Can Sote’s reform improve the experience of foreigners in the Finnish social and health care system?

From next year, Finnish health and social care providers will be under the control of the new county governments. Voters will go to the polls at the end of January to vote for the new institutions.

We asked our audience what they thought would be high on the agenda of the politicians elected to the new councils, and there were plenty of ideas.

Language barrier

Many people mentioned language difficulties when trying to navigate the system.

Many potential patients said they did not know which service to contact, said they had been misunderstood in describing the help they needed, and said they did not get the help they needed, among many other challenges.

One defendant, Sedge**, recalled how he encountered many unnecessary and completely avoidable problems while trying to solve a particularly sensitive personal problem in English. This included a misunderstanding and getting wrong advice, which made his problem worse – until his Finnish spouse came to help.

"I should be entitled to help without discrimination, but that was not the case. I shouldn’t bring [my spouse] just to get someone to listen to me," Sara said.

Henna LeppämäkiA specialist from the Ministry of Social Affairs and Health told Yle Uutis that the Finnish Language Act and the Administrative Law Act entitle you to interpretation services if you do not speak Finnish or Swedish. This provision will be continued and possibly improved in the context of the Sote reform, he added.

"Most municipalities have agreements with interpretation service providers and remote services are more common and more widely used, especially during and after the Covid-19 pandemic." he said.

An interpreter must be arranged and paid for by a social or health care provider, Leppämäki added, but it is important that the patient or client also requests this service.

On a broader level Anu CastanedaThe team leader of THL’s Migration and Cultural Diversity team suggested that the Sote reform could bring improvements to the use of the Finnish language in the provision of services.

"Answers to this problem could be, for example, developing the use of simple Finnish, supporting people in learning Finnish, developing multilingual and multi-channel aspects in health services, and training professionals to meet equality and cultural diversity and people from different backgrounds." Castneda said.

The introduction and scope of such measures would depend on the composition of the federations of the provinces selected on 23 January.

“Gatekeeping” and the obstacle course of appointments

Another recurring problem was the difficulty many people said they experienced when booking time, especially for an appointment with a nurse, doctor, or dentist.

Difficulties getting a referral to an expert were a common complaint, and even the first hours of reception can sometimes feel difficult to get into parts of the system.

Margarita * told Yle News he felt "completely abandoned" when he was constantly at a dead end when he turned to the public service system for help.

Despite all these challenges, Margarita remembers that she was making slow progress and finally got the referral needed to continue. However, his case was delayed for another two months due to the official "I forgot" send him a referral.

"I didn’t live, I survived, I was in pain. They knew this," Margarita said. "I needed help and [the official] I forgot."

Adviser to the Ministry of Health, Tapani Hämäläinen, said that people who feel denied access to services have the right to take the matter to the management of a health center or otherwise to a patient or social ombudsman.

"If people feel that they have been ill-treated in social and health services, or if they need advice about their rights, they can turn to a patient or social ombudsman," Hämäläinen advised.

Each municipal health center has a patient ombudsman and each municipality has a social ombudsman. Their contact details can usually be found on the website of either the health center or the municipality.

Both offices, Hämäläinen added, can also help people make complaints about social or health services to the Regional State Administrative Agency (Avi) or, in some cases, to the Social and Health Surveillance Authority (Valvia).

THL’s Castaneda also recommended contacting the Equality Ombudsman if anyone suspects that they are being denied access to services for discriminatory reasons.

"In the field of equality, the Equality Ombudsman can be contacted at a low threshold and will examine the situation on a case-by-case basis," he said.

Deficiencies in preventive care

Quite a number of respondents mentioned an obvious lack of preventive care in the Finnish system. They were concerned that smaller, relatively less significant problems could become much larger and more serious problems if not addressed quickly and effectively at an early stage.

"The requirement of failure, that is, how often you need to contact to solve a problem, is only now recognized as a problem [by Finnish authorities]," one respondent said.

"Detecting and treating a minor illness in a timely manner can prevent later life-saving."

There are several stages in preventive care, including the patient’s own responsibilities, but one key step is the early diagnosis and prompt treatment of life-threatening or even fatal diseases.

Kirsi PaasovaaraA specialist from the Ministry of Health told Yle Uutis that shifting the focus of services to preventive and proactive work is one of the government’s key goals in the Sote reform.

"The focus of services is shifting from specialist care to primary health care and preventive work. The role of social welfare is becoming more important," Paasovaara said.

Knock-on effects

Although most of the respondents mentioned so far in this article said that their problems were finally resolved to some extent – albeit after stress and frustration – Yle News also learned of a small number of cases that have had very serious side effects. to the people involved.

In one case Anna ** told Yle News how the doctor ‘s misdiagnosis almost led to the loss of his home.

Anna went to the clinic in the summer of 2020 complaining of severe pain, but she was told it was nothing serious and will soon pass. However, the pains continued, so he went to another doctor for a second statement where his correct – and very serious – diagnosis was found.

Anna’s fixed-term employment contract ended at about the same time as the misdiagnosis, but she was unable to renew her contract or find a new job due to her illness. He was also not entitled to sick leave benefits.

Anna’s financial situation deteriorated rapidly during the first months of 2021 due to continued problems with several surgeries and delays in social security contributions, as confusion over her initial diagnosis led to a misinterpretation of her rights.

As the revenue did not come for months at a time, the bills began to pile up and creditors eventually transferred them to collection agencies. This led to many additional problems, including repeated eviction threats.

"I am speechless about how the health care and social system works in Finland," Anna said. "If you have financial problems, you will not get help from anything."

According to Kirsi Paasovaara, Ministry of Health, Anna’s case is a good example of the problems that can arise when different departments work in “silos”, ie they only work inside their own bubble, as has often happened in the previous system. .

However, he added that the Sote reform is intended to solve these problems.

"The reform will develop and restructure health and social services. Basic public services and preventive work will be strengthened. The aim is for people to have smooth access to health and social services and help with their individual needs," Paasovaara said.

See our simple guide for everything you need to know about regional elections.

* Margarita asked Yle News not to use her last name.

** The names of Sara and Anna have been changed to protect the identities of the interviewees.

Source: The Nordic Page





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