Suboptimal prevention allocation in the school children’s health and social care system in Finland

Abstract Introduction Efficient allocation of preventive social and health services for school-aged children is fundamental to achieving sustainable and equitable outcomes in public health. However, existing systems often lack mechanisms to identify inefficiencies in resource use(Chisolm et al., 2023; Elshaug et al., 2017). In Finland, school children's public health and social care is organized by wellbeing counties, many of which struggle to meet regulatory obligations for timely access. At the same time, the effectiveness of current preventive measures has been questioned (Kosola, 2023). This study aims to build a framework for identifying potential misallocation of preventive resources using administrative records to support evidence-based planning (Vesikansa et al., 2023; Wikström et al., 2019). Methods A comprehensive administrative dataset from Southern Finland, covering ∼30% of Finnish school-aged children is used. An interdisciplinary group of experts -including pediatricians, school nurses, psychologists, and social service professionals-identified two candidate quality indicators deemed both clinically relevant and operationally feasible. Cost estimates for long-term service use and short-term contacts are drawn from national reference prices where available, and from local sources otherwise. Results We identified two indicators potentially linked to inefficient allocation: (1) substantial school absences without corresponding health or social care contacts, and (2) direct placement in residential social care without prior use of lighter, preventive social services. These are evaluated using regression modelling and stratified analysis to assess associations with subsequent use of costly non-preventive services. Conclusions This study proposes a novel, data-driven method for detecting inefficiencies in prevention. If validated, the indicators could help optimize resource utilization and inform planning across school children's health and social care systems. Key messages • Comprehensive administrative data is used to detect suboptimal school-based prevention allocation. • Two promising quality indicators and linked cost data were identified for this purpose.