Insights Series Issue 15: "Achieving healthcare happiness-the Finland mode"

Insights Series Issue 15 siemens-healthineers.com/ transforming-care-delivery 63 C3 A2 HERE 01010101010101010101010 0101010101010 0101010101019 1110 010101016 11010111010000110 Achieving Healthcare Happiness – The Finland Model A thought leadership paper on how to ‘Transform care delivery’ co-authored with Dr. Päivi Sillanaukee siemens-healthineers.com/transforming-care-delivery SIEMENS Healthineers Preface The Insights Series The Siemens Healthineers Insights Series is our preeminent thought leadership platform, drawing on the knowledge and experience of some of the world’s most respected healthcare leaders and innovators. The Series explores emerging issues and provides you with practical solutions to today’s most pressing healthcare challenges. We believe that increasing value in healthcare – delivering better outcomes at lower cost – rests on four strategies. These four principles serve as the cornerstones of the Insights Series. Expanding Transforming Improving Digitalizing precision care patient healthcare medicine delivery experience Our Insights portfolio is an integrated collection of events, speaking engagements, roundtable discussions, and an expanding array of print and digital platforms and products all carefully curated to share ideas, encourage discussion, disseminate original research and reinforce our position as a healthcare thought leader. Please visit siemens-healthineers.com/insights-series Executive Summary The people of Finland consistently rank among the The government of Finland has employed five strategies happiest on earth. According to the World Happiness to transform the country’s healthcare system. These Report, Finland was the happiest country in the world changes can serve as a model for other health systems, in 2020 – for the third year in a row.1–3 The Report whether public or private. points to numerous reasons for this including reliable welfare benefits, low corruption, a well-functioning These five strategies are: democracy, and dependable state institutions. • Establishing clear lines of responsibility: optimizing clinical operations and ensuring the right care is The Finnish healthcare system is a key component of delivered at the right time in the right place, this dependable public infrastructure, contributing to • Integrating care: so patients have access to care a broad and deep sense of what we call “Healthcare they need under one roof, Happiness”. • Specializing care services: improving workforce productivity and leveraging the skills of health Achieving “Healthcare Happiness” requires a number of specialists to deliver the best care and obtain a things: positive health outcomes; motivated and pro- competitive edge in the marketplace, ductive caregivers; a high level of confidence amongst • Digitalizing healthcare: embracing technology patients; and success as keeping demand, and and building a data-driven healthcare system, corresponding costs, at a manageable level particularly • Measuring healthcare performance: to understand in a publicly-funded system. what needs improving, and to reward providers for positive patient outcomes. The approach that Finland has taken to healthcare delivery is a noteworthy example of meeting challenges These strategies are widely understood to be effective through change, of actively transforming care delivery responses to specific problems in healthcare. Employed in order to sustain and improve it. together, in the manner that Finland is employing them, they go a long way to securing quality healthcare Finland has a long-standing commitment to delivering services for the present and ensuring continuous quality healthcare to its citizens; in fact, it is a consti- improvement for the future. tutional obligation. Yet, Finland has also had to respond to challenges in recent years, some relating to geography and population density, others relating to factors being felt throughout the world such as demographics and human resources. Siemens Healthineers Insights Series · Issue 15 3 What Finland does right “ In only a few decades, Finnish If there is one thing that the world knows about healthcare has developed from Finland, it is that the people who live there love a somewhat rudimentary health- doing so. For three years in a row, the World Happiness Report has declared the Nordic country care system into one that is in­- to be the happiest in the world.¹–³ One reason is ternationally acclaimed. Every undoubtedly the quality of public institutions including Finland’s healthcare system, which is permanent resident in the ranked among the top six in the world.⁵ Finns have sparsely populated country has a life expectancy of 81.8 years, which is higher than the EU average of 81.0 year,⁶ and an infant mortality access to an extensive set of rate that is the lowest in the world.⁷ services, yet total per capita Finns are happy with their lives, and they are happy with healthcare costs remain lower their healthcare. 