Cheap Finnish Health Care Is Built on the Back of Low-Paid Doctors

Kevin Drum and Bob Somerby are annoyed that journalists talk about the strong performance of Finland’s school system but don’t mention its highly efficient health care system. Specifically, the US spends $7,285 per year to Finland’s $2,900:

Finland’s test scores let a bunch of know-nothing journos push a preferred press corps narrative: Our public schools are a mess! (Maybe we need to privatize! It’s all the fault of the unions!) Finland faces none of the daunting educational challenges we face, of course. But so what! All pundits on deck!

By way of contrast, the press corps’ deference to corporate interests seems to make it shy from the topic of health care spending. Does Finland achieve good health care at a very low price? This topic can’t be discussed!

I dunno, when I went to Finland to learn about their school system I came away writing, among other things, about their highly cost-effective health care system and their health-enhancing school lunch initiatives. To be honest, in my experience something like 97% of commentary on Finnish education involves taking note of their generous and effective Nordic welfare state, so I feel like Drum and Somerby are mostly being cranky here.

But rather than counter-crank, let’s ask the question why is it that Finland is able to keep its health care spending so low? As best I can tell, it’s all pretty standard stuff. One huge factor is that their doctors make way less money $3,177 per month to $8,189 per month in the United States. They have pharmaceutical price controls. And according to a Harvard Business School analysis (PDF) “Within the municipal health care system, patients have had very limited freedom to choose their health care providers or physicians.” Specifically “There is great variability across municipalities in terms of patients’ ability to choose their primary care physicians” and for specialists:

A referral from a licensed physician is needed to access municipal specialized care (i.e. hospitals), and patients cannot usually choose their hospital or specialists. Instead, health centres have guidelines listing the providers to which patients with certain symptoms and diagnoses should be referred. Normally, patients are treated in a hospital within their hospital district of residence, and their freedom to choose their physicians within the hospital depends on factors including the organization of departments and the number of specialists.

This all seems to me to work well-enough. At a minium, it’s cheap! But who here thinks that running on a platform of drastic cuts in medical professionals’ salaries combined with restricted provider choice and large-scale government rationing is going to be a big winner? There’s more than “corporate interests” at issue here. Among other things, as long as doctors are about a million times more trusted by the population than are politicians, it’s going to be extremely difficult for politicians to ever enact measures that reduce doctors’ incomes. But it’s extremely difficult to imagine how a more efficient health care system could avoid reducing doctors’ incomes.