National planning for locally controlled health systems: the Finnish experience

The World Health Organization considers Finland's health planning system to be among the most successful in the developed world. Despite tight resource constraints--symbolized by total health expenditures held consistently to less than 7 percent of gross domestic product--the Finns have built up a strong primary care sector and dramatically improved the overall availability and accessibility of needed services. This article compares the official health planning system with the actual planning process as experienced within one Finnish central hospital district. The official planning system seeks to integrate national strategic goals with local municipal ownership, administration, and funding of service delivery. The actual planning process within the studied district suggests that technically oriented civil servants at the regional level may be at least as important in the overall decisionmaking structure. The article concludes with a brief exploration of this finding's potential consequences for the long-term development of the Finnish health care system and for national health planning efforts generally.