The cornerstone of unity

HEALTH
50 COMPREHENSIVE HEALTH CENTRES
The Primary Healthcare Act entered into force on April 1, 1972. Its enactment was preceded by careful 
preparation. In the 1960s, the health of Finnish adults had stopped improving. The coronary heart disease 
mortality of middle-aged men was alarmingly high. More than 1,000 people died annually in traffic accidents. 
There were many work accidents. Mental hospitals were large and full of patients. Cancers were becoming more 
common. An increasing number of people of working age were retiring every year due to musculoskeletal 
disorders. A nationwide network of central hospitals had been constructed in the 1950s and 60s, and this 
swallowed up 90% of public health expenditures. It was time for more preventive and outpatient care.
Finland’s solution was its health centres. Previously separate and unconnected basic health care services 
were combined under a single administration. Nurses, doctors, and school dentists became municipal officials. 
The construction of new premises was also quickly begun. In common parlan
ce, “health centre”(
terveyskeskus
) 
often referred to these new buildings, but officially it meant the basic health care system of a municipality or of 
several small municipalities.
The state played a strong role in the system’s expansion. State approval was required for all posts and 
premises, and the state subsidized much of the costs of the services. These funds were first directed to eastern 
and northern Finland, where people had the most health problems and where there were only few health 
services that were private or provided by large employers. I myself started as a health centre doctor in the city of 
Turku in autumn 1978. There were nine of us for the city’s 165,000 inhabitants, i.e. one doctor per 18,000 
inhabitants. In addition, the schools and child health clinics had their own doctors, also employed by the city.
The official name for primary healthcare was “public health work” (
kansanterveystyö
). It expanded strongly in 
the 1970s and 80s. By the beginning of the 1990s, the cities had also received much more staff and new 
premises. The city of Pori, for example, employed only three doctors in addition to a separate doctor for so-
called poor relief in the 1960s, before the Primary Healthcare Act. In 1990, the city had 40 health centre doctor 
posts, though one third were in fact vacant!
The large variety of services provided by health centres is one of the topics that Finnish politicians are most 
ignorant about. “Did you go to the health centre?” is understood to mean the same as “Did you have a doctor’s 
appointment at the health centre?” The availability of doctor’s appointments is one of the most debated issues in 
the history of health centres. Patients have wished for easy and quick access to a doctor. At first, they had to 
pay three Finnish markka to see a doctor. Then the fee was dropped completely. And then fees were 
reintroduced. Some municipalities have decided to keep appointments free of charge. It’s clear that the vast 
majority of people base their opinion of how well the entire health centre system works specifically on how easy 
it is to get a doctor’s appointment. This has fluctuated over time based on the resources allocated to doctor’s 
appointments. Depending on the calculation method used, about 10 to 15% of health centre resources have 
been used for doctor’s appointments. This, however, represents only about 4% of all public resources allocated 
to social and health care services (including hospital and outpatient clinic care and social welfare services). 
What then are the “other” health centre services?
These can be described in many different ways. I will use terms that are as familiar and comprehensible as 

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possible. I won’t list all the services. Among the significant ones are the maternity and child health clinics. 
Children get nine check-ups before their first birthday, with a doctor present during three of them. Children get six 
check-ups between the ages of 1 and 6, with a doctor present during two. The maternity clinics also provide very 
extensive and multifaceted services. Family planning and contraception counselling is also an important service. 
Then there is health care for schoolchildren and for students. Vaccinations are provided as a separate part of 
preventive healthcare. There are also counselling services for senior citizens (provided by nurses). Health centres 
also often provide occupational health care. They are also responsible for providing various other kinds of 
counselling and education. Dental healthcare is a separate unit that includes both preventive care and 
multifaceted curative care. At the end of the 1950s, the city of Pori, for example, employed two dentists, who 
mainly took care of schoolchildren. In 1990, the city employed 30 dentists and 30 other dental care staff. Health 
centres are also responsible for cervical cancer screening (Pap tests) and breast cancer screening 
(mammographies), services which are often purchased from private providers. 
Health centres also provide special services (speech therapists, psychologists, nutritionists, social workers, 
etc.
), home nursing, home hospital care, day ward, inpatient ward for rehabilitation and acute care (“health 
centre hospital”), an assistive device centre, distribution of healthcare products, prevention and care of 
communicable diseases, many certificates for various purposes, medical rehabilitation, physiotherapy, and 
healthcare services for social welfare (elderly care, substance abuse care, services for people with disabilities, 
etc.) including regular visits by health centre doctors.
These are only some o
f a health centre’s services, so we can see it is a real “health factory”. Healthcare 
includes many different services: appointment arrangement, emergency reception, prescription renewal, 
telephone consultations, etc. Health centres are also responsible for diagnostic services that support these, such 
as laboratory and imaging services, but these diagnostic services have been transferred to regional healthcare 
district units, as is also the case nowadays for first aid and ambulance services.
The Finnish health centre is a unique combination of services. It naturally faces many challenges. On the one 
hand, integration with social welfare and hospital care (including outpatient clinic care), i.e. horizontal and 
vertical integration. On the other hand, competition with private clinics in the current new legislative situation 
granting freedom of choice. The health centres’ role and importance as the foundation of Finnish healthcare is 
however worth fostering 
– not as an intrinsic value but to ensure the health and functioning of the population.
Aki Lindén, 
– managing director of
the Hospital District of Helsinki and Uusimaa