Ilmo Keskimäki

Tampere University | UTA · Faculty of Social Sciences

Tässä kartoittavassa katsauksessa (scoping review) tarkastelemme resilienssin käsitteen määrittelyä ja käyttöä terveysjärjestelmien tutkimuksessa. Tuomme esiin, millaisia näkökulmia viime vuosien kriisit, kuten COVID-19-pandemia, ovat tuoneet resilienssin käsitteen määrittelyyn. Analyysimme kohdentuu erityisesti terveysjärjestelmän resilienssin (he...

Purpose The worldwide prevalence of diabetes mellitus (DM) continues to increase. As DM is linked to various ophthalmological comorbidities, it is crucial to understand the incidence and the treatment patterns of these complications to minimise the treatment burden for the patient and the healthcare system. This study aims to evaluate the incidence...

Finland is a Nordic welfare state with universal access to health care. The health system has recently undergone a major reform and health care and social and rescue services are organized by 21 well-being service counties, the city of Helsinki and Helsinki-Uusimaa Hospital district which all get funding from the state. Publicly funded health servi...

Several countries have introduced health system reforms to foster integrated care within their health systems and in some case also between health and other welfare services such as social care. These integrated care initiatives have included reorganization of the work of professionals, developing patient pathways and removing barriers for organisa...

Background Though cardiac care in acute coronary syndrome (ACS) should be equitable, socioeconomic disparities in associated mortality persist. In this study we ask if problems in provision of cardiac care could be pinpointed by examining these disparities in mortality between different time-points of ACS care. Thus, we assessed how socioeconomic d...

Background Pandemics disproportionately affect vulnerable groups. There are documented socioeconomic, gendered, and racialized differences in the burden of disease during COVID-19 and previous pandemics due to factors such as lack of access to social safety nets, poor quality of housing, and precarious working conditions. Therefore, equity should b...

Background The integration of information systems in health care and social welfare organizations has brought significant changes in patient and client care. This integration is expected to offer numerous benefits, but simultaneously the implementation of health information systems and client information systems can also introduce added stress due...

Purpose Health care integration is crucial in improving service equality and patient outcomes. However, measuring integration between the health and social care sectors remains challenging. This article aims to review existing systematic models to identify alternative health and social care integration measurement tools. The review focuses on model...

Background Denmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance am...

In Finland, descriptive performance indicators point towards increasing and sustained use of the national Kanta Services among adults from May 2010 to December 2022. Adult users have accessed the web-based My Kanta, sent electronic prescription renewal requests to healthcare organizations, and caregivers and parents have acted on behalf of their ch...

Nationwide implementation and adoption of the Prescription Centre and the Patient Data Repository services required 5.5 years since May 2010 in Finland. The Clinical Adoption Meta-Model (CAMM) was applied in the post-deployment assessment of the Kanta Services in its four dimensions (availability, use, behavior, clinical outcomes) over time. The CA...

“A basic framework for pandemic governance existed, but was not followed” – expert views of agile governance and performance of the Finnish public health system during the COVID-19 pandemic in 2020–2021 The aim is to examine how public health authorities acted, what kind of roles they adopted, and how the expected roles and actions appeared in rela...

The COVID-19 pandemic has plagued health systems in an unprecedented way and challenged the traditional ways to respond to epidemics. It has also revealed several vulnerabilities in countries' health systems and preparedness. In this paper we take the Finnish health system as an example to analyse how pre-COVID-19 preparedness plans, regulations, a...

Power and politics are both critical concepts to engage with in health systems and policy research, as they impact actions, processes, and outcomes at all levels in health systems. Building on the conceptualization of health systems as social systems, we investigate how power and politics manifested in the Finnish health system during COVID-19, pos...

Background Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents’ work hours. Objectives We aimed to review residents’ work hours regulations in different countries with an...

Aims: Type 1 diabetes has been associated with a significant reduction in life expectancy. Major advances in treatment of type 1 diabetes have been associated with improved survival. However, life expectancy for type 1 diabetes under contemporary care is not known. Methods: Health care registers were used to obtain data on all people with type 1...

