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A Finnish City Cures Health-Care Inflation
Carol Matlack
Located just 100 miles below the Arctic Circle, Oulu, Finland, was for years famous for only one thing: the Air Guitar World Championships each August. Now the city of 196,000 has a new distinction: It boasts one of the world’s most advanced e-health programs.
A digital platform introduced in 2008 lets patients make appointments, refill prescriptions, and exchange messages with doctors from their home computers. There’s even a device that diagnoses ear infections by measuring vibration of the tympanic membrane. Some 70,000 residents are already on the system, called Self Care.
Most medical care in the country is provided by local governments, and Oulu introduced its e-health platform to control per capita health spending that ranked among Finland’s highest. A diet rich in salt and fat all that pan-fried muikku fish resulted in elevated rates of hypertension and heart disease. If we had done nothing, our costs would have doubled within a decade, says Kirsti Ylitalo-Katajisto, Oulu’s health and welfare director.
Before Self Care was introduced, Oulu’s health budget was growing more than 7 percent annually. The rate is forecast to fall to zero in 2015. Maria Vahakangas, a primary care doctor at Oulu’s Kaakkuri health clinic, says she used to set aside time every day to call patients but often couldn’t reach themand when she did, she spent too much time trying to figure out how to help them.
Now a nurse screens messages so Vahakangas knows what the patient’s asking about, and she can squeeze in time for e-mail replies. A regional government study found that doctors using Self Care could answer as many as 12 e-mails in the time it took to make one phone call. It makes things operate more smoothly, Vahakangas says. Doctors must answer non-urgent queries within three days. In emergencies, patients are told to go to a hospital.
Although Self Care is voluntary, patients are embracing itespecially those over 65. People with hypertension and diabetes who test blood pressure or blood sugar levels at home can enter that data directly into the system for doctors to view. Lab results are posted within a few hours, so patients can alert their doctors if there’s an abnormal reading. Before this, sometimes I had to wait two weeks to talk to the doctor about my lab results, says Hilkka Raappana, 68, a retired photographer diagnosed with coronary artery disease last year. Now she usually gets doctors’ replies within 24 hours.
Oulu has a deep pool of IT talent fed by two universities and by Nokia, which was the city’s biggest employer until a restructuring led to thousands of layoffs. Mawell, a local company founded by a group of ex-Nokia engineers, helped develop Self Care’s online platform and won a contract in 2011 to run it.
While Self Care would be difficult to replicate in the U.S., several countries with government-run health systems, including Britain, Norway, and Sweden, now have programs with similar features. Operating the system costs Oulu about €350,000 ($390,000) annually but has already saved it tens of millions of euros, Deputy Mayor Sinikka Salo says. Some of the biggest savings come from the city’s occupational health program, which uses an online questionnaire to screen workers’ health problems, reducing the need for face-to-face meetings with doctors. It’s too early to tell whether the program will improve citizens’ health.
But Salo says she’s encouraged that most of the city’s doctors and a growing number of patients use it. Nobody is going to use a new service if it doesn’t give you value, she says.