“Freedom of choice” reform threatens the continuity of laboratory monitoring

Published 09.09.2018
Author Virpi Ekholm
Photos Mikko Käkelä
Head of Laboratory Division, Medical Director Kari Pulkki from Tykslab participated in organising the Nordic Congress in Clinical Chemistry on 12-15 June in Helsinki.
Head of Laboratory Division, Medical Director Kari Pulkki from Tykslab participated in organising the Nordic Congress in Clinical Chemistry on 12-15 June in Helsinki.
Kari Pulkki
Kari Pulkki

Finnish public procurement legislation prevents public laboratories from offering their services to private health and social service centres. Consequently, the monitoring of chronic diseases is at risk of being fragmented to different laboratories.

If Finnish parliament passes the freedom of choice legislation, a client may select their health and social service centre from among public and private service providers in the future.

Head of Laboratory Division, Medical Director Kari Pulkki from Tykslab fears that this will fragment the monitoring of chronic diseases.

Approximately half of Tykslab’s customers have a chronic disease or are receiving long-term treatment. The results of their laboratory tests form the backbone for high-quality monitoring and any decisions to change treatment are often based on them, Pulkki emphasises.

In the last few years, Finland has built a number of new, regional laboratories serving one or more hospital districts. These laboratories provide laboratory services both for primary and specialist healthcare in their region.

Customers can visit any of the regional laboratory’s sampling points, all results can be viewed in the same information system and they are comparable.

According to Kari Pulkki, these positive developments could be lost as a result of the impending regional government, health and social services reforms. Different laboratories use different methods with potentially varying results. In addition, the results will end up appearing on different information systems, which will make them more difficult to compare.

If a customer chooses different treatment providers on a whim, going from a public hospital to a private healthcare provider and back again, this may lead to deficiencies and errors in monitoring, Pulkki warns.

Public procurement legislation curbs sales to private organisations

As a result of current legislation, public healthcare laboratories cannot offer many of their services to private health and social welfare centres even if they want to.

According to public procurement legislation, a health and welfare services’ in-house entity can only sell services worth up to 10% of its turnover to outside organisations, so that the public contracting entity can buy its services without going to tender.

Starting from 2022, legislation will become even stricter: after this time, an in-house entity may only sell services worth 500,000 Euros or 5% of its turnover.

We wish that legislation could be changed so that we could participate in service provision for our own hospital district or specialist medical care area even when a customer chooses a private health and welfare centre, Kari Pulkki explains.

Pulkki further emphasises that continuity is particularly important when monitoring chronic diseases. Fully utilising public laboratory centres would also be cost-effective.

The role of laboratories has been overlooked in the conversation about health and welfare reform. Their importance is perhaps not fully understood on a national level, he reflects.

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