Aim: To outline the organisation and responsibility for health and social care provided to older people in Denmark, Finland and Sweden. Methods: Non-quantifiable data on the care systems were collated from the literature and expert consultations. The responsibilities for primary healthcare, specialised healthcare, prevention and health promotion...

Purpose The purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland. Design/methodology/approach The authors utilized a qualitative research approach and conducted semi-structured interviews ( n = 32)...

Background Crisis management Managing crises often requires diverging from predetermined plans. In this paper, we investigate how public health authorities in Finland acted, what kind of roles they adopted and how the expected roles and actions appeared in relation to the legislative framework and preparedness plans during the COVID-19 pandemic. Ba...

The pressure of COVID-19 on health system functioning has made policies to strengthen health system resilience a major theme of research. Accordingly, crises like COVID-19 can be seen as windows of opportunity for health system reforms to enhance health system resilience. In Finland, COVID-19 arrived on the eve of a major health system reform. In 2...

Background The hospital discharge process of older adults in need of both medical and social care post hospitalisation requires extensive care coordination. Cooperation and continuity between involved care providers are essential, however, existing care systems including the Nordic care systems, are poorly designed to provide health and social care...

Health systems are the central part of infrastructure in societies and their smooth operation is important for the continuation of a wide range of critical operations in any country. The COVID-19 pandemic has actualised questions on health system resilience defined as the system's ability to prepare for, manage (absorb, adapt and transform) and lea...

Aim: To outline and discuss care transitions and care continuity following hospital discharge of older people with complex care needs in three Nordic cities: Copenhagen, Tampere and Stockholm. Methods: Data on potential pathways following hospital discharge of older people were obtained from existing literature and expert consultations. The path...

Introduction: The study explores regional approaches to integrated care, focusing on regions with regular municipality-based and integrated unified health and social care administration. The aim is to describe a governance approach that supports care integration in the regions. Methods: The study draws on analysis of integrated care governance u...

Background Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. Methods For this multinational, population-based study, we sourced data from 24 databases for 23...

Background A persistent research finding in industrialised countries has been regional variation in medical practices including elective primary hip and knee arthroplasty. The aim of the study was to examine regional variations in elective total hip and knee arthroplasties over time, and the proportions of these variations which can be explained by...

Hospital discharge of older people in need of both medical and social care following their hospital stay requires extensive coordination. This study aims to examine and compare the views of nurses in three Nordic cities on the influence of sociodemographic factors and having close relatives, for the hospital discharge and post hospital care of olde...

Population ageing with an increasing number of people experiencing complex health and social care needs challenges health systems. We explore whether and how health system reforms and policy measures adopted during the past two decades in Finland and Sweden reflect and address the needs of the older people . We discuss health system characteristics...

Objectives : To analyse the vaccination strategy as part of wider public governing of the COVID-19 pandemic in Finland. Methods The study provides a synthesis of vaccination strategy and health policy measures, as well as economic challenges, in the COVID-19 pandemic in Finland. The analysis is based on the systematic collection and reviewing of d...

Background Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals’ routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure succes...

Denmark, Finland, and Sweden pursue equity in health for their citizens through universal health care. It is however unclear if these services reach the elderly population equally between different socioeconomic positions (SEP) or living-areas. Our aim was to assess both socioeconomic and geographic equity in primary health care (PHC) performance a...

Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs rela...

Background Registries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe. Objectives We aimed to report on the organization of different sourc...

This paper explores and compares health system responses to the COVID-19 pandemic in Denmark, Finland, Iceland, Norway and Sweden, in the context of existing governance features. Content compiled in the Covid-19 Health System Response Monitor combined with other publicly available country information serve as the foundation for this analysis. The a...

BACKGROUND Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals’ routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure succes...

This chapter offers an in-depth look at health politics and the health system in Finland, which combines universal tax-financed health services provided by municipalities, national health insurance coverage for private provision, and an occupational healthcare system for those in employment. The chapter traces the development of the Finnish healthc...

Background A persistent research finding in Finland and elsewhere has been variation in medical practices both between and within countries. Variation seems to exist especially if medical decision making involves discretion and the best treatment cannot be identified unambiguously. This is true for hysterectomy when performed for benign causes. The...

