Health expenditure by area in Finland--an indicator of equity.

The responsibility of organizing and funding health services has in Finland been delegated to small local government units (to 461 communes, average pop. about 11,000), but not to counties or provinces like e.g. in other Nordic countries. PHC is organized by one or few communes and for the specialist level services they have formed 21 Central Hospital Regions (CHR). The central government pays per cent subsidies which are weighted on the basis of income of each community. In 1982 the average share of central government was 44.3% and the communes were responsible for 28.6% of the total expenditure. The national sickness insurance is subventing mainly private services. Its share was in 1982 about 11%. Direct personal costs were about 16%. There are no marked regional differences in the structure of services, e.g. the average share of inpatient care expenditure was 53% and the differences between regions small (z 6%). Total expenditure varied as indexes between regions from 82 tot 119. One reason is the high costs of some university hospitals which do not receive full compensation for services made available to other regions. The expenditure by region did not correlate at all with indicators of ageing. The same can be said of areal differences in income level. Only SMR, a crude indicator of the level of health, correlated positively with expenditure. It is concluded that the areal equity is acceptable if measured with expenditure. The general structure of services does not markedly differ between CHRs. The total health expenditure has been and will remain at the relatively low level of 6.5-7.0% of the GNP. The involvement of small communes is seen as a favourable basis of controlling the expenditure and developing an efficient service system.