78% of Finnish people are satisfied with than in most comparable coun- the medical treatment they receive, giving the country the highest rating in patient satisfaction in the European Union tries. Despite recent concerns (EU).⁸ However, for the government of Finland, delivering about equity issues, Finns are excellent healthcare is about more than just keeping people happy. It is about more than delivering a public generally very satisfied with service widely viewed to be essential. It is about fulfilling their healthcare services.” a constitutional obligation. The constitution of Finland guarantess every citizen the right to "heath and medical The Finnish Healthcare System: services" and further imposes an obligation on public A Value-Based Perspective – Juha Teperi, authorities to "promote the health of the population". Michael E. Porter, Lauri Vuorenkoski and All in all, a remarkably strong constitutional guarantee. Jennifer F. Baron⁴ This paper investigates the Finnish healthcare example, analyzing how the country has been able to achieve this state of relative ‘healthcare happiness’, and examining what other healthcare providers – either public systems or private organizations – can learn from Finland’s success at transforming care delivery. 4 Issue 15 · Siemens Healthineers Insights Series “ Public authorities shall guarantee for everyone adequate social, health, and medical services and promote the health of the population” The Constitution of Finland (731/99), 19§ Better equipped than the EU average Growing up healthy (per 100,000 population, 2016)⁶ 15 obligatory visits to a child health clinic (for children below school age) MR scanners EU average 1.4 free preventive Finland 2.6 dental care for children up to 18 years of age CT scanners EU average 2.2 Life expectancy at birth (years)⁶ Finland 2.4 EU average 81.0 Finland 81.8 Mammographs EU average 1.8 Staying healthy in the happiest Finland 3.1 country in the world Finland’s goal: smoke-free 100% of public primary healthcare country in 2030 centers and public hospitals use electronic (% of daily Smokers)⁶ health records¹⁷ 2009 23% 100% of medicine prescriptions 2018 14% are done electronically¹⁷ 2030 0% Siemens Healthineers Insights Series · Issue 15 5 Residents in the North of Finland face long travel times to the next hospital The challenge 400 km Because Finland’s healthcare system is publicly funded, the government has a great deal of control over both healthcare policy and how healthcare challenges are met. Over the past few years, Finland has moved to address several existing and emerging challenges, the most significant of which revolve around geography, structure, human resources and demographics. Geography: Big country, few people, many languages Delivering healthcare services equitably is always a challenge, particularly when taking into account Finland's population and geography. Finland has a population density of 18 inhabitants per square kilometer,⁹ one of the lowest in Europe. For a country close in size to Germany, Finland has a population of only 5.5 million (compared to Germany's 83 million). Making good on a constitutional promise to deliver “What we know about healthcare quality health and social services to everyone is a hard one to keep in a country where some people have to is that nothing ever really stands travel more than 400 km to find a hospital. The promise still. Technology changes, tools becomes even harder to keep in a country where there are two main official languages and several official change, new diseases emerge, minority languages. demographics wreak havoc with expectations.” 6 Issue 15 · Siemens Healthineers Insights Series Proportion of population over 65 years¹⁴ > 65 years 2070 2050 < 65 years 2019 Responsibility: Variations in quality, variations While the country’s ratio of physicians to population in demand is above to the EU average (3.8 in Finland, 3.7 in EU), Finland lags behind some Nordic countries such as As noted above, Finland is a large country with a small Denmark, Iceland, and Sweden.¹⁰ In 2018, 6% of clinic and widely dispersed population. In order to meet these physician vacancies in Finland were unfilled.¹¹ In the challenges, the Finnish government realized that eastern part of the country, this number reached responsibility for at least some the healthcare system almost 20%.¹¹ This has led to long wait times and, needed to rest with the municipalities where patients on occasion, patients being unable to see a doctor live. To that end, much of the responsibility for de- at all. livering healthcare in Finland falls to the country’s 310 municipalities. Delegating significant healthcare Indeed, in 2018, nearly 5% of Finns reported difficulty responsibilities to municipalities ensures that local in accessing treatment or medical examination as a needs are understood and responded to. Yet meeting result of long wait times – that is almost eight times those local needs is easier for some municipalities than the EU average of 0.6%, placing Finland 27th out of for others. In Finland, there is a great deal of variation 28 EU countries.