The impact of the Finnish “care guarantee” policy on primary care access – a mixed methods study

Abstract Background Prompt primary care (PC) access is salient for equitable care. Finland has a high level of unmet health needs, characterized by stark socioeconomic disparities and accounted for by long waiting times - especially for general practitioner (GP) visits in public PC. In Sep 2023, Finland updated its PC ‘care guarantee’ legislation for patients with new health problems requiring non-urgent care: their maximum waiting time to GP was reduced from 3 months to 14 days. Hereafter, the PC access statistics improved. This study assessed patients’ views toward PC access after the update and whether the statistics wholly capture access to non-urgent PC. Methods This is an exploratory sequential mixed-methods study in the rural North Karelia of Finland. Qualitative interviews with patients and staff (n = 40) and observations (150+ hours) were conducted in a public PC center in Jan 2024-Mar 2024. Quantitative data of non-urgent GP visits (hereafter ‘GP visits’) and their waiting times were obtained annually from individual register data for region's inhabitants in 2017-2023 (n = 168,588-170,529). Results Particularly older patients with chronic health needs stated increased difficulties in navigating an increasingly remote PC system and lack of access to in-person visits due to GP shortages. Staff reported an accelerated need to “gatekeep” GP visits due to lack of resources. The number of all GP visits increased 1.45 -fold from 2017 to 2023 but in-person GP visits reduced 0.61 -fold (1.25 and 0.71 -fold respectively for the number of patients). The waiting times for face-to-face GP visits improved slightly. Conclusions The stronger ‘care guarantee’ in Finland took place in tandem with austerity measures and a rapid shift to a more remote PC system. Improved statistics for PC access conflict with local experiences and ignore reduced provision of in-person GP visits, thus hiding the associated equity impacts. This calls for investing in more nuanced follow-up of policy changes. Key messages • The policy change for shorter primary care (PC) waiting times (‘care guarantee’) improved PC access statistics but increased especially the older patients’ difficulties in accessing care. • Seemingly straightforward health policy changes may have unintended equity impacts, the identification of which requires carefully designed follow-up with user perspectives and disaggregated data.