Background: Measuring primary health care (PHC) performance through hospitalizations for ambulatory care sensitive conditions (ACSCs) remains controversial-recent cross-sectional research claims that its geographic variation associates more with individual socioeconomic position (SEP) and health status than PHC supply. Objectives: To clarify the...

Background In 2015 Finland received the 4th highest number of asylum-seekers in Europe per capita, exceeding numbers of any previous year by ten times. Health services to them are provided in a parallel system with entitlements similar to most Western European countries. Our study explored the governance of this system following a right to health a...

The personal identification number was introduced in Finland in the mid-1960s. By 1970, it was universally used in administrative databases including population census, causes of death, cancer, hospital discharge, and health insurance registries. Early on data protection regulations recognised the use of registries and ID numbers for research and r...

Background Hospitalisations due to ambulatory care sensitive conditions (ACSCs) have been used for assessing access to and quality of primary health care (PHC) in many countries. To assess the validity of ACSCs for assessing PHC performance we carried out a series of studies on regional and sociodemographic variations and time trends in ACSC hospit...

Background Care integration through high level care continuation for older patients discharged from the hospital may secure positive health outcomes and reduce subsequent emergency visits. Integrated transitional care is, however, challenged by fragmented care delivery systems. We explored integrated transitional care from the delivery system persp...

Aims: Hospitalisations for ambulatory care sensitive conditions are used as an outcome indicator of access to and quality of primary care. Evidence on mortality related to these hospitalisations is scarce. This study analysed the effect of ambulatory care sensitive condition hospitalisations to subsequent mortality and time or geographical trends i...

Objectives To study the interplay between several indicators of social disadvantage and hospitalisations due to ambulatory care-sensitive conditions (ACSC) in 2011─2013. To evaluate whether the accumulation of preceding social disadvantage in one point of time or prolongation of social disadvantage had an effect on hospitalisations due to ACSCs. Fo...

Objectives : The objective of this study was to describe and analyze the impact of the coronavirus disease COVID-19 on health policy, social- and health system, and economic and financing system to prevent, treat, contain and monitor the virus in Finland. Methods : This study provides early outcomes of health policy measures, social- and health sy...

Tyypin 1 ja 2 diabeteksen ja niiden lisäsairauksien ilmaantuvuus ja esiintyvyys Suomessa vuosina 2000–2017

This paper describes the collection of database of the Diabetes in Finland (FinDM) project which aims to identify all potential persons with diabetes from national registers in Finland between 1964 and 2017. Further, it lists the definitions used in the research of diabetes and its complications in the project.

Women with a history of severe mental illness (SMI) have elevated breast cancer mortality. Few studies have compared cancer-specific mortality in women with breast cancer with or without SMI to reveal gaps in breast cancer treatment outcomes. We compared breast-cancer specific mortality in women with or without SMI and investigated effects of stage...

This paper describes the collection of database of the Diabetes in Finland (FinDM) project which aims to identify all potential persons with diabetes from national registers in Finland between 1964 and 2017. Further, it lists the definitions used in the research of diabetes and its complications in the project.

Objective: Individuals with severe mental disorders have an impaired ability to work and are likely to receive income transfer payments as their main source of income. However, the magnitude of this phenomenon remains unclear. Using longitudinal population cohort register data, the authors conducted a case-control study to examine the levels of em...

In Finland, the implementation of the national Kanta services’ second phase was carried out step by step from May 2010 to December 2017. My Kanta Pages, launched in 2010, is an online service where citizens can browse their own health information recorded in the Prescription Centre and the Patient Data Repository regardless of whether the healthcar...

Background Geographic variation is common in ambulatory care sensitive conditions (ACSCs) - used as a proxy indicator for primary care quality. Its use is debated as it is more strongly associated with individual socioeconomic position (SEP) and health status than factors related to primary care. While most earlier studies have been cross-sectional...

Background Since the 2000s, integrated care has been a policy aim in Finland. Reforms for creating larger care authorities have failed at national level, but municipalities have established regional joint health and social integrated care authorities. Our study focuses on integration of services for children and young people and adults’ psychosocia...

