Finland’s 2023 health and social services reform was one of the country’s largest administrative transformations in decades. Health and social services in Finland are funded mainly by taxation and managed by publicly owned institutions. Since 1 January 2023, responsibility for organising publicly funded social and health services and rescue services moved from municipalities and joint municipal authorities to integrated one-leadership organisations in 21 ‘well-being services counties’, alongside Helsinki’s separate arrangements for the Capital Helsinki and the Uusimaa region, where specialist and hospital care was retained as a separate joint organisation.
At the same time, the principal financial responsibility moved from municipalities to the state. The reform therefore sought not simply to reorganise administration, but also to address longstanding problems of unequal access, fragmented services, barriers between primary and specialist care, rising costs, and growing health and welfare inequalities.
The underlying ambition was broad. The parliamentary process emphasised stronger integration of social and health services, improved access and greater equality. The new counties were expected to strengthen population-level well-being and health promotion. Crucially, prevention was not intended to be an optional addition to health care: the legislation and the national framework give well-being services counties responsibilities for preventive services and for incorporating health and well-being promotion into their strategies and cooperation with service providers.
Making prevention visible in funding
The financing model illustrates both the potential and the difficulty of this objective. Well-being services counties have no independent taxation power and are predominantly financed through state funding. The distribution of funding is based on annual official electronically collected administrative surveillance data on disease burden and service need directly transferred from the counties’ own patient and client management systems. In 2023, approximately €22.3 billion was allocated, with the needs-basis formula incorporating population, estimated service need, demographic and geographical factors, rescue service risks and, importantly, a well-being and health promotion component. Although the allocation for this component was close to €220 million for 2023, it nevertheless represented barely 1% of total social and health funding. This is a fundamental lesson: if prevention is politically important, it must be financially and institutionally visible enough to compete with the immediate demands of treatment.
The early evidence suggests that structural reform alone cannot produce this shift. Evaluations conducted by the Finnish Institute for Health and Welfare (THL) and others found major differences in the starting positions of the counties, inherited fragmented service structures, and substantial constraints from personnel and finances. National steering has also had its challenges: THL’s broader assessment concludes that during the first two years, the roles of the Ministry of Social Affairs and Health, Ministry of Finance and Ministry of the Interior were still developing, while financial steering and economic objectives became increasingly influential.
Data as a democratic instrument
This is where data become a democratic instrument, not merely a management tool. THL’s county-level assessments already allow comparison of population needs, staffing, costs, financing and service availability. Such information can establish whether political promises are translated into outcomes. Data should therefore be published in forms that allow citizens and elected representatives to ask: Who decided? What changed? Who benefited, and who became more vulnerable? THL has also stressed that social care data must connect individual service needs with the wider social conditions producing those needs. In addition to providing the nationally collected data to the ministries, THL is developing multiple public dashboards to increase transparency and opportunities for benchmarking the services of the different regions.
This perspective challenges the tendency to describe poor health outcomes as merely systemic or technical. Waiting times, unmet needs, mental health issues, preventable illness or unequal access may indeed reflect complex systems – but the distribution of these outcomes is also shaped by political choices: taxation, income security, housing, education, employment, alcohol and tobacco policy, transport, food environments, service closures and the allocation of preventive resources. Data can reveal these choices by linking health outcomes to geography, income, education, age and access to services. It can show where vulnerability existed before people entered the healthcare system.
The next phase of reform should therefore move beyond asking whether services are efficiently organised. Finland should ask whether public policy is producing health. That means strengthening prevention in funding formulas, protecting early intervention and primary services, requiring transparent outcome reporting, integrating health indicators into budgeting across government and publishing comparable county-level data. It also means recognising that many of the determinants of health lie outside health care – in schools, housing, employment, urban planning, taxation and social protection. THL has repeatedly stressed that effective health promotion requires cooperation across sectors and evidence-based interventions. This would require sticking to long-term systematic health policy over several government coalitions – something that has proved a challenge, as clearly shown by recent developments to allow marketing of nicotine pouches and the substantial deregulation of alcohol sales in Finland.
The central lesson of the 2023 reform is consequently political rather than technical: organisational change creates the capacity for healthier government, but it does not guarantee it. Data can make responsibility visible. The next task is to use that visibility to make deliberate choices that reduce vulnerability before people become patients – and to make a healthier future a measurable political commitment rather than an aspiration. This requires that elected decision-makers follow a health policy pathway stretching over decades instead of only the current election cycle.
