Human rights organisation Amnesty International has criticised inequality in Finnish healthcare in a report published on Tuesday. The report states that Finnish healthcare has failed to stop a deterioration in standards for people reliant on public healthcare.
The NGO noted that Finland has a shortage of sexual and reproductive health services, among other things, even though Finland has committed to eliminating discrimination based on gender. There are also problems in dental care and mental health provision, according to the report.
The biggest problems in sexual and reproductive health are the patchy availability of services in the public sector, the high cost of private sector alternatives, and the limited range of services available.
According to doctors' union the Finnish Medical Association, gynaecological services are nearly impossible to access in the public sector.
Silja Kakkola, General Secretary of the Coalition of Finnish Women's Organisations, said in the report that gynaecological services are heavily concentrated in the private sector.
Women who have access to a broad range of private and public providers find it easier to access a gynaecologist than those who only have access to a narrower range of services.
Unemployed people and older people are reliant on public-sector healthcare, and therefore have poorer access to gynaecologists.
Liina-Kaisa Tynkkynen from the National Institute for Health and Welfare (THL) agreed.
"Access to gynaecological services is weak in the public sector," Tynkkynen confirmed.
The report also found that prices for gynaecological appointments vary by region. A 20 minute appointment in Helsinki costs 255 euros, while in Kuopio a similar appointment is 150 euros.
Not all health centres have the right equipment or skill set to diagnose and treat gynaecological problems.
Experts interviewed for the report did say, however, that the recent reform of social and healthcare services made it possible for gynaecological services to be improved.
Dental services cause health inequalities
The report found that inequality in Finnish dental care is a long-term phenomenon: since the 1980s dental health has improved the most among higher income and higher-educated Finns.
Public sector dental care started to be offered to adults at the start of the 2000s — before that free services were restricted to children and certain other groups.
The Finnish Dental Association has said that inequality in dental care is down to adult provision being insufficient.
There is a significant shortage of dentists in public health centres, and regional differences are large. According to the report, the Eastern Savo healthcare district has a bigger shortage of dentists than the Helsinki and Uusimaa healthcare district.
Amnesty's expert Mariko Sato noted that Finland has around the right number of dentists overall, but they don't work in the public sector.
Amnesty's report suggests that there has never been a plan to ensure public health centres' dental care capacity matches demand. Around half of all adults are treated by public sector dentists, and the other half in private sector settings.
A dissertation published in 2022 suggested that public sector dentistry had worsened, with longer waiting times and an increase in tooth extractions as a last-ditch measure in place of preventative dentistry and high quality care.
Anna Kouvonen, a social policy professor at the University of Helsinki, said that Finns' oral health had improved over recent decades, but there were still significant differences between different groups.
"Inequality in dental services based on income has always been greater than inequality in other healthcare services," said Kouvonen. "Dentistry causes healthcare inequality, because oral health problems affect other health issues and are connected to common diseases."
"If we sorted out dentistry, it would have a positive impact elsewhere," she added.
Other factors also at play
Mariko Sato told Yle that a decades-long decline in standards of basic public healthcare is partly to blame for the increased inequality.
"Healthcare has been described as really expensive without really considering if we are spending enough money on it," said Sato.
She further added that healthcare has long been seen as a source of savings, but that is not realistic as the population continues to age dramatically.
"This decline in public healthcare has been partially compensated through occupational healthcare, but that only covers part of the population," said Sato.
Sato said that within the occupational healthcare system there were different levels of service.
"Some employers offer broad occupational healthcare services, while others offer only the bare minimum required by law," said Sato.
THL's Liina-Kaisa Tynkkynen adds that employers decide what kind of occupational healthcare services they will offer.
"Working people can be in very different positions," said Tynkkynen.
Saton says this inequality can mean for example very long waiting times, and sometimes a failure of public sector services to call back when a callback request is made.
"These types of problems are not common in the private or occupational healthcare sectors," said Sato.
"It is clearly more difficult to access care for people reliant on public sector healthcare services, even though there are also very well-functioning healthcare centres," said Tynkkynen.
According to the report, inequality is also caused by charges for certain services in the public sector.
"They are not moderate for everyone," said Sato. "People could decide not to visit the health centre, because they know they don't have the money to cover it. Customer service charge debts are also enforced."
Sato also added that digitalisation can cause inequality, because not everyone knows how to use digital services and not everyone has the right devices to access them.
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