Rehabilitation reform done in Finland

Rehabilitation reform committee published its report

Ministry of Social Affairs and Health  9.11.2017 12.00

Rehabilitation reform committee published its report

The Finnish rehabilitation system works well in many cases, but fragmentation in the rehabilitation processes creates problems, according to a committee for reforming the rehabilitation services for restoring and maintaining functional and work capacity. Clients are not receiving the rehabilitation services they need at the right time or on an equal basis. Moreover, they do not have sufficient information about available services.

The rehabilitation reform committee submitted its report to Minister of Social Affairs and Health Pirkko Mattila and Minister of Family Affairs and Social Services Annika Saarikko on Thursday, 9 November.

The final report contains a total of 55 development proposals. Most of the proposals aim to improve the rehabilitation processes and the organising of rehabilitation services, but there are also proposals to improve relevant information systems, training, and research and development. The committee has not been able to give detailed proposals for legislative amendments in all respects because the health and social services reform is still under way. The committee is unanimous in all its proposals.

According to the committee, the system should be improved especially with regard to the rehabilitation processes and the rehabilitation opportunities of older persons and unemployed persons.

Rehabilitation services provided to older persons at home

The committee proposes a regional model for home rehabilitation for the ageing population. A regional operator would assess clients’ needs for rehabilitation services and plan and organise the services according to clients’ needs.

Successful rehabilitation requires a model for responsible client guidance services and a clear target for the rehabilitation, according to the committee. The rehabilitation targets defined together with the client and the services needed to reach those targets would be brought to together in the client care plan in a way that helps the client’s daily life. The plan would serve as a guide to the clients themselves, their relatives, the service providers involved and all the operators responsible for the clients’ services.

Clearer rehabilitation paths for unemployed clients

The regional government, health and social services reform will give the counties the responsibility for employment services (i.e. growth services) and for the organising of health and social services. This opens up new opportunities to create a more coherent system of rehabilitation services for unemployed clients. Research shows that prolonged unemployment increases the risk of incapacity for work. The committee urges that the organisation of the new growth services take into account the needs of long-term unemployed persons. It is also important to care for the work capacity of unemployed job seekers, and monitor their need for rehabilitation services. Clients’ need for services should be assessed straight away at the start of unemployment and on a regular basis thereafter.

Other development targets

The current diagnostic assessment methods do not offer a sufficient foundation for assessing clients’ functional and work capacity or for implementing rehabilitation services and evaluating rehabilitation outcomes. The committee finds that there are better ways to measure the effectiveness of rehabilitation once there are clearly defined targets for rehabilitation and harmonised indicators for functional and work capacity. The rehabilitation and client information systems must be reformed in ways that ensure harmonised flow of information and cater for the needs of the rehabilitation system. This must be taken into account in the further preparations for the health and social services reform, according to the committee.

The counties would be responsible for organising and funding the medical and social rehabilitation associated with healthcare and social welfare. However, at the moment, the Social Insurance Institution of Finland (Kela) is responsible for organising specialised medical rehabilitation and compensates for rehabilitative psychotherapy until decisions are made regarding the final content of the health and social services reform, reforming of multisource financing and appeal procedures concerning rehabilitation. The committee also proposes regional experiments. Transferring the organising responsibility to the counties can be assessed in 2025 at the earliest, after it has been ascertained that the services where the organising responsibility is transferred to the counties work well and that the results of the regional experiments are available.

The committee proposes a streamlining of the division of rehabilitation-related duties between Social Insurance Institution of Finland (Kela) and the authorised pension providers. Another committee proposal is to integrate organisations that represent clients in health and social services in the rehabilitation processes as experts, peer support and developers.

The committee further proposes that the rehabilitation centre of excellence consisting of universities of applied sciences be obliged to reform the system of rehabilitation education and research together with universities, research institutes and upper secondary educational institutions. When developing their education and training in the field of healthcare and social welfare, higher education institutions should take into account the requirements for a rehabilitative work approach that supports functional capacity and draws on responsible client guidance.

The committee proposes the creation of a separate incentive system. The need for incentives depends on the allocation of the benefits of rehabilitation and the harm from non-rehabilitation. The committee proposes that the Ministry of Social Affairs and Health lead the work to develop an incentive system that rewards service organisers and providers for making available a comprehensive selection of high-quality rehabilitation services that are also cost-effective.

Comprehensive reform of the rehabilitation system in the Government Programme

The existing rehabilitation legislation consists of many different acts on services and insurance schemes that have been enacted over the years. The rehabilitation system was created on the foundation of the Care of Invalids Act in the 1940s. In the following decades the system has grown into a fragmented package where different operators can have overlapping duties. The most recent comprehensive reform of rehabilitation legislation took place in 1991.

According to Prime Minister Juha Sipilä’s Government Programme, a comprehensive reform of the rehabilitation system will be implemented during the government term. The Ministry of Social Affairs and Health appointed a rehabilitation reform committee on 1 September 2016. The committee members represent several ministries, parties responsible for rehabilitation, labour market organisations, research institutes, parliamentary groups of the government parties, and non-governmental organisations.

The task of the committee is to prepare proposals for a reformed rehabilitation system and the necessary amendments to the legislation. The committee was tasked to prepare proposals that ensure client-orientation, seamless service processes for rehabilitation clients and rehabilitation services that help clients in their daily life. Rehabilitation services must form a part of the overall services promoting clients’ wellbeing.

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