Evaluating health care financing in a highly decentralized Beveridge model

Jan Klavus, Ilkka Vohlonen, Juha Kinnunen, Veli Koistinen, Martti Virtanen

Audiapro Ltd., Helsinki, Finland.
Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland;.
Nordic Casemix Centre, Helsinki, Finland.

DOI: 10.4236/health.2012.411160                

Abstract

The Finnish health care system is financed in a highly decentralized manner. In the tax-financed Beveridge model each municipality is responseble for financing and organizing health care services for its residents. This paper examined the annual incidence and treatment costs of three cost-intensive DRG-groups, and all DRG-groups together. The objective was to estimate municipal level predictions on the incidence of new illness cases and their associated costs, and to analyze whether there was greater uncertainty in anticipated specialized health care costs in municipalities with smaller populations. The dataset comprised of longitudinal hospital utilization and discharge data from Hospital Discharge Registers. The expected annual variation of illness cases and costs was assessed with respect to 95% confidence intervals estimated for each morbidity group and municipality. The results indicated that the costs of the selected morbidity groups fluctuated in a completely uncontrollable manner in municipalities with small populations. As the median size of Finnish municipalities is less than 6000, the inability to anticipate periodic health care costs constitutes an extensive financial problem and calls for the establishment of larger regional units and funding pools.

Keywords

Health Care Financing; Beveridge Model; Predictability of Treatment Costs; Risk Pooling

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Huuhtanen, J. (2005) The Kela model on the financing and organization of health services (in Finnish). PowerPoint Presentation, Helsinki.
[2]	Aronkyt?, T., Hallipelto, A. and Kangasharju, A. (2010) A new health care financing and organization scheme (in Finnish). SITRA Reports 24, Helsinki.
[3]	National Institute for Health and Welfare (2010) The advantages, drawbacks and development requirements of the multichanneled health care financing system (in Finnish). Report by the THL Expert Panel, Helsinki.
[4]	Figueras, J., Saltman, R.B., Busse, R. and Dubois, F.W. (2004) Patterns and performance in social health insurance systems. In: Saltman, R.B., Busse, R. and Figueras, J., Eds., Social Health Insurance Systems in Western Europe. Open University Press, Berkshire, 81-140.
[5]	Busse, R., Saltman, R. and Dubois, H. (2004) Organization and financing of social health insurance systems: Current status and recent policy developments. In: Saltman, R.B., Busse, R. and Figueras, J., Eds., Social Health Insurance Systems in Western Europe. Open University Press, Berkshire, 33-81.
[6]	Teperi, J., Porter, M.E., Vuorenkoski, L. and Baron, J.F. (2009) The Finnish Health Care System: A value based perspective. Sitra Reports 82, Helsinki.
[7]	Thomson, S., Foubister, T. and Mossialos, E. (2004) Financing health care in the European Union: challenges and policy responses. Observatory Studies Series, 17.
[8]	Statistics Finland (2010) Public expenditures price index. http://www.stat.fi/til/jmhi/