Making health care policy according to new rules
Abstract
The article analyses the change in the institutional characteristics of the Finnish health services policy in the beginning of the 1990's, related to a profound change in the state subsidy system, to the dismantling of the National Board of Health and to the deep economic recession. The national governance of the health services system was fragmented into different centres and channels. The service provider interests were manifested more openly and the municipalities had to take the role of guardians of macroeconomic stability and cost discipline. Although a change in the Constitution strengthened the role of the citizens as the beneficiaries of the health services system, this was not supported by the other institutional developments. The National Health Care Project started in 2001 is, both in terms of the implementation and of the priorities, an expression of the impact of the institutional changes of the early 1990's.
