Finland's new wellbeing services counties face a funding crisis rooted in flawed medical data. A single diagnostic error involving 'oxygen bottle' treatments has led to a €10 million windfall for one region, while others may have lost up to €90 million. The system's foundation is cracking.
Minister of Local Government Anna-Kaisa Ikonen has acknowledged errors in the diagnostic data underpinning Finland's massive social and healthcare reform. She has launched an investigation, but its limited scope—starting only from 2023—has left many regional leaders frustrated. The funding for the 21 wellbeing services counties, which took over responsibility from municipalities in 2023, is largely calculated based on the health diagnoses recorded in their populations. Errors in this data create immediate and significant financial imbalances.
"It feels very wrong and unfair," says Chief Physician Petri Kivinen of the Central Finland wellbeing services county. His region is among those suffering the worst financial strain and estimates it may have missed out on €75–90 million due to incomplete diagnostic records. The problem stems from inconsistent recording practices in the years leading up to the reform.
A System Built on Shifting Sand
The core issue is historical. Before the wellbeing services counties launched, diagnostic recording was not uniform across Finland. Regions like Central Finland used patient record systems that required healthcare staff to manually re-enter a chronic diagnosis, like diabetes, during every patient visit. Other regions had systems that automatically transmitted this data to the national registry maintained by the Finnish Institute for Health and Welfare (THL) each time a patient was seen, even for an unrelated issue like a cold.
This created a fundamental inequity. "The current model is about which system collects data on long-term diagnoses most efficiently, not about the actual prevalence of disease in the area," Kivinen states bluntly. Regions with unified, automated systems gained a significant funding advantage over those with multiple, older systems and variable recording practices. The funding formula mistakes data collection efficiency for healthcare need.
Kivinen and Chief Physician Jari Kankaanpää of the South Ostrobothnia region investigated the diagnostic shortfalls last autumn. They identified the recording of long-term diagnoses as the central problem. For example, a patient with chronic obstructive pulmonary disease (COPD) who requires an oxygen bottle might have this diagnosis recorded dozens of times in one system, inflating the region's perceived disease burden, or barely at all in another.
The €10 Million Oxygen Bottle
The most glaring example is in North Ostrobothnia. The region gets to keep approximately €10 million in funding that was allocated based on erroneous recordings of respiratory deficiency diagnoses. In essence, the funding model interpreted frequent data entries as a high prevalence of severe respiratory illness, leading to an overpayment. Meanwhile, regions that under-recorded the same conditions are financially penalized.
Minister Ikonen's investigation will only review diagnostic data submission from 2023 onward. This is a major point of contention. The diagnostic data collected by municipalities from 2019–2022 directly influenced the baseline funding allocated to each new wellbeing services county. Errors from those formative years are now locked into the financial structure, creating what critics call an unfair starting point.
"It is problematic that the government-commissioned report does not examine the recording of diagnoses for the years 2019–2022," Kivinen emphasizes. This limitation means the investigation will not address the root cause of the current disparities. It merely audits the process after the flawed system was already set in motion.
The Human Cost of Data Errors
The financial discrepancies translate directly into service pressures. A county that received less funding than its population's health needs require must make cuts. This can mean longer wait times for non-urgent care, reduced access to specific therapies, or staff shortages. The counties in the most severe financial distress are forced to make impossible choices between essential services.
The reform, known as sote-uudistus, was intended to guarantee equal access to healthcare and social services across Finland and curb rising costs. The funding flaw undermines both goals from the outset. It rewards efficient data bureaucracy over actual clinical workload and patient complexity, potentially incentivizing counties to focus on data entry over patient care.
Experts point out that the problem reveals a deeper issue in large-scale public reforms: over-reliance on quantitative metrics without sufficient quality control. The diagnostic data was treated as a neutral, objective foundation when it was, in reality, a messy and inconsistent administrative byproduct of different local IT systems and clinical practices.
A Patchwork of Digital Infrastructure
Finland's healthcare IT landscape is fragmented. There is no single national patient record system. Major vendors like Tietoevry's Apotti, Epic, and various older systems are used in different combinations across the country. This patchwork directly contributed to the diagnostic recording disparity. The funding model assumed a uniformity of data that never existed.
For the reform to succeed, a massive harmonization of data practices is required. The new investigation may standardize future reporting, but it does nothing to correct the historical baseline. Some regions are now advocating for a recalculation of the initial funding allocations, a move the Ministry of Finance has so far rejected as too complex and disruptive.
The situation places the wellbeing services counties in a difficult position. They are accountable for their financial stability and service quality, yet their starting budget was partly determined by factors outside their control. The political promise of equal services nationwide clashes with the technical reality of unequal data.
Looking Ahead: Can the Flaw Be Fixed?
The path forward is unclear. A full recalculation of funding based on corrected historical data would be a monumental administrative task and could trigger political disputes as some regions would see their budgets reduced. The alternative—leaving the imbalances in place—condemns some counties to perpetual austerity and could lead to a postcode lottery in healthcare quality, the very problem the reform aimed to solve.
The "oxygen bottle phenomenon" is a symptom of a larger disease in the reform's implementation. It highlights the danger of building a new, centralized system on top of old, decentralized data without first ensuring its accuracy and consistency. The credibility of Finland's landmark healthcare and social services restructuring now depends on whether policymakers choose to address this foundational flaw or continue to build upon it.
As the counties struggle with their first years of operation, the question remains: will Finland invest in fixing the data, or will it accept an unfair system where a patient's diagnosis is worth more in one zip code than another? The €10 million oxygen bottle has made the choice impossible to ignore.