¹² between municipalities in terms of geographic location and demographics. Healthcare demands in some areas are greater and more expensive than in others, which Demographics: People getting older, care getting makes the task of coordinating and ensuring equal more expensive healthcare more complex. Like many jurisdictions, Finland is coping with a classic demographic quandary. Life expectancy in the country Human Resources: Not enough doctors is growing – it was 81.8 in 2019, and is expected to be 85.9 in 2050.¹³ At the same time, the proportion of The defining relationship in healthcare is between the elderly people is growing rapidly. In 2019, 22% of the patient and his or her doctor. This has been the case population was 65 years or older.¹⁴ That figure is since time immemorial, and to this day it is almost expected to be 29% in 2050.¹⁴ Because seniors are impossible to properly deliver care if there are not increasingly dependent on healthcare as they age, enough doctors to do the delivering. This has become these trends pose a significant challenge for the a problem with which Finland has had to contend. publicly-funded Finnish healthcare system. Siemens Healthineers Insights Series · Issue 15 7 The solution “Healthcare systems are Something that has set Finland somewhat apart in enormously complex. its approach to healthcare has been its refusal to rest on its laurels. Success has not bred complacency. But the goal in healthcare Quite the opposite. Over the past few years, the country has taken significant steps to build on an is really simple – excellent already solid foundation of healthcare achievement to address a number of challenges that were patient care. If you can emerging. In the process of doing so, it can be safely maintain a laser focus on said that Finland has transformed care delivery. that goal, the changes you That transformation has taken place in five distinct ways. Establishing clear lines of responsibility, integrating need to make really do services, encouraging specialization of care, fully embracing digitalization, and measuring performance. become quite clear.” All have been successful, and as a result, all are expected to continue. 1 Establishing clear lines of responsibility The point to clear lines of responsibility for the delivery for primary, secondary, and tertiary care is to ensure that wherever patients might be, they will always know who is responsible for the specific type of care they need, and the system itself will always be ready to provide it. And so, in Finland, the 310 municipalities are responsible for funding and managing primary care. They are also responsible for ensuring that anyone living within their boundaries can receive any necessary secondary, or more specialized care. That care is provided by the country’s 20 hospital districts. Every municipality belongs to one of the hospital districts, and they are all responsible for the 8 Issue 15 · Siemens Healthineers Insights Series Hub-and-spoke models have proven to be effective at optimizing clinical operations management and funding of those districts. Tertiary care primary level mental health and substance abuse is delivered by Finland’s five university hospitals. services, outpatient rehabilitation services, prevention of chronic illnesses as well as maternity and child health In effect, the Finnish system is a variation on the clinics and other preventive services. These future health hub-and-spoke model in which anchor establishments, and social services centers will introduce electronic in this case university hospitals, act as hubs offering a assessment of the need for a healthcare consultation, wide and complex array of services, with secondary digital and mobile remote services, online booking establishments, in this case hospital districts and primary systems, specialist consultations to support the work care providers in the municipalities, acting as spokes of GPs, and longer hours that include weekends and offering more limited services. evenings. Hub-and-spoke models have proven to be effective at It is widely understood that integrating care increases optimizing clinical operations. It is an operating model quality as well as access to care. Wait times decrease. that increases and improves coordination between In addition, the ‘one-stop shop’ model enables the primary, secondary, and tertiary care. By contributing to deployment of multidisciplinary teams of health and a more efficient allocation of resources, municipalities social services professionals, as well as a shift in focus with fewer resource are not left behind and are better from specialized care to primary care and prevention. able to provide for the needs of their residents. 