Suchergebnisse

Yksityisen ja julkisen sektorin kumppanuus ei toteudu sosiaali- ja terveyspalveluissa Yksityisen ja julkisen sektorin yhteistyö terveys- ja vanhuspalveluissa ei näytä olevan sellaista, että se tällä hetkellä palvelisi niitä tavoitteita, joita kunnissa yksityisten palveluiden ostoilla tavoitellaan. Palveluiden tilaajilla ja yksityisillä palveluntuottajilla on keskenään hyvin erilaiset näkemykset yhteistyön luonteesta. Väitöstutkimus avaa uuden näkökulman yksityisen ja julkisen sektorin yhteistyöhön nostamalla esille organisaatio ja yksilötasolla vaikuttavat esteet kumppanuudelle. Yksityisen ja julkisen sektorin yhteistyöstä sosiaali- ja terveydenhuollossa keskustellaan nykyään kiivaasti. Yksi viimeisimmistä pinnalle ponnahtaneista yhteistyön muodoista on niin kutsuttu yksityisen ja julkisen sektorin kumppanuus. Kumppanuudesta puhutaan entistä enemmän, ja siitä on tullut myös osa poliittisen retoriikan sanastoa. Yksityisen ja julkisen sektorin yhteistyösuhteita ei ole Suomessa kuitenkaan juuri tutkittu. Väitöstutkimuksessa tutkittiin julkisen ja yksityisen sektorin yhteistyötä terveyspalveluissa ja vanhojen ihmisten palveluissa. Tutkimuksessa tarkasteltiin 1) millaisia tavoitteita kunnissa asetetaan yksityisten palveluntuottajien kanssa tehtävälle yhteistyölle, 2) millaisia edellytyksiä yhteistyölle on, kun asiaa katsotaan organisaatioiden johtamiskulttuurien näkökulmasta ja 3) miltä yksityisen ja julkisen sektorin yhteistyö näyttäytyy käytännössä. Kunnissa palveluiden ostojen taustalla on muun muassa halu oppia yksityisiltä palveluntuottajilta ja näin kehittää omaa palveluntuotantoa. Lisäksi halutaan tarjota monipuolisempia palvelukokonaisuuksia palveluiden käyttäjille. Käytännössä yhteistyö ei kuitenkaan näytä olevan sellaista, että se palvelisi yhteistyölle asetettuja tavoitteita. Tulokset osoittivat, että palveluiden tilaajilla ja yksityisillä palveluntuottajilla on hyvin erilaisia näkemyksiä yhteistyön luonteesta. Palveluiden tilaajat kokivat, että he kykenevät luottamaan yksityisiin palveluntuottajiin, että palveluja kehitetään yhteistyössä ja että sopimuksia arvioidaan myös sopimuskauden aikana. Yksityiset palveluntuottajat sen sijaan kokivat yhteistyön luonteen jokseenkin päinvastaisena. Voidaankin todeta, että kun yhteistyötä tarkastellaan palveluja tilaavien julkisten organisaatioiden näkökulmasta yhteistyöstä on mahdollista löytää kumppanuuden elementtejä. Yksityisten palveluntuottajien näkökulmasta, kumppanuuden elementtejä ei sen sijaan ole juuri mahdollista tunnistaa. Tutkimus tarjoaa kuntapäättäjien, poliitikkojen ja palveluntuottajien käyttöön tietoa, jonka avulla yhteistyön eri osa-alueita on helpompi tunnistaa. Tällaisia yhteistyön elementtejä ovat muun muassa yhteistyölle asetetut tavoitteet ja yhteistyön kautta tavoitellut hyödyt, tiedon jakaminen toimijoiden kesken, luottamus, palveluiden yhdessä kehittäminen sekä sopimusten joustavuus. Keskustelu yksityisen ja julkisen sektorin yhteistyöstä on tähän asti keskittynyt Suomessa suurelta osin yhteistyön esteenä oleviin rakenteellisiin ja lainsäädännöllisiin tekijöihin. Väitöstutkimus avaa kuitenkin uuden näkökulman yhteistyöhön ja nostaa esille organisaatio ja yksilötasolla vaikuttavat esteet tiiviimmälle yhteistyölle. ; Delegating public tasks to the private sector is not only a product of recent decades but rather a much longer tradition in most Western societies. However, the nature of the collaboration between public and private sector is dynamic and changing. One of the most recent trends in terms of collaboration between public and private sectors is an aim towards partnership. The term "public-private partnership" has made its way into the political rhetoric in recent decades and is now increasingly appearing in both international and national debates on methods of accomplishing public tasks and the means to tackle social challenges in society. In Finland PPP was introduced as a national level policy option in 2007. The collaborative relationship between the public and private sectors in Finland has not been studied to any large extent. In this study I addressed this area in the context of health and elderly care services in Finland. I discussed two types of collaboration between public and private sectors: contracting out and public-private partnership. The particular the research question was: What kind of aspects of partnership could be identified in the collaborative relationships between public and private sectors in Finnish local health and elderly care systems in the first decade of the 2000s? The research consists of four sub-studies and a summary. Sub-studies I–IV focused on different aspects of collaboration between the public and private sectors in Finland. Collaboration was analysed from three perspectives drawn from the literature: goals set for and benefits sought through the collaboration, collaboration in practice and organizational properties. The collaboration between public service purchasers and private service providers was approached by discussing the aspects of contractual relationship and partnership. The results suggest that in terms of the goals that municipalities set for collaboration with the private sector certain aspects of partnership can be identified. These include willingness to learn from the private providers in order to develop the service provision in the public sector and willingness to provide enriched selection of publicly funded services. In addition, the prerequisites for partnership in terms of organizational properties seem to be no worse than they might be regarding partnership between public and public organizations or between for-profit and not-for-profit organizations. It seems that there is no specific leadership culture in public, for-profit and not-for-profit organizations. However, the public purchasers and the not-for-profit and for-profit providers have different perceptions of the nature of the collaboration in practice. Public actors perceived that they could trust to their partners, the services were developed together and that the contracts were evaluated also during the contractual period, while perceptions in the private sector among for-profit providers especially, were fairly much the opposite. That is, if the issue is discussed from the public actors' perspective there seems to be support for the existence of partnership aspects. However, if the issue is discussed from the private providers' perspective the aspects seem to be largely missing.

