3.B. Scientific session: Whom are health system reforms designed for? Lessons from a large-scale structural reform in Finland

Abstract   Health and health care equity are widely shared policy priorities, but still health systems and policies often better accommodate the needs of people with more power and privilege. This stems also from the political determinants of health (PDOH) framework which emphasizes the structural barriers to health care equity created by power and politics. PDOH can be further amplified when health systems undergo major changes making health system reforms critical windows of opportunity during which equity can be either enhanced or inequities exacerbated. In this workshop we use a large-scale health system reform as an entry point to analyze the political determinants of health system reforms. In Finland health system was reformed in 2023 marking a major redistribution of power and resources in the system. The responsibility for services, including health care, was transferred from nearly 300 municipalities to 22 self-governing regional organizations, Wellbeing Services Counties (WSCs). The responsibility for funding was transferred from the municipalities to the state. With this workshop we bring together researchers from health services research, administrative science, health systems and policy research, and medical anthropology to explore the role of power and politics in the context of health system reform implementation. Such large-scale structural reforms are rare in health systems, which makes the Finnish case a valuable subject for research. Health systems are also complex entities which emphasizes the need to study the reform at different levels and by multitude of disciplines. The first presentation sets the stage and focuses on the power balances and governance structures in the new system structure and highlights the changes that have taken place at macro and meso levels of the system after the reform. The second presentation focuses on the meso level and the establishment of WSCs by addressing the public values that are driving the implementation of the reform and the establishment of the new self-governing organizations. The third presentation showcases the micro level perspective by exploring whether the patient groups whose access and quality of services were at the core of the reform goals are benefiting from the changes brought by the reform. The fourth presentation drills further into the micro level of implementation by addressing the lived experiences of citizens and health workforce on the reform implementation and by analyzing how they align with the reform objectives. Each presenter will give a 7-minute presentation which are followed by a comment from the second chair who will analyse the Finnish reform and its implementation against the international experiences of health system reforms. Finally, there is time for comments and joint discussion with the audience to explore, how power and politics shape health system reform implementation and how public health community could tackle the political determinants of health system reforms. Key messages • Power and politics shape health system reform implementation making reforms critical windows of opportunity during which health care equity be can either enhanced or inequities exacerbated. • To understand health system reform outcomes there is a need to study health system reform implementation by multitude of disciplines and through various methodological approaches.