3 Specializing care services 2 Integrating care Finland has a long history of encouraging specialized One of the most significant recent healthcare develop- healthcare services. There have been several speciali- ments in Finland has been the introduction of the zation initiatives over the course of the past few decades, so-called Future Health and Social Services Centres and in 2017 the country moved to support specialized Programme, which is expected to be completely imple- services even further with regulations mandating mented by 2022. The program envisions a future in which minimum volumes for certain types of healthcare all primary care-level health and social services that services. The effect of the regulations has been to patients need will be available to them under one roof. encourage the development of centers that focus on just a few services. This helps these centers to meet Available services will include primary healthcare, oral their annual volume requirements. Patients benefit from healthcare, local social work and home care services, the knowledge that they are receiving care in a highly Siemens Healthineers Insights Series · Issue 15 9 specialized facility. And this specialization and expertise The results? A solid argument for specialization. COXA becomes self-perpetuating, as clinics attract the best performs 5,300 joint replacements per year, well above medical practitioners in their respective fields. the regulatory requirement of 600. The revision rate for COXA joint replacements is half the Finnish average: For these types of services, implementation of special- 2.7% for knee replacements and 0.9% for hip replace- ized approaches is at the core of optimizing their clinical ment. According to a recent OECD report, COXA is also operations. It allows them to benefit from economies of leading internationally.¹⁵ The hospital achieves top scores scale, while attracting an increasing number of patients. in terms of effectiveness of joint replacement surgery, measured by patient-reported outcomes.¹⁵ Financially, The first example is COXA Hospital for Joint Replacement, the hospital sees a growth rate of 15 – 20% per year. the only hospital in Finland to specialize exclusively in endoprosthetic surgery and joint replacement surgery. The COXA example provides a clear demonstration of COXA was founded in 2002, and was thus making the how specialization can help optimize clinical operations. case for specialization long before the recent regulations But COXA is located in a city, and Tampere is the second- opened the door further. largest urban area in Finland. The question that needed to be answered was whether minimum volumes and COXA is a blueprint for healthcare specialization. The specialization could be made to work in sparsely center operates on a single site in the city of Tampere, populated Northern Finland, particularly in time-critical with a focus on standardization that results in superior situations. The answer, as it turns out, is yes. outcomes while enabling high volumes. The system runs like clockwork and clearly improves workforce Northern Finland accounts for almost 50% of the productivity: a 30 minutes doctor/ patient interaction country’s geographical area, but just 13% of its citizens. prior to surgery, a 45-minute surgery, 52 hours of Long distances between where people live and where inpatient rehabilitation, follow-up after 3 months. they can receive care are challenging, doubly so in time- COXA has 14 fully qualified orthopedic surgeons, each sensitive cases such as childbirth. The whole of Northern performing 200 to 250 joint replacements per year. Finland is the special responsibility area of the Oulu Surgeries are performed six days per week. There is only University Hospital. The distance from a village like a 15-minute changeover time between patients, and Utsjoki, in Finland’s most northerly region, to that there is always a patient ready for surgery if a planned hospital is 650 kms, an eight hour drive. surgery gets canceled. What Oulu Hospital has done is make it as easy as possible for an expectant mother in a place as far away as Utsjoki to give birth at Oulu. Pregnant mothers are 10 Issue 15 · Siemens Healthineers Insights Series encouraged to travel days if not weeks before their planned birth date. They are housed in facilities called Kanta: Patient Data Repository and patient hotels, where they are supported and cared for Prescription service¹⁷ as they prepare for the arrival of their babies. The law requires a minimum volume of 1,000 childbirths Patient Data Repository Prescription Centre per year for a childbirth performing hospital. In 2019, Oulu University Hospital performed 3,309. More than 187 1 billion million 4 Digitalizing healthcare records on service events electronic prescriptions If Finland has an ace up its sleeve when it comes to trans- and treatments forming its healthcare system, it may be digitalization. There is no model of future healthcare that does not forecast a steadily increasing amount of digitalization, More than so countries whose citizens have embraced electronic technology enjoy a real advantage in adapting that 6 million technology for healthcare. As it happens, Finland ranks personas has patient data first according to the The Digital Economy and Society in Patient Data Repository Index 2020, which measures the overall digital per - formance of all EU countries.