Lived experiences of health system reform among citizens and health workforce

Abstract Introduction Health system reforms are often studied from a system-focused perspective, despite growing calls for social participation in decision-making processes and health system governance. Inattention to or disregard of the perspectives of those most affected by the reform can have dramatic social consequences, as this may undermine the legitimacy of and trust towards public health care systems. Therefore, there is a need to examine the lived experiences of citizens and health workforce to better understand how everyday experiences of the reform are aligned with or at odds with the reform's policy objectives. Methods A multi-sited ethnography was conducted in local primary health care centers (HCCs) in three regions. The data consist of interviews (n = 114) with citizens and health workforce as well as observations (400+ hours) in the HCCs. The analysis followed an iterative thematic process with deductive and inductive elements. Findings Interviews and observations at local HCCs indicate that citizens and health workforce view the reform as a critical juncture for the Finnish welfare state. These views have been exacerbated by the context of poly-crises and strict cost containment in which the reform has been implemented. While positive experiences about the reform exist, measures taken during implementation, such as retrenchment of local health and social services and increased transition to remote care, may have dire consequences particularly for marginalized citizens as well as for the retention of health workforce. Conclusions The lived experiences of citizens and health workforce are crucial knowledge for identifying matches and mismatches between citizen needs, policy processes, and implementation. Longitudinal research is needed to better understand the long-term equity impacts of the health system reform in Finland.