The context for supply and demand of public online services in Finland

The Finnish state is composed of three administrative levels: the central level made up of the national ministries and central authorities; the regional level consisting of the 6 provinces Aland, Etela-Suomen Laani, Ita-Suomen Laani, Lansi-Suomen Laani, Lappi and Oulun Laani, and the municipal level, which has a high degree of sovereign power for policy-making. Finland has a very low density of population (17 inhabitants / km²) and an economy which is heavily concentrated in the three big agglomerations around Helsinki, Tampere and Turku, all of which are in the south of the country. Most other parts of the country have much lower rates of income and tend to suffer from emigration.

Finland has made a remarkable transformation from an economy based on farm and forest products and heavy machinery to a diversified modern industrial and service economy. Average per capita income is now above the EU15 mean. So does GDP growth, as measured by the five year average (2.7%). The country invests heavily in education as well as in training and research. This investment pays dividends by delivering one of the best educated and trained workforces in the world. Education is considered by all Finnish stakeholder groups as a key factor in the development of a modern, competitive economy. In recent decades the telecommunication sector has surpassed the traditional timber and metals industries as they biggest source of exports. World-renowned Nokia and the Linux computer system have established Finland a place among the word's leading innovators.

Key figures about Finland[1]

	Finland	Ø EU15	Ø EU25
Old age dependency ratio	23.3	25.5	24.5
Population density	17.0	119.8	116.3
GDP per head	115.1	108.6	100.0
GDP growth - 5 year average	2.69%	1.85%	1.92%
Unemployment rate	8.8%	8.1%	9.0%
Inequality index	27	30	29

Meanwhile, there is much support from all parts of society for a strong role of the state in industrial policy and the safeguarding of social cohesion. Inequality is less tolerated than in Europe outside of the Nordic countries. Healthcare services, albeit not free, are of a high quality and access to tertiary education is fairly open even for children of low-income parents.

The most pressing and persistent problem is unemployment, which has remained high since the last downturn - the official rate was 8.8% in 2004. Unemployment affects, in particular, low-qualified workers and the more peripheral parts of the country.

The ethnic composition of Finland is very homogeneous, apart from the Swedish-speaking minority, which has existed for many hundred years already (5.7% of the total population). The original inhabitants of Northern Finland, the Sami, account to only 0.1% of the total population, but play an important role especially for the tourist industry. In comparison to the other Nordic countries, influx from southern European migrant workers and from asylum-seekers has been next to nil until only a few years ago.

Finland's performance on the UN Telecom Index[2]

According to available indicators, Finland ranks among the countries which are most advanced in Information Society developments. Rates of Internet and broadband penetration are very high. Among the underlying reasons most important seem to be the traditional affinity of the Finns to technological progress and the role the ICT sector plays for the national self-image. A further reason can be found in low prices for Internet connections on the market - a result of early market liberalisation. Moreover, eSkills and - more in general - the skills for utilising ICTs for one's own ends are widespread across all segments of the society.

Information Society indicators[3]

	Finland	Ø EU15	Ø EU25
Households with Internet access	51%	45%	42%
Broadband penetration	11.0%	7.6%	6.5%
Price for Internet use basket	37.08	49.57	48.35
ICT expenditure as percentage of GDP	3.2%	3.2%	2.6%
Digital Divide Index	53.4	53.0	50.1

eHealth in Finland[4]

At the moment the supply of eHealth services in the country is still limited, except for the usual portals and online services providing easy access to general type information, which are numerous. Hospitals, private medical centres and GPs throughout the country all have their own websites with contact details and information about the services offered. Specialist doctors usually have webpages on hospital websites.

There are plenty of regional portals with general health information for the Finns[5]. Every municipality features information about public health services on their website. Finland's state-owned National Television Companies, YLE, runs a huge website containing information about diseases, nutrition, addictions (smoking, drinking, drugs) and so forth. The site also contains newsgroups and discussion forums covering various topics. Privately operated health websites also play an important role. www.tohtori.fi and www.terveysinfo.net are both privately run sites giving access to a huge amount of information and service provider related information.