¹⁶ Thus, digitalization is able to support the goal of providing adequate health and social services to the people of Finland, because the people of Finland support digitalization. Digital assets With “The National eHealth and eSocial Strategy 2020”, Finland has begun shaping the future of digital health. The strategy is built around two digital assets developed to help Finland forge a more effective digital healthcare future for both patients and providers. The two assets are Siemens Healthineers Insights Series · Issue 15 11 “ Today, we are better at gathering data than we are at using it. There is so much potential not yet being tapped in healthcare data, but that is beginning to change. And we want to lead that change here in Finland.” the National Archive of Health Information called Kanta, care paths to guide patients in preparing for an and the eHealth service called Health Village. operation, dealing with chronic diseases, and finding coaching and web therapy. There were more than Since 2013, Kanta has been Finland’s national archive 6.2 million visitors to Healthvillage.fi in 2018. of electronic health information. Kanta provides citizens with their health data, wherever and whenever they Data utilization need it. It also provides that data to private and public welfare and healthcare sector actors who are authorized In healthcare as in much else, the more you know, the to view it. Patients can use Kanta to browse their pre - more you are able to do. Data is knowledge. In Finland, scriptions and order repeat prescriptions online. They can the goal is not only to generate significant amounts of also state their organ donation wishes, and issue certifi- data, which eHealth services and electronic health cates to authorities. Professionals can access needed data records will do, but to find ways of analyzing and using nationwide, store patient records and enter prescriptions. it to its maximum potential. That is the key to data-driven Simply put, Kanta has improved the experience of healthcare. patients in interacting with the healthcare system, and has allowed providers to optimize clinical operations At HUS Helsinki University Hospital, Finland is piloting and increase workforce productivity. All public primary the utilization of the data. HUS is building a ‘data lake’ healthcare centers, public hospitals and community to aggregate data coming from sources such as patient pharmacies in Finland have subscribed and use these information systems, quality registers, billings, picture services.¹⁷,¹⁸ As of 2018, almost half of Finnish adults archiving and communication systems, genome data, participated in Kanta.¹⁸ mobile applications and administrative data. Since 2014, HUS has used this data to develop algorithms which can The second asset is Health Village, a mobile electronic be used for everything from predicting septic infection health platform that brings healthcare directly to health to image analysis to head trauma mortality prediction. professionals, patients, and the general public. For pro - For example, the algorithm to predict a septic infection fessionals, Health Village offers everything from expert- of preterm infants 24 hours before onset reaches a level information on rare diseases, access to sensitivity of 82% and a specificity of 96%. teleconferences, trainings, telemedicine, a virtual knowledge center with guidelines and treatment Patient trust instructions, as well as guidance and training on Trust continues to be an essential cornerstone of the how to develop eHealth services. For patients, Health relationship between healthcare providers and patients. Village is designed to become a part of the patient’s Trust plays an especially important role when it comes treatment plan. There are self-care programs, digital to the security of patient data, particularly in a digital 12 Issue 15 · Siemens Healthineers Insights Series environment. The generation and utilization of data can providers are paid based on the number of services they only work if the owners of the data – the people – are deliver, or patients that they see. The goal is to reward willing to use digital assets and share their data, con - providers for helping patients improve their health, fident that it will be used properly and securely. When reduce the effects and incidence of chronic disease, developing the legislative framework that governs and live healthier lives in an evidence-based way. digital healthcare data, Finland has been rigorous about including public consultations and public discussions There is a saying in healthcare that “if you can’t mea- as part of the process. This openness and transparency sure it, you can’t improve it.” Those words inform the has helped to nurture a strong sense of trust from the work of the Finnish Institute for Health and Welfare beginning. Strong patient trust also contributes to the (THL), which carries out an assessment of social and ongoing growth and increasing effectiveness of digital healthcare systems in Finland annually. The THL has innovations. Trust contributes to increased use of digital been tasked with monitoring and measuring