The original aim of the reform of social and health services was to facilitate access to health services in particular.
The need for reform was justified by the fact that there were differences in the availability of services between municipalities.
Another problem was the dichotomy of Finnish health services: there is public health care, the costs of which are mainly covered by taxes, and private health care, which bills its users more vigorously.
The majority of employers have organized their occupational health care with the help of private service providers, and the wealthier part of the population favors the private sector.
In private healthcare, you know in advance that you can always deal with the same doctor, which promotes both communication and the care package.
Access to treatment is also much faster for the private than for the public.
In public health care, waiting for 2-3 months is commonplace, and in cases classified as non-urgent, it is easy to wait up to six months.
It is no coincidence that special child insurance is available for children under the age of three, at the expense of which sudden otitis media and other pediatric diseases are quickly treated in private medical clinics and not, for example, in the queue at the only nightclub in the area.
Congestion in public health has been considered a problem almost always.
This is obvious from an economic point of view: free, or cheap, perceived service is always consumed more than perceived as expensive.
After all, public health care is not really cheaper than private health care, it is only paid for by tax funds and not by the user, with the exception of the health center fee.
Be that as it may, the original goal of the SOTE reform was both to improve access to publicly funded health care across the country and to make it more efficient and cut costs.
Another key goal was to better integrate primary health care and specialist care.
However, it calls for increased inter-municipal cooperation, especially in sparsely populated areas.
The problem with municipal associations is that, according to the Constitution, municipalities have the right to self-determination and therefore decide for themselves whether or not to unite with someone.
Another, more practical dilemma is that the union of two low-income small communities is by no means wealthier than both of them alone.
Especially when it was invented somewhere that in the event of a municipal union, the employees of all the federations will retain their positions for five years.
This effectively prevents the central association of municipalities from cutting access costs by cutting administrative duplication, for example.
A municipality of 10,000 inhabitants can cope with fewer officials than two municipalities of 5,000 inhabitants.
An association of several municipalities is also less dependent on the activities of one company, but can accommodate more than one operating company.
A fresh, sad example of such a relationship of dependence is provided by the Kaipola plant and Jämsä.
When no sustainable program of measures could be built on municipal associations, it was invented to establish sote areas, which at some point were also called provinces.
At the beginning of the Sote process, health professionals estimated that a five-area model to be built around five university central hospitals would be the most effective, both in terms of care and cost.
At the same time, efforts were made to improve local access to care by integrating private health care companies into local care provision.
How this was to be done remained an open question at the time.
It was considered e.g.
public commitments and service vouchers, but the practical implementation was left to hatch.
Now, years and countless man-hours and committee reports spent on the plans, the process has progressed so far that 21 sote areas will be established and Helsinki will be left as its own area.
All care is provided with public funds, even so that the West Bank sote area, which has privatized its own health care, has to cancel the arrangement and rebuild it on its own.
How this will be paid is more unclear.
Differences in cost-bearing capacity between regions will be smoothed by a calculation model that takes into account their population and population aging, as well as a number of other factors.
Presumably, the Ministry of Social Affairs and Health has calculations to predict the development of costs, as the younger population in particular will for the most part move to agglomerated jobs in the service sectors.
The provincial model and the exclusion of private health care from the solution are obvious ideological choices.
Unfortunately, this ideological way of thinking seems to have forgotten the main thing: increasing and enhancing the provision of health care.
After all, the efficiency and profitability of publicly produced services compared to private ones are generally known.
When planning the preparation for the implementation of the program, municipal health care cannot develop its operating methods or invest in new methods because there is no information on the activities and payers of the coming years.
Somehow descriptive is the clearest change from the past in the recent presentation: sote areas, or provinces, are now called welfare areas.
I do not think I'm the only one whose mind rises to the waiting Pertti Jarlan Fingerpori comic strip, next to the well-being of the area where the limit is a sign of nausea fenced area where the flock to vomit and otherwise ill people.
The author is a freelance journalist.