We started the day with a ride on Omnibus. We thought we were going to take a small, local bus (Pika) from Lahti to Helsinki but instead a double-decker Omnibus showed up. This could have been a problem as Omnibus usually needs to have tickets purchased in advance. The driver was very nice and offered to sell us tickets at the door if spaces were available. He was not able to accept cash so I was going to pay with Visa, but when the card reader wouldn’t work, he invited us to come aboard for no charge. He even made a special point to give additional instruction in English for us at the stops. It was perhaps a small thing, but I was very impressed with this service.
That evening, we met with Opti, an Averett alumni and his brother Antti, a 5th year resident in orthopedic surgery in one of the suburbs of Helsinki. Antti gave us an overview of the Finnish health care system and allowed us to ask many questions. He also had questions for us on the US healthcare system as he was about to move to DC when his wife takes a position in the Finnish Embassy.
Finland is divided into five health districts. Each contains a multi-tiered system of primary care clinics (primary care physician / urgent care equivalent), district hospitals (community hospitals), central hospitals (mid-level), and university hospitals (top-level centers). Most care starts at the primary care level and patients are transferred up as needed. In emergency cases, the patient would go to the higher level immediately.
EMS is similarly divided into Level 1 (Critical Care air and ground), Level 2 (Advanced Life Support, most 112 (911) calls), and Level 3 (Basic Life Support, usually transport but some 112).
There are essentially two health systems in Finland, one public, one private. The public is available to all Finns and prioritizes based on acuity. Critical cases are seen quickly. Routine problems are scheduled for later. The private system has two parts, doctors working after hours for individual payment and company-provided physicians for employees. Most residents continue to go to the public hospitals for major and emergency care, but those who have the means can employ the private system so that they do not have to wait for routine complaints. The government pays all but a small co-pay for the public system, but they also reimburse a small percentage of the private payment.
I told Antti about our conversation with Eugene earlier in the week. He admitted that the system is not perfect, but noted that in his experience, many more patients come to Finland for the available healthcare than leave the country to seek it elsewhere. Other informal conversations I have had on this trip align with Antti’s assessment.