English summaries
The effects of outsourcing and other changes in health care organization on municipal emergency primary care services
Julkaistu 10.08.2012 00.01
Background
In Finland, it is the responsibility of municipalities to organize and fund health care services for their inhabitants. Although the majority of municipalities in Finland have outsourced some or all of their emergency primary care services to private-sector service providers, there has been no research into the effects of the outsourcing on service production or on the effectiveness of care. The municipality of Vantaa outsourced all of its emergency primary care services to the private-sector healthcare service provider Attendo MedOne Ltd at the beginning of 2008. Before 2008, these services had been provided by the Hospital District of Helsinki and Uusimaa, which is owned and controlled by municipalities. The goals of the outsourcing, from the point of view of the municipality of Vantaa, were to gain better control over the resources, costs and service production of the emergency primary care services. The purpose of this research was to study the effects of the fully outsourced service production on the emergency primary care services of the municipality of Vantaa.
Methods
The evaluation was based on a simple timeline design with three points of observation, ranging from 2007 to 2009. The evaluation criteria were examined and analyzed as yearly figures. The selection of the evaluation criteria for the emergency primary care services was based on the four main perspectives of the Balanced Score Card frame of reference: customer, process, personnel and costs.
Results
The costs of funding the emergency primary care service of the municipality of Vantaa decreased by about 14% after full outsourcing had taken place at the beginning of 2008. Other effects of the outsourcing and other changes in health care organization, from the perspective of the process, included a sharp decline in the use and costs of diagnostic services in the emergency primary care service and a similar increase in the costs and use in the emergency ward of the secondary health care unit in the same hospital. The number of visits to doctors at the emergency primary care service of the municipality of Vantaa decreased, and visits to nurses increased markedly. The percentage of referrals from the emergency primary care service of the municipality of Vantaa to the secondary care services of the same hospital decreased. Instead, the municipal health clinics of Vantaa referred more patients to secondary care than before the outsourcing of emergency services. From the customer’s point of view, the percentage of people who waited more than two or three hours to see a doctor in the emergency primary care service declined. The change, from the personnel’s point of view, was that fewer doctors and about the same number of nurses worked in the emergency primary care service after the full outsourcing had taken place.
Conclusions
The effect of the outsourcing of the emergency primary care service reflected the overall goals for the outsourcing set by the municipality of Vantaa. The Balanced Score Card frame of reference can be used to depict various changes in emergency primary care service production and can, therefore, be applied to the evaluation and contractual monitoring of these services.
Juha Palmunen
M.Sc., Senior Consultant
FCG Finnish Consulting Group Ltd
Jarmo Kantonen, Timo Aronkytö, Mika Keinänen
Finnish Medical Journal 2012;67:2147–52
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