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Let’s be honest about it. There is no longer a primary level National Health Service in Oulu . . . and we all need adjust to it or try and do something about it.
Over the last few years the Medical Centre level National Health Service in Oulu – which we all fund through our tax bills – has pretty much collapsed. If by a National Health Service you mean a medical system that is free at the point of delivery and ensures you get seen by a doctor within a reasonable time period then we have to accept that there is basically no NHS for minor ailments in this city.
To a certain extent, there never was one. Even three years ago you had to pay an upfront flat charge (of about ten euros) to see a medical centre doctor, double that if it was a consultant and there was some kind of charge for every night spent in hospital. In addition, prescribed medicine varies in cost – rather than being free or a flat-rate – meaning that you are financially penalised for having certain illnesses. But at least you could see an NHS doctor within a week or so, sometimes less, of making your appointment and at least you could make an appointment.
Acting your way to an appointment
Since last year, this has changed so radically that there is, effectively, no NHS at all in terms of basic care. Medical centres have become for ‘emergencies’ only, which is surely the purpose of hospitals not doctors’ surgeries. If you go to a medical centre now in Oulu you can’t just make an appointment. You have to be interviewed by a nurse so that she can decide whether you’re ill enough to justify seeing doctor. You will almost certainly not be ill enough to need to see a doctor – though if you have done something serious like broken your leg you will be seen quickly.
If it’s not so serious and you’re very lucky the nurse may arrange a telephone appointment for you with a doctor so that the doctor can you ring you at her (this is not political correctness. Doctors in medical centres are almost always women and the ‘Keskus’ centre doesn’t have any male doctors) convenience rather than your convenience as a paying (through your taxes) customer.
If your condition is not seen as ‘acute’ then you are not even given an appointment in the distant future. You are just not given an appointment at all but rather put on a ‘waiting list’ (which may be several months long) so you can continue living with a potentially fatal (though undiagnosed) allergy, a severe and humiliating – though not ‘acute’ – skin complaint, possible diabetes or any number of other things where a nurse decides that you don’t need to see a doctor. The only solution – and I’m sure its one being increasingly employed – is to lie, exaggerate and convincingly act your way to an appointment with a GP.
And, of course, the whole system raises the question of whether people feel comfortable seeing nurses. Nurses are not doctors and are not really in a position to diagnose illness. They are not as highly trained, are more likely to get it wrong and are less covered against being sued if they do get it wrong. I wonder if there have been any cases of people possibly dying because they were never able to see a doctor and their complaint wasn’t taken seriously by the nurse.
No choice but to go private
This is the point that it has got to in Oulu. It may not be an exaggeration to claim that a US-like system (at least at Medical Centre level) has been introduced by stealth. To see a doctor, you have little choice but to go private – where, for some reason, most of the doctors seem to be men. Though KELA will pay you back a fraction of the costs, it is hideously expensive unless you’ve had to foresight to purchase private health insurance. A twenty minute consultation with a doctor – you’ll get one the day you make your appointment (through a receptionist who asks you no questions) – is about 70€ (including the various office charges that are inexplicably whacked on).
But one problem here is that you really are a paying customer and so the doctor may well be inclined to do what you ask – ‘I think I need antibiotics.’ ‘Certainly, sir. How much would you like?’ – rather that what may be in your best interests. One friend of mine – trying to get a NHS appointment – was actually asked by the nurse, ‘Well . . . doesn’t your job give you private health cover?’ Even if it did, that is no reason to accept an appalling free-system when you’re paying for it with your taxes. But the nurse’s point was interesting. It may be that there is a deliberate attempt to get rid of the NHS and it is working very well. Quite a lot of jobs have private medical cover (even jobs that aren’t especially well-paid like hair-dressers). This surely implies that there is a widespread realisation that the NHS is so bad as to be detrimental to your workers. Most self-employed people also have medical insurance so – stereotypically - the only people that use the NHS Medical Centres are expectant mothers (who only have to see nurses so it’s not really a problem), the (probably less well-off) elderly (who are of a ‘different generation’ where there was no question of private health insurance) and just the poorly off. These people are unlikely to kick-up a fuss so NHS medical treatment can be effectively killed by a thousand cuts.
Not enough doctors
Oulu has got to this stage for a variety of reasons. Firstly, the amount of tax money going to the NHS over the years has gone down and down it what may well be an attempt to get rid of an expensive and cumbersome system. Secondly, there are not enough NHS doctors. According to the Ministry of Health, newly qualified doctors do not want to come and live all the way up here. Thirdly, Finland does not train enough doctors. The education minister said only last week that it is far too difficult to get into a Finnish university. This leads to the crazy situation where Finnish students have to go off to Britain, Sweden and Estonia just so they can return to Finland and get a job as a doctor . . . and there still aren’t enough! At Estonia’s Tartu University, about two-hundred Finns join each year (usually having taken a year out to learn Estonian) and half of those Finns are Medical students and Tartu is undoubtedly a very good university. And a fourth factor is that, considering the stress involved, Finnish NHS doctors are very badly paid, strongly incentivising them to go into private practice or do a different and better paid job.
How can we solve this problem? It’ll probably be quite difficult because so many people have private medical care with their jobs but if you believe that the poor shouldn’t just get a terrible deal or that your tax money should lead to results, then there is a problem. NHS Medical Centres are overstaffed with nurses. They can be replaced by a few receptionists (who would be paid much less than nurses), a handful of nurses to deal with expectant mothers and then far more doctors.
Becoming a doctor too difficult
Secondly, it should be easier to become a doctor. The simple fact that students can get rejected from every Finnish university but qualify at Tartu (an internationally respected institution) shows that Finland’s system is too selective for its on good.
Thirdly, the government can follow the policy that the Danish government uses to persuade doctors to go to Greenland. It is seen as such an unpleasant place to live that Danish doctors that go there get paid more than their colleagues in Denmark. Though northern Finland is surely more developed than Greenland, this carrot approach might work here.
And then, of course, there is the stick approach. Finnish medical students are funded by the tax-payer for the full cost of doing their degrees so is it not only fair that they be forced to work for the NHS at least until they have paid back the full cost of their tuition and living expenses through their work? And of course, if they wanted, they could just pay back the full cost upfront and go straight into private practice or the biomedical industry.
‘We have major difficulties’
Pekka Järvinen, a lawyer for the Ministry of Health, insists there is no policy to get rid of the Finnish NHS. ‘This is not the basic idea . . . though in some municipalities it has kind of happened like that. We have major difficulties and it is very hard to see a doctor. We are trying to find ways to deal with this.’
Järvinen felt that suggesting that there was a ‘stealth’ attempt to introduce a private health system was a ‘provocative question.’ ‘People can mostly get to see a doctor,’ he insisted, ‘and quite many people have private health care, often through their work.’
The Ministry of Health is trying ‘several ways’ to improve the situation. ‘We already have a co-operation with the Ministry of Education about trying to train more doctors. We are trying to find ways to get their earnings up and one of the biggest problems is leadership in the health centres. In many health centres it is not the best and so people don’t want to work there.’
He claimed that the ministry had certainly ‘thought about’ raising the wages of doctors in ‘remote areas’ but stressed that, ’65 percent of the funding for healthcare comes from the municipalities. It is 35 percent from us.’ They had not contemplated forcing medical graduates to work in the NHS.
The NHS is destined to be a major issue in the forthcoming local elections.
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