Setting the context

The constitution of Finland stipulates that society must guarantee adequate social, health and medical services for each of its 5.3 million inhabitants, and promote the health of the population. Due to decentralized governance, responsibility for financing long-term care for older people rests heavily on the shoulders of 336 relatively independent local authorities (municipalities), as does the delivery of long-term care services. Obliged by law to provide long-term care services for older dependent people, these municipalities are free either to provide services themselves or to purchase them from various for-profit or not-for-profit providers. Historically, municipalities have tended to rely on providing their own services.

According to the Statistical Yearbook on Social Welfare and Healthcare (National Institute for Health and Welfare, 2010), 87 per cent of all long-term care days in residential facilities were produced in public facilities, 10 per cent in not-for-profit private facilities and only 3 per cent in for-profit private facilities. In contrast, when it comes to sheltered housing for older people, officially known as ‘service houses’ or ‘sheltered housing’, only 42 per cent of long-term care days were furnished by public providers while the private sector provided 32 per cent of care days in not-for-profit facilities and 26 per cent in for-profit facilities. Chronic care hospitals, known as ‘health centres’, are predominantly public (95 per cent). Recent statistics are not available for home care. In all these types of facilities municipalities are responsible for monitoring care but they are aided in this task by other entities. The National Supervisory Authority for Welfare and Health (known as Valvira), supervised by the Ministry of Social Affairs and Health, undertakes a national supervisory role, together with six Regional State Administrative Agencies (AVI).