Key figures about the Finnish Health System[6]

	Finland	Ø EU15	Ø EU25
Percentage satisfied with own health	84.3%	82.5%	79.8%
Prevalence of long-term illness	31.8%	13.8%	20%
Doctors per 100,000 inhabitants	313	233	251
Health expenditure as percentage of GDP	6.1%	7.4%	7.3%

Thus, the large majority of online health services available to Finnish citizens provide general health-related information, often supplemented by the possibility to receive (partly) personalised advice on specific conditions. For example, the Health Compass[7] is a database service for personal health information. The service can give feedback on blood pressure levels supplied by the user. Results can be transmitted via e-mail or SMS. In the Helsinki metropolitan area the website www.10023.fi offers advice on health related issues. The provider also offers the same service through the phone, with the call centre being open around the clock and seven days per week. 10023.fi is operated by a private company, but financed by the municipalities of the Helsinki metropolitan area. Verkkolääkäri (NetDoctor) is a health question and answer (Q&A) service by specialists and other health-care professionals[8].

All of these systems assist citizens and patients to be better informed on issues related to their health status and on the services that are available and accessible.

Additionally, eHealth applications may provide possibilities for consultation services. It is possible to make use of e-mail when communicating with the family doctor in Finland, for example for receiving test results - but there remain security issues to be solved. ePrescriptions, eReferrals and eConsultations are already in use in Finland, or there are relevant national pilots on their way. The online sale of prescription pharmaceuticals is not permitted, but other health-related products are being offered for online purchase.

Home-care systems, disease management and fitness systems are also in use. Home-care systems are meant for monitoring chronic diseases at home, for the follow-up of elderly patients, or for tele-consultation of professionals from one's home. They are often based on wireless technology, such as mobile phones, handheld computers, or PDAs. Wellness and fitness systems are those meant for healthy people who want to monitor, maintain and improve their health status and fitness. Supply with such services is best for inhabitants of the Helsinki metropolitan area.

The biggest issue for eHealth provision appears to be security. The problem of protecting the information flowing between patient and doctor, and of securing that data privacy protection will also be guaranteed in the future, has not yet been solved satisfactorily.

A further barrier to fast development of supply and demand for patient-targeted eHealth applications is the fact that the Finnish state does not encourage patients to take a more active role in healthcare management. The public sector reserves the right to judge whether the patient's perceived need makes her or him eligible for a certain service or not. Finns who want a specific treatment often have to visit a GP from the private sector, which offers a service that is more tailored to individual needs - for a price.

Satisfaction with National Healthcare System[9]

A structural barrier towards the development of eHealth is that the most frequent users of the health system are elderly people. Elderly people are less familiar with information technology, and also tend to prefer personal interaction.

Finally, the overall satisfaction of the Finnish population with their healthcare system is high - actually it is better than in any other country in the EU25. This means that there is comparatively little demand-side pressure to change established procedures.

A number of factors, though, speak in favour of an increased uptake of eHealth services. Finland is a country with huge geographical distances, with many people living in isolated and sparsely populated areas. This should encourage the development of new services that help bridge the distance between healthcare providers and patients. There is potential from some services to be de-centralised, such as x-rays, which can be taken in one place, and then sent to experts through electronic networks. On the other hand, some services can be provided from a centralised location, such as a call-centre, without any negative effects on service quality. Centralisation and creation of call centres also imply the possibility of outsourcing via ICTs.

Other important driving forces include the fact that eServices, when implemented, can often lead to significant savings in money. The relative scarcity of doctors and nurses in some regions can be remedied, and processed can run faster, thus saving time.

User orientation in eHealth services

The necessary components for the development and implementation of eHealth in Finland were outlined in the National Strategy on the Application of Information Technology in Healthcare and Welfare (1998/2002). Among the key objectives of the strategy are improvements in information sharing and data flows between parts of the healthcare system, making reliable and accurate information easily and rapidly available at the time and place where it is needed for citizen and patient care. Online interaction between patients and the healthcare system is intended to substitute for, or complement, the traditional face-to-face model of healthcare service delivery.

Citizen empowerment and participation in the healthcare process are also mentioned in the strategy. However, the Finnish Government has set a clear priority that the development of tools for health professionals, enabling them to share distributed patient information in a secure way, should come first. Common messaging standards and the basic structure of the Electronic Health Record (EHR) are being defined at the national level. Major enablers for eHealth, such as a PKI service for health professionals and service providers, and citizen identification tools (citizen smart card), are also implemented at the national level.

eHealth services for citizens will be at the centre of the second phase of the eHealth implementation which is realized simultaneously at the local/regional and national levels. Local information systems are being integrated and linked to form regional networks that use common national services (e.g. security and link directory services). The introduction and implementation of eHealth applications will be done, in most cases, at the regional level by public service providers. In parallel, both private healthcare organisations and the private non-profit sector are also offering eHealth services.