Finnish alcohol policy has aimed for decades years to mitigate alcohol-related harm by using high taxation and restrictions on the physical availability of alcohol. The state monopoly on the retail of alcohol has played a central role in reducing the availability of alcohol. In 2011, preparations began for a comprehensive reform of the Alcohol Act...

Background: Due to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic dispar...

Background Although the link between severe mental illness (SMI) and elevated cancer mortality is well established, few studies have examined lung cancer survival and SMI in detail. Our study compared cancer-specific mortality in patients with lung cancer with and without a history of SMI and analysed whether mortality differences could be explaine...

The Finnish social and health care system is under major transformation. One of the main goals of the reform is to integrate social and health care services, which will require new practices in the workplace as well as a competent and committed workforce. It is known that major organizational changes always impact employees in various ways. In this...

Introduction: Elderly care and especially home care has severe challenges in Finland. As home care has become more dominant in elderly care and clients are more dependent work has become most stressful. The proportion of people over 75 years in institutional has decreased clearly and proportion of people in home care has increased, but the number o...

Introduction: Since the early 2000s, Government policies in Finland have supported administrative and operative integration of health and social care to create larger authorities for organising services and to strengthen coordination of primary and specialised care, and social services. Nationally, the policies have led to attempts to reform the se...

This analysis of the Finnish health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Finland is a welfare state witha high standard of social and living conditions and a low poverty rate. Its health system has a highly decentralized administration, multip...

Objectives A persistent finding in research concerning healthcare and hospital use in Western countries has been regional variation in the medical practices. The aim of the current study was to examine trends in the regional variation of avoidable hospitalisations, that is, hospitalisations due to conditions treatable in ambulatory care in Finland...

In 2015 Finland received an unprecedented number of asylum seekers, ten times more than in any previous year. This surge took place at a time the Finnish Government was busily undergoing a wide-range health and social care reform amid growing nationalist and populist sentiments. Our aim is to explore the governance of a parallel health system for a...

Objective: To examine the associations between an onset of serious mental disorders before the age of 25 with subsequent employment, income, and education outcomes. Methods: Nationwide cohort study including individuals (n=2 055 720) living in Finland between 1963 and 1990, who were alive at the end of the year they turned 25. Mental disorder di...

Diabetes and cancer are common diseases both with enormous impact on health burden globally. The increased risk of several types of cancer among people with type 2 diabetes mellitus has been indicated repeatedly. This study aimed at exploring and describing the association between type 2 diabetes and cancer incidence. A cohort of 428,326 people wit...

The Directive on the application on patient rights’ in cross-border healthcare (2011/24/EC) was transposed in Finland by the Act on Cross-Border Health Care (1201/2013), which entered into force on 1 January 2014. A new reimbursement model for cross-border health care costs was designed. The Finnish legislator considered the chosen reimbursement mo...

Objective To study trends in socioeconomic equality in mortality amenable to healthcare and health policy interventions. Design A population-based register study. Setting Nationwide data on mortality from the Causes of Death statistics for the years 1992–2013. Participants All deaths of Finnish inhabitants aged 25–74. Outcome measures Yearly ag...

Objectives Endoscopic sinus surgery (ESS) is a common operation typically performed due to chronic rhinosinusitis (CRS). There are limited data on the nationwide ESS rate and factors contributing to its regional variation. The aim was to evaluate factors causing variation of ESS rate. Design Cross-sectional nationwide observational study. Setting...

Background: While the link between mental illness and cancer survival is well established, few studies have focused on colorectal cancer. We examined outcomes of colorectal cancer among persons with a history of severe mental illness (SMI). Material and methods: We identified patients with their first colorectal cancer diagnosis in 1990–2013 (n = 4...

Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Mal...

Huonossa sosioekonomisessa asemassa olevat sairastavat muita enemmän ja heillä on tyydyttymätöntä terveyspalvelujen tarvetta, vaikka he käyttävät runsaasti perusterveydenhuollonpalveluja (1). Hyvin toimeentulevat käyttävät tutkimusten mukaan erikoislääkäripalveluja yleisemmin kuin alemmat tuloryhmät (20, 21). Helsinkiläisten toimeentulotukiasiakkai...