Integration of Public and Private Health Services: Health Gain in Finland from Clinical Cooperation of Patient Care between Inpatient Hospital Procedures and Outpatient Occupational Health Clinics

Abstract

Background : In 2002, the length of recovery period and sick leave of the Finnish working-age population after hospital discharge were found to be 2 - 4 times longer than those in comparative countries. The cost of health care (financed by municipal taxes) made up about 25% - 35% of the total cost to society. Extensive waiting and recovery periods caused a remarkable loss of productivity. A major proportion of subsequent public expenditure was paid through income subsidies (financed by Social Insurance Institution). The objective of this study is to report the main results of academic and health political work in Finland aimed at the improvement of health gain that reduces non-productivity due to work absence and sick leave. Methods : From 2017, a re-structuring and cooperation of clinical practices between public hospitals, private occupational services and public ambulatory care was undertaken. The objective was to implement a system where patients discharged from public hospitals were subsequently supported by occupational health services. Resu lts : A crucial qualitative result was the development of e-referral from hospital to occupational health services. As quantitative results, lengths of Return-to-Work periods among lumbar discectomy (M51.1) patients decreased from 80 days to 40 days. Corresponding reductions were observed in 15 other DRG groups. Annual productivity of the Finnish work force was estimated to increase by 150 million euros by implementing the process for only a few patient groups. Conclusions : Change in clinical practices did not require legislative actions or monetary incentives. It required a commitment from multiple professionals to a common objective, a clear process of achieving it, and a sustainable monitoring of the change.