Primary health care quality at the early stages of Finnish health system reform

Abstract Introduction The main goals of Finnish health system reform were 1) to ensure and improve equal access to health services, and 2) to better answer to the needs of frequent attenders (FAs) through integration of health and social services. However, identifying non-users and FAs of primary health care (PHC) has remained challenging both at local and national levels. This study aims to identify these two population groups from national registers in Finland and analyses whether their PHC quality - measured with hospitalisations for ambulatory care sensitive conditions (ACSCs) - differs from non-FAs. Methods This register-based cohort study combined individual data for sociodemographics, PHC visits in 2021-2023 and hospitalisations in 2023-2024 for Finns aged 25 and over. We defined non-users as those with no PHC visits in 2021-2023 and persistent FAs as those in the top 10% of annual visits in each year. Finally, we analysed the incidence rate ratios (IRRs) of ACSCs with Poisson multilevel models. Findings Of 3,838,152 persons 286 964 (7.5 %) had no PHC visits in 2021-2023 but 2,627 ACSCs. The used FA definition resulted in limit of 7-8 annual visits. We identified 85,574 (2.2%) persistent FAs, who consumed 9 % of all PHC visits in 2021-2023 and had 2,906 ACSCs. After adjusting for sociodemographics the incidence of ACSCs was 0.73-fold (CI 95 % 0.70-0.76) in non-users and 2.94 -fold (2.83-3.05) in persistent FAs than in non-FAs. Conclusions At the initial stage of the reform, 7.5 % of adult Finns did not use PHC, even though some of them needed medical care. Moreover, 2.2 % of adults continuously sought relief to their needs through high number of PHC visits. However, the excess ACSCs suggest that the provided PHC did not properly answer their needs. Our results highlight that Finland has a clear potential for improving equal access to PHC as well as to benefit from integrated care, and that these should be strongly invested in during the reform implementation.