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SHARED DATA IN THE MUNICIPALITIES, INTERNAL AND EXTERNAL SHARING. EXPERIENCE FROM FINLAND
D.Sc. (Tech) Katja Klemola, Project Manager, South Karelia Social and Healthcare district (Eksote), Finland
Finland
Area 338 224 km2
Population 5,5 million
Density 17/km2
Social and healthcare reform in Finland • Public social and healthcare services
have been decentralized • Primary care & social services
(over 300 municipalities) • Secondary care (20 hospital
districts) • Specialized secondary care (5
university hospital districts) • The aim is to integrate primary care,
social services and secondary care regionally • ~12-18 social and healthcare
districts • Eksote has been a forerunner of
integrated social and healthcare services
Responsible for the whole Social and Health Care in the South Karelia Region Population 132.000 Budget 450 M€ Workers 4600 One acute hospital 280 beds Nine welfare centers in municipalities
Hospital districts
Different phases in service development
1. Different units in
hierarchy 2. Bigger
administrative
framework
4. Service integration
Ecosystem
3. Organizational
integration
Municipal based structure.
Added value comes from hierarchy
Main focus is on the organization and professionals
Administratively integrated structure.
Added value from economies of scale.
Main focus is on the organization and professionals
Integrated ecosystem
Added value comes from Big Data and common data analyzing.
All parties have the main focus on the citizen
Functionally integrated structure
Added value comes from data.
Main focus is on the citizen
Merged and bigger municipality HOSPITAL
Third sector
Private companies
Municipality
HOSPITAL
Municipality
Municipality
Municipality Social
Insurance
Municipalities
• Tools for operative management
– Information about unit’s activities, finance and personnel
• Analysis of unit’s activities
– What kind of patients/customers visit
– What operations are made
– How activities are done
– Have resources increased or decreased
– Has productivity increased or decreased
• Open question:
– What happens to patient/customer after visit?
– What are the effects of unit’s activities?
• Integrated model of Eksote is developed for regional monitoring of social and healthcare utilization and costs that is based on – Regional perspective
• Area, in which citizens use social and healthcare services
– Individual perspective • Service utilization must be connected to individual (social security
number)
• Costs of service utilization must be connected to individual (= costs per patient/customer)
– Continuously up to date information • Data is updated every night from the source systems
• Rehabilitation 5% – inpatient rehabilitation, physiotherapy
• Family services 7% – maternity clinic, child welfare, psychiatry, student health
• Adult psycho social services 11% – mental health and intoxicants, employment services, social assistance
• Services for disabled 6% – inpatient and outpatient services
• Primary health care 9% – health care, dental care
• Elderly care 25% – domiciliary care, housing services, inpatient services
• Secondary health care 35% – Hospital
• Administration and support services 2%
• Evaluation of effectiveness and cost-effectiveness – By following different customer groups (with current data it is
possible to form and follow up tens of thousands of customer groups) • What happens to the customer after treatment/service?
– Do customers come back to other services?
– Where are customers after certain time period?
• What is the service utilization (and costs) of different customer groups and are there any changes?
• How the customer groups care/service pathways have gone (processes)?
• How the customer groups mortality, performance (or quality of life) have developed?
• Aid in decision making: What are the options and what are the effects (to customer and costs) on longer term?
Rehabilitation 5%
Family services
11%
Adult psycho social services
5%
Services for disabled
16%
Primary health care
1% Elderly care
38%
Secondary health care
24%
The previous slide shows that 1252 different customers or
patients (1% of the population) create 100 million of the
costs which is 25% of the whole budget.
- accordingly 10% of the population -> 80% of the costs
- and 90% of the population -> 20% of the costs
Those patients or customers who can be classified to the
most expensive group are mostly in day-and- night housing
care.
• Every year 1% of the population -> 25% of
the social and health care costs
Number of customers 2012 2013 2014 2015 Total
Rehabilitation 624 604 722 724 1 768
Family services 196 172 170 164 405
Adult psycho social services 221 215 222 222 667
Services for disabled 282 301 354 339 622
Primary health care 942 984 801 768 2 379
Elderly care 871 875 845 887 2 122
Secondary health care 761 769 817 905 2 406
Total 1 248 1 234 1 227 1 252 2 929
Rehabilitation
6%
Family services
0%
Adult psycho social
services 2%
Services for disabled
3%
Primary health care
7%
Elderly care 47%
Secondary health care
35%
Number of Customers
(over 65) Costs (over 65)
Number of
Customers
(total) Costs (total)
65+ -% (number
of customers)
65+ -%
(costs)
Rehabilitation 5 400 11 861 760 13 473 19 885 807 40 % 60 %
Family services 514 49 841 25 287 28 889 620 2 % 0 %
Adult psycho social services 1 695 4 062 154 13 032 36 677 280 13 % 11 %
Services for disabled 760 6 076 139 1 829 26 900 972 42 % 23 %
Primary health care 20 965 14 409 605 70 347 36 441 518 30 % 40 %
Elderly care 11 533 92 889 981 13 658 99 151 786 84 % 94 %
Secondary health care 18 294 69 267 940 57 578 149 753 003 32 % 46 %
Total 30 444 198 617 420 104 556 397 699 987 29 % 50 %
• In the previous slide you can see that the customer group (65+) uses 50% (150 million euros) of the total budget which was 398 million euros 2015, although the share of the age group is 29% of all customers.