healthcare assets, which results in more data being gathered and performance on a population health basis, in order to generated, which in turn boosts the speed of further lay the groundwork for outcomes-based health funding. innovations and contributes to better patient outcomes. Every year, THL provides an expert assessment for each Comprehensive and reliable health and social data can of Finland’s counties, in 11 defined service areas. contribute to better knowledge management, more These are measured against five performance indicators effective research, and stronger innovation. The current (availability, costs of services, customer orientation, COVID-19 pandemic offered an opportunity to see how equality, quality). strongly the Finnish people trust their digital healthcare assets. Within only two weeks, the Finnish COVID-19 Regardless of whether THL’s work results in changes mobile contact tracing app was downloaded by 40% to the funding model, it has resulted, and continues to of the population. In Germany, where the government result, in greater performance transparency and better was very satisfied with the download numbers, the resource allocation/planning. It allows the system to share was “only” 17.5% after two weeks.¹⁹ assess the various hospital districts’ abilities to organize services so that population needs are met in an equitable manner. It also supports funding that is reliably based 5 Measuring healthcare performance on costs, production efficiency and cost-effectiveness. Moreover, the data generated is used for prediction and The growing trend in healthcare is for providers, in- forecasting and comparison between counties can be cluding hospitals and physicians to be paid based on made to identify best practices and close performance patient health outcomes. This differs from the conven- gaps. tional fee-for-service or capitated approach, in which Siemens Healthineers Insights Series · Issue 15 13 Conclusion Finland’s success in transforming care delivery is Health systems will look at the manner in which setting reflected in the commitment of its government, the clear lines of responsibility can result in the right care engagement and buy-in of its service providers, and being delivered at the right time in the right place. the participation and trust of its citizens. This rare Providers will look at how integration and specialization synergy stems from the fact that the changes being can improve their ability to leverage their skills and wrought reward those who embrace them. Simply deliver care in the best possible ways. Finally, digitali- put, there is something for everyone. And the world zation and measuring outcomes will underpin all future is taking notice. healthcare, and the systems and providers who embrace them will gain a step up in the marketplace. In a real sense, we consider the Finland healthcare model to be a roadmap to future healthcare success. Change has been a constant in healthcare for a very The five approaches are solid, proven, effective re- long time. In Finland, the pattern has been to change sponses to different challenges, and taken together proactively, to bring about healthcare transformation form an excellent strategy for transforming healthcare in response to challenges, instead of responding to systems to overcome future obstacles and meet present challenges that stem from changes nobody planned for. demands. We believe other governments and health The results, and the overall happiness of the population, systems will embrace these strategies in the years ahead. suggest the pattern is a good one. For patients, there is surely comfort in knowing that Regardless of whether the health system under some of the most vexing problems in healthcare are discussion is a public or private one, there will always being solved. How and where to receive the care one be pressure to deliver better care at lower costs. For needs. How to access care from remote locations. How public systems, that pressure will come from taxpayers to take more control over one’s own healthcare and the and from competing resource demands within govern- outcomes of the healthcare measures. What Finland has ment. For private systems, that pressure will come from demonstrated is that not only are the answers to these competition between providers. In the years to come, questions available, they can in fact be influenced by the we believe that both types of systems will work to patients asking the questions. emulate the Finnish model, and their patients will enjoy the best possible 21st century care. 14 Issue 15 · Siemens Healthineers Insights Series Establishing clear lines of responsibility Integrating care Empower patients Specializing care services Digitalizing healthcare Measuring healthcare performance Siemens Healthineers Insights Series · Issue 15 15 Acknowledgements The authors gratefully acknowledge the contribution and insights Suggested follow-up on they received from Kari Hakari, Ministry of Social Affairs and Health Finland, Dr. Jaakko Herrala, Council of Tampere Region, Dr. Visa