By Ed Dutton

Imagine going to your nearest doctors’ surgery at 9am on a weekday with your sick six-year-old daughter because you cannot make an appointment over the phone. After your drive to another part of the city, you can’t simply book a time with the receptionist. There isn’t one. Instead, you must swipe your daughter’s national insurance card through a machine, which gives you a number. Then you and your feverish child simply sit and wait. Or rather, you stand, because the room is so crowded that people are sitting on the floor, on steps, or leaning against walls. The numbers come up on a screen every 10 minutes or so, in no particular order so you’ve no idea how long your wait will be as your daughter complains of feeling cold then hot and then cold again.

By 10.45, another patient’s dad exclaims he’s been there since 8.15, he’s had enough, and he’s going to go to a private GP. “You used to just be able to make an appointment with a doctor!” he says angrily.

You see, you are not even waiting to see a GP. You’re waiting to a see a nurse in order to justify to her how quickly your child needs to see a GP or whether she needs to see one at all. At 11.30, you give up and take your daughter to see a private doctor as well, forking out £50 for the privilege.
Finland is pioneering joined-up services, and reaping the rewards
Read more

This isn’t some nightmare vision of the NHS after 10 years of Tory cuts. This happened to me recently in a country I have moved to from Britain that is normally lauded as the shining example of a successful welfare state.

Finland receives such a positive press in Britain. Its schools consistently have the best international student assessment results in the western world; there’s high social equality; all its teachers have master’s degrees. But it has one of the worst health services in Europe.

Finland’s health service has been in a parlous state for decades and it is getting worse.

According to an OECD report published in 2013, the Finnish health system is chronically underfunded. The Nordic nation of five million people spent only 7% of GDP on its public health system in 2012, compared with 8% in the UK. In 2012, the report found, 80% of the Finnish population had to wait more than two weeks to see a GP. Finland’s high taxes go on education and daycare.

Finland has more doctors per capita than the UK but, at the level of primary care, a far higher proportion of these are private than is the case in Britain. And the Finnish equivalent of the NHS is far from free at the point of use. A GP appointment costs €16.10 (£12.52), though you pay for only the first three visits in a given year. A hospital consultation costs about €38, and you pay for each night that you spend in hospital, up to a maximum of €679. And once you get to the chemist, there is no flat fee; no belief that you shouldn’t be financially penalised for the nature of the medicine you require. The service is not national, but municipal, meaning that poorer areas of the country tend to have a bad health service and limited access even to private GPs, who set up practices in more affluent areas.
Get Society Weekly: our newsletter for public service professionals
Read more

In Helsinki there are reports of huge queues at health centres (GP surgeries), waits for appointments of many weeks, and greater and greater demands with less and less funding. In south-eastern Finland it takes about a month to see a GP. Back in December 2013, it was reported that Finns were increasingly using private doctors in neighbouring Estonia to save time and money.

I live in Oulu, Finland’s northern technology hub, famed for its annual Air Guitar Festival. Jani Saarinen (not his real name), an Oulu doctor in his 30s, who has worked in both the state and private sectors in different parts of the country, explained to me that the municipal health system was plagued by “cost pressures” and “long waiting times”.

“There used to be an outsourced health centre in Oulu, so it was private, but it was the public service that the city offered,” says Saarinen. “Using a different system from the municipality, they managed to get waiting times down to two weeks and see emergency appointments on the same day. Outsourcing was a much more efficient way of working, but it was closed down.”

Saarinen explains that the system essentially forces people to go private or rely on friends who are doctors.

“I was at work and I got something in my eye. I couldn’t carry on working because of this,” Jani recalls. “As the hospital only provided minimal occupational health, I’d have to go to the health centre and maybe wait four hours. I obviously didn’t have time to do that, so the only solution was to find a friend who was an ophthalmologist or go to a private doctor. Many parents see private health insurance for their kids almost as mandatory.”

The dad I waited with at Oulu’s Kontinkangas health centre was Ville Ranta, a political cartoonist. He says that the Finnish left believes that the health service is being deliberately made so bad that everyone goes private. Certainly, no Finnish government has been led by a leftwing party since 2003 and, since then, private primary care has expanded hugely.
Even in Finland, universal basic income is too good to be true
Declan Gaffney
Read more

According to the Finnish Medical Association, 17% of Finnish doctors work solely in the private sector, generally in primary care. This is double the percentage it was 20 years ago. Another 20% are partly in private practice, and most employers pay for their workers – though not their workers’ families – to have private primary healthcare. The private system is better paid and there is less pressure. Accordingly, claims Saarinen, more experienced and “better” doctors end up in the private sector, leaving the “inexperienced” and “inefficient” doctors running the health centres.

Hospitals are struggling as well. In December, my wife slipped on the ice so badly that she broke her leg. Visiting her in hospital, I found the corridors lined with bedridden elderly women, so overcrowded were the wards. On my second visit, the glass-fronted room on my wife’s ward set aside for patients to drink coffee with their relatives had been closed off and curtains hung on the windows. It was now a makeshift bedroom for an ice victim.