• In this case the important points to note are that the biggest part of the costs is naturally in the elderly services but this group also uses 46% of acute hospital services
Rehabilitation
6% Family
services 4%
Adult psycho social
services 45%
Services for disabled
3%
Primary health care
6%
Elderly care 14%
Secondary health care
22%
Number of
Customers
(social
assistance
customers)
Costs (social
assistance
customers)
Number of
Customers
(total) Costs (total)
Social
assistance
customers -%
(number of
customers)
Social assistance
customers-%
(costs)
Rehabilitation 1 312 3 152 609 13 473 19 885 807 10 % 16 %
Family services 988 1 968 318 25 287 28 889 620 4 % 7 %
Adult psycho social services 5 672 22 396 237 13 032 36 677 280 44 % 61 %
Services for disabled 177 1 534 077 1 829 26 900 972 10 % 6 %
Primary health care 4 032 2 734 620 70 347 36 441 518 6 % 8 %
Elderly care 699 6 773 947 13 658 99 151 786 5 % 7 %
Secondary health care 2 875 10 908 258 57 578 149 753 003 5 % 7 %
Total 5 672 49 468 065 104 556 397 699 987 5 % 12 %
• The number of social assistance
customers is 5672 persons (5% of the total
number of customers)
• They use 49 million euros of our services
(12% of the total costs)
• Mental disorders represent almost 22
million euros of the services.
ft
From hospital to home
sh sh
From rehabilitation to home
2 weeks
3 months
6 months 12 months
1 month
AVH-koord
sh sh
ft
DEPS mRS FSQfin
DEPS mRS BMI MNA RR+lab
DEPS mRS FSQfin
mRS BMI MNA RR+lab
A3
mRS weight
AR3
DEPS mRS FSQfin BMI
DEPS mRS MNA RR+lab
DEPS mRS FSQfin BMI
mRS BMI MNA RR+lab
ft
DEPS mRS FSQfin
Hospital Elderly care Primary care Services for disabled Adult psycho social services Family Services Rehabilitation
2013 january-june 6 months before and after stroke
2015 january-june 6 months before and after stroke
Death
Inpatient services
Outpatient / domiciliary services
No services
0
0,5
1
1,5
2
2,5
3
3,5
4
12014
22014
32014
42014
52014
62014
72014
82014
92014
102014
112014
122014
12015
22015
32015
42015
52015
62015
72015
82015
92015
102015
112015
122015
12016
Masennus
Palvelutarve, 1-5
Päivittäinen toimintakyky
Number of measurements 2014 2015 2016
Depression 432 663 48
Need for services, 1-5 471 36
Daily performance 432 664 48
Total 864 1798 132
Depression Need for services, 1-5 Daily performance
• Examples: – Long-term unemployed
• Partner organizations: Social Insurance Office and The Employment and Economic Development Office
– Students who need special guidance at school • Partner organizations: Schools at the municipalities
• We have the data, but analysis of the results is unfinished (2 age groups, born in 1990 and 1995)
• By combining the data we are able to see how unemployment or need for special guidance at school affects social and healthcare utilization
Rehabilitation 3% Family services
6%
Adult psycho social services
13%
Services for disabled
1%
Primary health care 35%
Elderly care 0%
Secondary health care 42%
Comparison group, 30-49 years
Rehabilitation 4%
Family services 2%
Adult psycho social services
45% Primary health care
31%
Elderly care 0%
Secondary health care 18%
Long-term unemployed, 30-49 years
• 34% of the long-term unemployed belong to the group of the most expensive 10% of the population – Vs. 13% of the comparison group
• Long-term unemployed use 50% more social- and health care services than comparison group – More adult psycho social services, primary care,
secondary care
– Less services for disabled and family services
– As much rehabilitation and care
• Handbook of knowledge management at social and healthcare services (Sosiaali- ja terveyspalveluiden tietojohtamisen käsikirja) – Publisher: Sitra
– Authors: Katja Klemola, Jussi Uusi-Illikainen, Tero Askola
– http://www.sitra.fi/julkaisu/2014/sosiaali-ja-terveyspalveluiden-tietojohtamisen-kasikirja
• Dissertation: Evaluating productivity, effectiveness and cost-effectiveness of regionally integrated social and healthcare services – a model based on service utilization and examples (Tuottavuuden, vaikuttavuuden ja kustannusvaikuttavuuden arviointi alueellisesti integroiduissa sosiaali- ja terveyspalveluissa – palvelujen käyttöön perustuva malli ja esimerkkejä) – LUT School of Business and Management, Katja Klemola (11.12.2015)
– http://urn.fi/URN:ISBN:978-952-265-859-3
THANK YOU! D.Sc. (Tech.) Katja Klemola
Project Manager, South Karelia Social and Healthcare District (Eksote), Finland