Living at home is a core value in old age policies worldwide. This study examines how members of parliament (MP) depict the home in two parliamentary discussions related to a law on older people's care and living arrangements in Finland. The data contained 110 speeches from 42 MPs in the first discussion and 17 in the second and was examined using thematic analysis. The extracts with the word "home" were coded and grouped as potential themes. These themes were reviewed further and reflected using relevant literature. As a result, the overarching theme 'home as a restricted space' was formulated with three subthemes: home as a space in which old people 'manage to live', 'are treated' and 'live without contacts'. The findings suggest that policymakers misrecognised the valued attributes related to older persons' homes, and in doing so, they hamper the potential for success in home-centred old age policies. ; publishedVersion ; Peer reviewed

Local governments in pursuit of their objectives have become increasingly dependent on the private and third sector actors. New Public Governance (NPG) is an approach to understand the production and delivery of public services in a fragmented and pluralist society. The development of health care and social services and the creation of service innovations have been a part of the ongoing change. Local governments have started to search for new approaches to service delivery in co-operation with private firms and third sector organizations. This study focuses on the role of local government as a meta-governor in creating and developing a service innovation called the Kotitori model in Tampere, Finland. Meta-governance is needed to govern complexity and plurality in a network society. Local authorities can exercise power by using meta-governance tools while sharing the responsibility for public governance with other actors. The results of this study suggest that tools provided by NPG theory can be identified in the process of developing a service innovation. Thus, it may be that local governments should use both hands-on and hand-off meta-governance tools in order to exercise successful meta-governance. The results also suggest that adequacy of the different meta-governance tools differs according to the stage of the innovation process. In this sense this study provides also new insight to the theory of NPG.

