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Dental Hygienist in the Midst of Freedom of Choice
This has again been a busy autumn for the FADH. We have had meetings in the Finnish Parliament,
and the ADEE and EDHF meetings in Europe, which will be covered in more detail in this issue. We
have also had the pleasure of visiting member meetings in Finland. The social and healthcare
reform has produced a stack of requests for comment. The association has given its comments on
the Counties Act, financing, as well as taxation and management. A bigger and more significant
comment is still in progress – the law reform regarding freedom of choice in healthcare.
A group of officials led by the Under-Secretary of State, Tuomas Pöysti, presented its proposal
regarding freedom of choice on 10 October. In the presented model, oral healthcare services
would be part of directly selectable ”own team” healthcare services. For dental hygienists, this
means that each public and private service provider must be listed as a service provider in their
own region, and the customer can freely select a service provider among those listed. Will this
include the use of e.g. service vouchers, or would the referral practice for dental hygienist services
be abolished altogether – finally? At the moment, it is unclear how the selection will direct funding
to the service provider, and with which criteria one can be listed as a service provider. If this direct
selection model is implemented, it is meant to be adopted in the beginning of the year 2019.
According to many evaluations, the schedule is tight, so it cannot be taken for granted.
How the oral health examinations of children and the young will be executed and whether they
will be included in the freedom of choice model and in which form – we still have no answers to
these questions. The law on child, school, and student healthcare sets out obligations for the
current municipalities to provide preventive oral healthcare services and to pay special attention
to preventing marginalization in children needing special support. It is still open how these
obligations will be dealt with in the new county model. The operational models for multiprofessional co-operation will also have to be examined.
The change is also bringing about a division in the current public sector oral health care operators.
If the examinations and healthcare obligations of children and the young are left outside the
freedom of choice, every region will have separate dental hygienists and dentists for these
children, and the others will move on to serve the regional companies. This will divide the current,
functional healthcare teams and separate oral healthcare from other healthcare. The association
considers this imprudent.
The association is also concerned about the protection of personnel when moving from municipal
to regional personnel, as well as the harmonisation of salaries in context with the change, and
maintaining the current pension benefits. No consensus regarding this matter has been reached in
the negotiations. This is no surprise when considering the financial impact of these decisions on
the regions and municipalities. The Negotiation Organisation for Public Sector Professionals,
however, is continuously working towards this as a negotiating party.
Something must be done, because with the current resources and ways of operation we cannot
meet the continuously growing need for service, but narrow-mindedly separating oral healthcare
from other healthcare is not the best solution in our opinion. Strengthening basic healthcare and
integrating it with special healthcare was the original objective of the healthcare reform, which
now seems to be forgotten, as the freedom of choice model is steamrollered as the most
important reform. The association hopes that the diverse expertise of the professionals could be
utilized more extensively in developing the processes and doing the groundwork for this
demanding reform in order to foresee the pitfalls of this change before it takes place. There is still
time.
This issue includes more information on the autumn’s activities in the association as well as an
extensive info package on the needs of working life. Finally, I would like to thank all our members
for this year and wish a peaceful Christmas and happiness for the new year from the whole board
– we will meet again!
Mari Heinonen
President
Finnish Association of Dental Hygienists FADH