siemens-healthineers.com/insights/transforming- Honkanen, Helsinki University Hospital, Jaana Lappi, Ministry of care-delivery Trade and Economy Finland, Kristiina Michelsson, Coxa Hospital for • Joint Replacement, Pasi Pohjola, Ministry of Social Affairs and Health Insights Series, Issue 13: Finland, Mika Pyykkö, The Finnish Innovation Fund Sitra, Pekka Sight to the world: How Aravind improves access to Rissanen, National Institute for Health and Welfare. care for millions • Insights Series, Issue 7: Do one thing and do it better than anyone else • Insights Series, Issue 4: Achieve twice as much but only work half as hard • Harvard Business Review: Transforming care delivery to increase value Information The Siemens Healthineers Insights Series is our preeminent thought leadership platform, drawing on the H. knowledge and experience of some of the world’s most respected healthcare leaders and innovators. It explores emerging issues and provides practical solutions to today’s most pressing healthcare challenges. All issues of the Insights Series can be found here: siemens-healthineers.com/insights-series Contact If you have further questions or would like to reach out to us, please do not hesitate to contact our expert directly: Dr. Herbert Staehr Vice President Global Head of Transforming Care Delivery at Siemens Healthineers [email protected] 16 Issue 15 · Siemens Healthineers Insights Series References 1. Helliwell JF, Huang H, Wang S, Shiplett H. 11. Finnish Medical Association. World Happiness Report 2018. World Terveyskeskusten lääkäritilanne 2018 Happiness Report 2018. New York; 2018. (Medical situation in health centers 2. Helliwell JF, Layard R, Sachs JD. World 2018) [Internet]. Helsinki; 2018. Happiness Report 2019. New York; 2019. Available from: https://www.laakariliitto. 3. Helliwell JF, Layard R, Sachs JD, De Neve fi/site/assets/files/5223/ J-E, Aknin L, Huang H, et al. World terveyskeskusten_laakaritilanne_2018_ Happiness Report 2020. New York; 2020. valmis_2.pdf 4. Teperi J, Porter ME, Vuorenkoski L, 12. Eurostat Statistics Explained. Unmet Baron JF. The Finnish Health Care System: health care needs statistics [Internet]. A Value-Based Perspective. 2019. Available from: ec.europa.eu/ Sitra Reports #82. Helsinki; 2009. eurostat/statistics-explained/index.php/ 5. Fullman N, Yearwood J, Abay SM, Unmet_health_care_needs_statistics Abbafati C, Abd-Allah F, Abdela J, et al. 13. Eurostat Statistics Explained. Mortality Measuring performance on the and life expectancy statistics [Internet]. Healthcare Access and Quality Index for 2020. Available from: ec.europa.eu/ 195 countries and territories and selected eurostat/statistics-explained/pdfscache/ subnational locations: 1274.pdf A systematic analysis from the Global 14. Statistics Finland. Population projection Burden of Disease Study 2016. Lancet. Finland [Internet]. 2019. Available from: 2018;391:2236–71. http://www.stat.fi/index_en.html 6. Keskimäki I, Tynkkynen L-K, Reissell E, 15. OECD. Measuring what matters for Koivusalo M, Syrijä V, Vuorenkoski L, people-centred health systems. In: et al. Finland Health system review. Health at a Glance 2019. Paris: OECD Vol. 21, Health Systems in Transition. publishing; 2019. p. 39–63. Copenhagen: World Health Organization; 16. European Commission. Digital Economy 2019. and Society Index (DESI) 2020 7. WHO. Infant mortality rate (per 1000 live [Internet]. 2020. Available from: ec. births) [Internet]. 2018 [cited 2020 Aug europa.eu/digital-single-market/en/desi 24]. Available from: who.int/data/ 17. Lehtokari O, Hyppönen K. Kanta maternal-newborn-child-adolescent/ services for healthcare: Prescription indicator-explorer-new/mca/infant- service and Patient Data Repository mortality-rate-(per-1000-live-births) [Internet]. 2019 [cited 2020 Aug 24]. 8. European Commission Directorate- Available from: slideshare.net/THLfi/ General for Health and Consumers. kanta-services-for-healthcare- Special Eurobarometer 425: Patients’ prescription-service-and-patient-data- rights in cross-border healthcare in the repository European Union [Internet]. 2015. 18. Jormanainen V. National Kanat Services Available from: https://ec.europa.eu/ Support Clinical Work in Finland commfrontoffice/publicopinion/archives/ [Internet]. 2019 [cited 2020 Aug 24]. ebs/ebs_425_sum_en.pdf Available from: slideshare.net/THLfi/ 9. The World Bank. Population density national-kanta-services-support-clinical- (people per sq. km of land area) work-in-finland [Internet]. 2018 [cited 2020 Aug 24]. 19. Statista. Anzahl der Downloads der Available from: data.worldbank.org/ Corona-Warn-App über den Apple App indicator/EN.POP.DNST?locations=FI Store und den Google Play Store in 10. The World Bank. Physicians (per 1,000 Deutschland von Juni bis September people) [Internet]. 2016 [cited 2020 Aug 2020 [Internet]. 