Background: Obligations arising from trade and investment agreements can affect how governments can regulate and organise health systems. The European Union has made explicit statements of safeguarding policy space for health systems. We assessed to what extent health systems were safeguarded in trade negotiations using the European Union (EU) negotiation proposals for the Transatlantic Trade and Investment Partnership (TTIP) and the negotiated agreement for the EU-Canada Comprehensive Economic and Trade Agreement (CETA). Methods: We assessed if and to what extent the European Union policy assurances were upheld in trade negotiations. Our assessment was made using three process tracing informed tests. The tests examined: i) what was covered in negotiation proposals of services and investment chapters, ii) if treatment of health services differed from treatment of another category of services (audiovisual services) with similar EU Treaty considerations, and iii) if other means of general exceptions, declarations or emphases on right to regulate could have resulted in the same outcome. Results: Our analysis shows that the European Union had sought to secure policy space for publicly funded health services for services chapter, but not for investment and investment protection chapters. In comparison to audiovisual services, exceptions for health services fall short from those on audiovisual services. There is little evidence that the same outcome could have been achieved using other avenues. Conclusions: The European Union has not achieved its own assurances of protection of regulatory policy space for health services in trade negotiations. The European Union trade negotiation priorities need to change to ensure that its negotiation practices comply with its own assurances for health services and sustainable financing of health systems. ; publishedVersion ; Peer reviewed

BACKGROUND: Obligations arising from trade and investment agreements can affect how governments can regulate and organise health systems. The European Union has made explicit statements of safeguarding policy space for health systems. We assessed to what extent health systems were safeguarded in trade negotiations using the European Union (EU) negotiation proposals for the Transatlantic Trade and Investment Partnership (TTIP) and the negotiated agreement for the EU-Canada Comprehensive Economic and Trade Agreement (CETA). METHODS: We assessed if and to what extent the European Union policy assurances were upheld in trade negotiations. Our assessment was made using three process tracing informed tests. The tests examined: i) what was covered in negotiation proposals of services and investment chapters, ii) if treatment of health services differed from treatment of another category of services (audiovisual services) with similar EU Treaty considerations, and iii) if other means of general exceptions, declarations or emphases on right to regulate could have resulted in the same outcome. RESULTS: Our analysis shows that the European Union had sought to secure policy space for publicly funded health services for services chapter, but not for investment and investment protection chapters. In comparison to audiovisual services, exceptions for health services fall short from those on audiovisual services. There is little evidence that the same outcome could have been achieved using other avenues. CONCLUSIONS: The European Union has not achieved its own assurances of protection of regulatory policy space for health services in trade negotiations. The European Union trade negotiation priorities need to change to ensure that its negotiation practices comply with its own assurances for health services and sustainable financing of health systems.

This paper presents a baseline picture of the co-operation between service purchasers and private elderly care and primary health care providers both at the national level and at the level of local welfare regimes in Finland. Data from two national surveys and from interviews conducted in six municipalities are analysed. The perceptions of the co-operation during the contractual period differed substantially between the private providers and the municipalities. The differences were evident especially between the for-profit providers and the municipalities. In general the private providers would be willing to work together with the municipalities, but to them it seems that the municipalities lack interest in this. The municipalities, in turn, considered that contracting is mostly a tool to reduce administrative responsibilities. However, in order to be able to gain benefits from contracting, to avoid excessive transaction costs and to co-ordinate the network of different service providers, the municipalities should invest in contract management and also be active during the contractual period.

Background In the literature there are only few empirical studies that analyse the decision makers' reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens' access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services. Methods Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions. Results Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people. The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions. Conclusions This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state. ; BioMed Central open access

Abstract Background In the literature there are only few empirical studies that analyse the decision makers' reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens' access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services. Methods Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions. Results Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people . The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions. Conclusions This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state.

This paper takes a critical view of the interplay between two widespread approaches towards policy making and the ways in which they have played out in the critical realms of higher education and health care in the Nordic context over the last decade. It adopts a multiple case study design substantiated on a cross-sectorial and cross-national compara- tive approach. Empirically, we provide case evidence from Norway and Finland. The paper's conceptual foundations are based on seminal work emanating from the policy- transfer literature combined with key insights from organisational theory and its neo- institutional tradition. We address recent calls for a better understanding of the policy- formation process across national jurisdictions and sectors of the economy.

