Benchmarking study on publicly and privately managed primary care providers in Finland

Abstract

This study is a benchmarking study of Finnish primary care providers in three different municipalities between 2017-2019. The research questions of the study are first whether there are differences between privately and publicly managed health centers in access, quality or cost of care. Second question is whether there are management practices that explain such differences. In the study total of 13 health centers is analyzed, 6 of the health centers being privately managed and 7 being publicly managed. The benchmarking is conducted quantitatively and qualitatively. The performance of the health centers is divided into three subgroups: quality, accessibility and cost-efficiency. The qualitative analysis focuses on the management practices of the operators and health centers. The first phase of the research was based on the quantitative data of the health centers provided by the municipalities the health centers operate in. The data collection standards between the municipalities differed, which made the comparisons between the municipalities impossible. Regardless, it was possible to analyze and compare the operators within the municipalities, which provided few answers to the research questions. First, the private providers tend to have better accessibility. Second, the private providers had little shorter consulting times when data was available and relatively higher amount of nurse consultations. Third, the public providers had little higher patient satisfaction, whereas the finding was not consistent for the whole study period in every municipality. The second phase of research included interviews of the health centers’ management as well as the leadership of the municipalities and the private service provider. The interviews focused on the service process and management practices of the health centers. The most significant results that arose included that the private providers had higher focus on operational efficiency and data utilization. Also, the public organizations wanted their health centers to operate similarly to within the municipalities, which led to lower levels of autonomy for the management. Last, the process for evaluation of need for care differed rather significantly between the private and public providers, which in part led to differing utilization of nurse resources. Based on the study, the outsourced providers operate differently compared to public providers, which also shows in their process figures. Still, the basic mission of improving the health of their served population unites the types of service providers and the different practices could be implemented to different types of providers if deemed useful.