Finland wellbeing services reform has taken a new turn following the release of a government commissioned report that calls for major structural changes across the country. The expert group behind the findings says the current system of 21 wellbeing services counties cannot continue in its present form. They describe it as financially fragile, uneven in capacity and too scattered to run core services in a stable way.
The evaluation was led by Marina Erhola, a former deputy permanent secretary at the Ministry of Social Affairs and Health. Her team looked closely at how healthcare, social services and emergency operations are organised. Their conclusion is clear. Finland must rethink the number of autonomous health regions if it wants a model that can survive population shifts and rising costs. The experts say the country should target a range of 6 to 11 regions. This figure is shaped by international comparisons and by the reality of how many people each area needs in order to operate a complete service network.
Researchers from several Finnish universities contributed to the review. One of the strongest points in the report is that most current regions are simply too small. Only four areas have more than 500,000 residents, which the panel views as the minimum size for a region that can run broad services without slipping into repeated deficits. The rest operate below that threshold and are facing increasing financial stress.
Prime Minister Petteri Orpo said the recommendation makes sense and gives politicians a serious basis for debate. His own party once supported a five region model before agreeing to the current 21 county setup as a compromise in 2023.
Three regions are already under closer state monitoring due to financial concerns. These include Itae Uusimaa, Central Finland and Lapland. The Ministry of Finance launched assessment procedures earlier in the year after budgets in these regions showed warning signs. A few other areas have been allowed more time to stabilise their accounts.
The report suggests that deficit correction deadlines could be extended to 2028 if the regions submit detailed recovery plans. Without larger structural changes, however, the experts warn that Finland may end up with sudden mergers, inconsistent service development and a lack of long term direction.
Another major point in the evaluation concerns Finland’s hospital and emergency care structure. The panel recommends bringing back the 2024 model that was put aside after political resistance. Under that plan, Finland would keep its five university hospitals. It would also maintain between five and eight central hospitals offering round the clock specialised services. The remaining hospitals would shift into acute care roles with narrower service menus. Local politicians strongly opposed the idea last year, but the expert group says it should be reviewed again before the 2027 parliamentary elections.
The report sets out three governance paths for the future. Finland could strengthen regional autonomy, increase central government control or maintain the current arrangement. If the country chooses greater regional self rule, the experts say wellbeing services counties should be allowed to levy their own taxes. This would give them an independent income base. It would also add new layers to the national tax structure, which would be complicated to manage.
Minister for Local and Regional Government Anna Kaisa Ikonen rejected the taxation idea immediately. She argued that it would raise the overall tax burden, weaken transparency and require major equalisation payments between regions.
Oversight of wellbeing services counties is now divided among three ministries. The report says this split approach leads to confusion and slower decision making. It recommends giving full supervisory responsibility to a single authority to bring clarity and reduce overlap.