Healthcare has traditionally been heavily influenced by health professionals and managers, but it is increasingly recognised that patients' experiences and voices can play key roles in the development and design of sustainable healthcare services. In this article, we take an exploratory approach to user involvement (UI) in healthcare in two Nordic countries – Finland and Norway. Our theoretical and analytical approach draws on recent works by Dent and Pahor (2015) and Vrangbæk (2015), focusing on three types of participation – choice, voice and co-production. According to our results, these three types of UI have become more visible and acknowledged at the level of national policies in both countries. However, it seems that UI is more entrenched in the governance structures of Norwegian healthcare. The types of involvement are also different. In Finland, the emphasis seems to be on the consumerist ways of involvement, while in Norway, the focus has been more on co-production and voice.

Objectives: To analyze the vaccination strategy as part of wider public governing of the COVID-19 pandemic in Finland. Methods: The study provides a synthesis of vaccination strategy and health policy measures, as well as economic challenges, in the COVID-19 pandemic in Finland. The analysis is based on the systematic collection and reviewing of documents and reports. The review was complemented with relevant pandemic and vaccination monitoring data from Finland. Results: The vaccination strategy approved by the Finnish Government in December 2020 prioritised various risk groups and health and social care professionals attending to COVID-19 patients. The Government has purchased COVID-19 vaccines through the EU joint procurement programme. Vaccinations were organised by municipalities and offered free of charge. The Government recommends universal vaccinations, including foreign residents and undocumented migrants. In 2021, the Government adopted a revised COVID-19 hybrid strategy, which aimed to dismantle wide restrictions as a means to control the epidemic. Despite high vaccination coverage, the Omicron variant became widespread in the population. The economic consequences of the pandemic have been less severe than expected. Conclusions: In the approach to manage the pandemic, the vaccination strategy has a central role. Finland has probably benefitted from the EU joint vaccine procurement programme. The rapid launch of the vaccinations was supported by the existing vaccination capacity in municipalities. High vaccine coverage was seen as a key in opening society. Although a relatively high vaccination rate was not able to stop the spread of Omicron in late 2021, it has efficiently curbed serious cases and kept the death rate low. ; publishedVersion ; Peer reviewed

The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors.

"A basic framework for pandemic governance existed, but was not followed" – expert views of agile governance and performance of the Finnish public health system during the COVID-19 pandemic in 2020–2021
The aim is to examine how public health authorities acted, what kind of roles they adopted, and how the expected roles and actions appeared in relation to the legislative framework and national preparedness plans during the COVID-19 pandemic. The research is theoretically grounded in the concepts of agile and adaptive governance. Our empirical data consists of 53 qualitative interviews with public health actors at national, regional and local level collected from March 2021–February 2022. We analyzed interviews using directed content analysis. Major issues regarding the response of public health authorities included ambiguity, lack of knowledge in decision-making, and a mismatch between the locations of public health competence and public health authority.

The issue to be addressed in this study is whether ownership and HRM practices are associated with employees' perceptions of organisational justice, job control and job demands. The study focuses on care personnel working in sheltered housing facilities for elderly people. Multi-level linear regression is applied to analyse the data. The results support the argument that an increased similarity between public, not-for-profit and for-profit organisations is emerging in HRM issues. HRM practices were found to associate with positive outcomes in organisational justice and job control. However, to be successful in the implementation of HRM, it is crucial that employees understand the justification for each procedure as well as find it a useful resource in terms of their own job.

This paper explores and compares health system responses to the COVID-19 pandemic in Denmark, Finland, Iceland, Norway and Sweden, in the context of existing governance features. Content compiled in the Covid-19 Health System Response Monitor combined with other publicly available country information serve as the foundation for this analysis. The analysis mainly covers early response until August 2020, but includes some key policy and epidemiological developments up until December 2020. Our findings suggest that despite the many similarities in adopted policy measures, the five countries display differences in implementation as well as outcomes. Declaration of state of emergency has differed in the Nordic region, whereas the emphasis on specialist advisory agencies in the decision-making process is a common feature. There may be differences in how respective populations complied with the recommended measures, and we suggest that other structural and circumstantial factors may have an important role in variations in outcomes across the Nordic countries. The high incidence rates among migrant populations and temporary migrant workers, as well as differences in working conditions are important factors to explore further. An important question for future research is how the COVID-19 epidemic will influence legislation and key principles of governance in the Nordic countries.