Municipalities in Greater Helsinki area increasingly often give up population responsibility model

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The so-called population responsibility (väestövastuu) system is a model whereby a team of doctors and nurses is responsible for the health care of a geographically specified population.
      One of the features of the model is the personal doctor (omalääkäri) system which was initially supposed to improve access to health centre doctors and continuity of care.
      This model has now run into trouble in the Greater Helsinki area, where many municipalities are planning to give up or at least amend the system.
     
”It is obvious that the system has come the end of the road”, says Kati Liukko, the director of health services in Sipoo.
      The municipality of Sipoo more or less abandoned the system already at the beginning of March, while a personal doctor was assigned only to those 2,500 inhabitants who were found to have needed a doctor at least four times in the course of the past 12 months.
      The municipality of Kirkkonummi to the west of the capital also intends to give up the population responsibility model at the beginning of the summer, but is willing to keep the personal doctor system, reports medical director Helena Varonen.
      At the same time, Vantaa also plans to reform the system, while Espoo will test a new concept, says director of health services Tuula Heinänen.
      Antti Iivanainen, the director of health services in Helsinki, thinks that the population responsibility model requires further consideration and potential changes, while access to health centre doctors and continuity of care should be provided for those who are in need of such services.
      The town of Kerava plans to continue the present personal doctor system.
     
One of the reasons for abandoning the population responsibility system in Sipoo was the long-term shortage of physicians. A person who wanted to make an appointment to see a specific doctor had to queue for 1-7 weeks, depending on the address.
      Today, the average waiting period is two weeks, and the disparity between city districts has been reduced.
      According to Kati Liukko, the availability of physicians has also improved. Moreover, the municipality has changed over to the traditional collective bargaining contract and has increased salaries.
     
A centralized triage on the phone, the assignment of degrees of urgency, has been introduced in Sipoo’s district of Nikkilä. Decisions on the order of treatment of callers are made by nurses and a doctor every morning.
      This model was copied from the city of Loviisa that has abandoned the personal doctor system entirely, while developing the specific skills of nurses in cooperation with the neighbouring municipalities.
     
The attitude of clients towards the reform appears to be cautious.
      ”It would be nice to have a contact person”, says Karl-Eric Lönnholm in Sipoo’s district of Nikkilä. He also would like to maintain the personal doctor system for senior citizens.
      ”It is not good to have a different doctor every time”, thinks Esa Mikkola, who previously had a permanent personal doctor.
      However, some people say that even previously it was not certain that one had the same doctor all the time.
      Health centre physician Mikaela Mickos is sorry about no longer being a family doctor, even though she finds good aspects in the new system as well.


Previously in HS International Edition:
  Delays in implementation of medical treatment guarantee (31.8.2005)
  Helsinki hiring 137 new people to upgrade health services (18.2.2005)
  Helsinki Health Centre wants to rent doctors from recruitment agencies (16.8.2004)

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