Models used in other countries to organise social and health care provide useful insights for developing Finland’s system, but they do not offer quick fixes. This is the conclusion of a report THL conducted in 2025 on different ways of organising these services internationally.
The report indicates that Finland does not necessarily need major structural reforms. Instead, the best features of different models could be adopted within the current system. Rather than overhauling the entire social and health care system, our existing model should be developed in a long-term and systematic manner.
In public debate, models from other countries have also been presented as alternatives to Finland’s current approach to organising social and health services. Our report reviews four different models and assesses their potential applicability in Finland.
“The models are not proposals by THL. Our aim is to provide information and perspectives to support public discussion on the future direction of Finland’s social and health care system,” notes Liina-Kaisa Tynkkynen, Chief Researcher at the Finnish Institute for Health and Welfare (THL).
Four models of organisation examined
The report examined the following models for organising social and health care, or health care alone:
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1
National social and health care system
A national organisation is responsible for organising services and steering the providers responsible for service delivery. Service provision is mainly public. The United Kingdom, for example, has a national health system.
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2
Strong regional organisers of social and health care
Strong self-governing regions are responsible for organising services within their own areas. This model typically emphasises strong regional democracy and the regions’ ability to collect tax revenues. Spain, for example, uses this model.
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3
Insurance-based health care
Health insurance is mandatory for all. Private insurance companies collect premiums from customers and contract with private providers, through whom clients receive services. The state usually also participates in financing. Social services are organised and financed separately. This model is used, for example, in the Netherlands.
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4
National health insurance
A single national insurer reimburses the use of health services or compensates providers directly for the costs incurred. Regulation and financing are strongly nationally steered. Services are mainly delivered by private providers. This model is used, for example, in Australia.
National system and strong regions closest to Finland’s current model
Finland’s current system already contains elements of all the models described above.
“Our current solution, based on wellbeing services counties, lies somewhere between a national model and strong regional organisers. However, the increasing prevalence of private insurance and the Kela reimbursement system mean that our health care system also contains elements of the other models discussed,” says Tynkkynen.
According to the report, the most natural directions for further development of Finland’s current model would be either a national social and health care system or a model based on strong regional organisers.
A national model would further centralise decision-making, leaving regional actors responsible for running services without politically elected councils.
A model based on strong regional organisers, in turn, could strengthen the self-governance of the current wellbeing services counties, which remains limited due to the absence of taxation powers. A regional model would also support Finland’s long-standing commitment to local services.
The most significant change compared to the current system would be an insurance-based model.
“In Finland, an insurance-based health care model would likely involve significant constitutional challenges, as the Constitution assigns responsibility for organising social and health care services to public authorities,” Tynkkynen notes.
She also reminds that all social and health care solutions are closely tied to the surrounding society, culture, and values, which makes transferring models from other countries challenging.
“However, examining international examples provides a useful mirror for assessing the current state of our own system and its development opportunities.”
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