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The European Journal of Public Health 1998 8(4):313-318; doi:10.1093/eurpub/8.4.313
© 1998 by European Journal of Public Health
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MEDICAL CARE

Local population responsibility in Finnish health centres in 1989–1993

MARJUKKA MAKELÄ1, SALLA SAINIO1, MIRJA ÅSTRÖM2 and MONICA BERGSTROM3

1Stakes (National Research and Development Centre for Welfare and Health), Helsinki, Finland
2Padasjoki Social and Health Centre Finland
3Finnish Institute of Occupational Health Finland

Correspondence: Marjukka Makela, MD, PhD, M.Sc, Stakes/Pala, P.O. Box 220, 00531 Hehinkl, Finland, tel. +358 9 3967 2290,fax +358 9 3967 2227, e-mail: marjukkaostakes.fi

Background: Since 1991, the working patterns in Finnish primary care health centres have been changing from traditional group practices towards local population responsibility (LPR) with personal patient lists. As a result, it was expected the services would change notably. Methods: A controlled intervention study included 30 health centres changing their working pattern to LPR and 30 control health centres. We studied the use of health services in both primary and secondary care in the areas served by these health centres during the transition phase from 1989 to 1993. Data were collected from national statistics. Results: The application of LPR was associated with an initial increase in physician consultations. Consultations for preventive care decreased in both LPR and control health centres. The use of specialized care and consultations with private physicians particularly decreased in large LPR municipalities. Conclusions: The most significant changes occurred in the working patterns of large health centres that had introduced LPR. A wide range of variations between the health centres was observed for all activities in both groups.

Keywords: health centres, health service use, local population responsibility, primary health care, remuneration systems


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