Internet Use for Searching Health Information[10]

The strategic decision to develop online back-office and buiness-to-business healthcare applications first means that user orientation is not much addressed directly at the moment, as far as top level policy-making is concerned. A variety of stakeholders, however, have started bottom-up initiatives to make best use of the Internet for targeting hard-to-reach citizens and those people in danger of exclusion from mainstream healthcare services. For example, "Verneri and Papunet" is a portal for people with development disabilities, offering accessible communication for the speech-impaired[11]. Virtuaalitulkki is a video-conferencing interpreter service which intends to help overcome language barriers in the context of education, welfare and health-care services[16].

eUser - the Project

The eUser study is funded by the European Commission's IST (Information Society Technology) programme. eUser a major research and support project which has set out to provide solid evidence as to users' real needs regarding eGovernment, eHealth and eLearning offers, as well as providing data about their attitudes and the uptake levels of current public online services. The project supports the IST programme to achieve its key objectives of putting the user and his/her needs at the centre of IST developments. It provides empirical information on key public eServices domains -eGovernment, eHealth, eLearning - identified as priorities by the European Council, and assesses the demand/supply match in these fields.

The eUser Approach

To achieve its objectives, eUser addresses both generic user-related issues and domain-specific topics, and develops a globally accessible repository of evidence-based knowledge, methods and best practice examples. It pursues an extensive programme of active knowledge translation, transfer and dissemination supported by sophisticated online knowledge dissemination tools. The knowledge base will consolidate both existing knowledge and approaches, and novel data generated by the project through representative population surveys (demand side) in old and new Member States, and through comparative analyses of readiness to address user aspects of public eServices in each Member State (supply side).

The project is designed in two phases. Phase I - the preparatory phase - has developed a conceptual framework that systematically identifies and cross-references user issues and service characteristics in relation to online public services. An EU-wide population survey regarding the needs, experiences and requirements of both current and potential users of online public services has been carried out in early 2005. Concerning the supply side, information from national public sector environments has been collected, about the degree to which the European public sector pays sufficient attention to user-orientation of online services. Good practice examples regarding user-appropriate online public service provisions are being identified and described.

All these results build the basis and provide content for the eUser interactive online knowledge base and support service which is being set up as an online observatory on user issues. This constitutes the basis for active support services on user-centred topics which are being made available inside and outside the IST programme.

eUser Country Briefs

This document has been prepared by empirica with input from the Danish Technological Institute and the Finnish National Correspondent (Martti Paasikallio, Efektia Ltd), as well as secondary data sources such as Eurostat and other Commission Services.

25 eUser eHealth Country Briefs are available in a common format, one for each member of the enlarged European Union. You can access and download these documents in PDF format (for free) from our website.

More information

Check our results and achievements on: www.euser-eu.org. If you wish to be provided with more details, or to receive news and updates, please contact us at: eUser@empirica.com or get in touch with any of the project partners listed below.

empirica Gesellschaft für Kommunikations- und Technologieforschung mbH (Project Co-ordinator) Oxfordstr. 2, 53111 Bonn, Germany, Tel.: +49 228 985 30 0, www.empirica.com

Danish Technological Institute Center for Competence and IT Kongsvang Allé 29, Aarhus, Denmark, Tel.: +45 72201417, www.teknologisk.dk

Foundation for Research and Technology - Hellas Institute of Computer Science P.O. Box 1385, Heraklion, Crete, GR - 71110 Greece, Tel: +30-2810-391741, www.ics.forth.gr

Work Research Centre Ltd. 1 Greenlea Drive, Terenure, Dublin 6W, Ireland, Tel.: +353 1 492 7042, www.wrc-research.ie

University of British Columbia, Vancouver, BC, Canada #105 - 2194 Health Sciences Mall, Vancouver, B.C., Canada, Tel.: +1 6 04 6 39 46 68 www.cme.med.ubc.ca

National Research Council Canada, Saint John, New Brunswick 127 Carleton Street, Saint John, New Brunswick, Canada, E2L 2Z6, Tel: +1 5 06 6 35 06 33, www.iit-iti.nrc-cnrc.gc.ca

Notes About the Data Sources Used in This Document