definition of different sub-segments was under consideration. The challenge concerned especially how to identify the clients who need several different services. The present public service providers were extensively involved in the definition practices in every county, while there were differences between the counties who, organiser or provider, was leading the definition practice. The different client groups were heard in different occasions and forums in the counties, but they were not participating in the actual definition practices. Conclusions and lessons learnt : The counties were preparing the service packages and chains in extreme uncertainty because the suggested laws were not accepted in the parliament yet. So far they were in the beginning of the definition work. Segmentation, defining the service packages and chains on the basis of the needs of client groups, multifaceted utilization of knowledge, and above all the role of the counties as an organizer of services were new things which required time and learning. Limitations and suggestions for future research : This research defines generic socio-technical elements to be taken into account when implementing new models of integrated care. Later it will analyse how the way the service packages and chains have been defined constitutes preconditions, possibilities and challenges for enacting person-centered integrated care by the service providers.