2020 [cited 2020 Sep 24]. Available from: data.worldbank.org/ 25]. Available from: de.statista.com/ indicator/SH.MED.PHYS.ZS?locations= statistik/daten/studie/1125951/umfrage/ FI-DK-NO-SE-IS-EU downloads-der-corona-warn-app Siemens Healthineers Insights Series · Issue 15 17 About the authors Dr. Päivi Sillanaukee Ambassador for Health and Well-being Dr. Ralf Meinhardt at the Ministry for Foreign Affairs of Finland Senior Global Marketing Manager and Member of the WHO Executive Board at Siemens Healthineers Dr. Sillanaukee serves as Ambassador for Health and Wellbeing at Ralf Meinhardt engages in thought leadership activities for Trans- the Ministry for Foreign Affairs of Finland and represents Finland in forming Care Delivery. Prior to his role at Siemens Healthineers he the WHO Executive Board. With more than 20 years of experience in spent several years in the pharmaceutical industry, consulting and the highest civil servant administrative positions both from govern- scientific research. Ralf holds a Doctor of Economics and Social ment and public sector, she is sharing Finnish know how and Sciences degree from the University of Erlangen-Nuremberg. In experiences on legislative framework, as well as enabling regulation addition, he holds a Master of Science degree in Management and on secondary use of social and health data for innovation policies, Bachelor of Arts degree in Business Administration. He studied at R&D&I and implementation of new technology, digital and AI solu- the University of Erlangen-Nuremberg and Indian Institute of tions as well as personalized medicine. Dr. Sillanaukee served as Management, Bangalore (IIMB). His scientific background is in Director General and Permanent Secretary of the Ministry of Social the field of corporate strategy where he has authored several Affairs and Health of Finland. She was the Deputy Mayor and publications. Director of Social and Health Services of Tampere, Finland and held clinical and managerial positions in the Pirkanmaa Hospital District. She has worked on policies to promote public health, social pro- tection and gender equality in the European Union and served as first and third Vice Chair at the WHO Executive Board. Dr. Sillanaukee holds a MD, PhD, and eMBA from University of Tampere, and an honorary doctor from University of Helsinki Faculty of Medicine. Dr. Herbert Staehr Dr. Sinikka Salo Vice President Chief Medical Officer at the Regional State Global Head of Transforming Care Administrative Agencies, Finland Delivery at Siemens Healthineers Dr. Salo is working on the transformation of healthcare in Finland. Herbert Staehr is passionate about healthcare and, as global head She was leading the implementation of national reform of social of Transforming Care Delivery, drives activities to equip healthcare welfare and healthcare in Finland from 2016 to 2020 with the providers to deliver higher-value care. Prior to this position, he led Ministry of Social Affairs and Health, focusing on service integration, Portfolio Development and Marketing within the Enterprise Services digitalization, developing electronic services and information sys- and Solutions business of Siemens Healthineers. Before joining tems. Her current position as Chief Medical Officer at the Regional Siemens Healthineers, Herbert Staehr worked with a major private State Administrative Agencies provides her with the opportunity hospital group in Germany in senior leadership roles including to work in close collaboration with local authorities. The agencies' serving as managing director of an acute care and a post-acute mission is to promote regional equality by carrying out executive, care hospital. Earlier, he led the group’s Corporate Development steering and supervisory tasks laid down in the law. To this end, department. He was employed for several years in the Healthcare they aim to strengthen the implementation of basic rights and legal Consulting practice of McKinsey & Company on various European protection, access to basic public services, environmental protection, and international assignments. Herbert Staehr holds a PhD in environmental sustainability, public safety and the provision to a Healthcare Economics from the University of Hohenheim, Germany. safe and healthy living and working environment in the regions. He obtained a dual degree (Bachelor of Arts and Diplom-Betriebswirt) Dr. Salo holds a Ph.D. and a DDS, with a focus on telemedicine, in International Business and Finance from the European School of eHealth, and forensic odontology. Business, Germany, and Dublin City University, Republic of Ireland. 18 Issue 15 · Siemens Healthineers Insights Series At Siemens Healthineers, our purpose is to enable healthcare providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experience, all enabled by digitalizing healthcare. An estimated five million patients worldwide benefit every day from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine as well as digital health and enterprise services. We are a leading medical technology company with over 120 years of experience and 18,500 patents globally. With about 50,000 dedicated colleagues in over 70 countries, we will continue to innovate and shape the future of healthcare. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · Printed in Germany · 1020 · ©Siemens Healthcare GmbH, 2020