Potilas ja hoitotakuu terveyspolitiikan ristiaallokossa : Potilaan asema ja hoitotakuu-uudistus valtionhallinnon sekä kansanterveysjärjestöjen näkökulmasta 2004-2010
The purpose of this study is to shed light on the status of the patient in health policies implemented in order to secure patients access to care and to improve the quality of the care. The study focuses on patients and the treatment guarantee from the viewpoints of government and nongovernmental organisations in 2004-2010. The treatment guarantee is the only segment of legislation that gives patients concrete assurance of access to treatment and quality care. The experiences of patients and organisations in combination with inconsistencies in official follow-up data reinforce the need for this study. The three-level theoretical framework of the study based on the discourse-historical approach in Ruth Wodak s linguistic model. It builds on the impressive background of period pieces and modern-day diagnostics (zeitdiagnose), special phenomena such as the notion of patients as actors in the health policy debate, and language management. The task of the study is to describe the status of patients in the context of the treatment guarantee, as well as to outlines the relationship of public health organisations and government authorities to the reform in national health policy over the period 2004-2010. The study addresses questions about the status of patients and questions about the viewpoints of government and public health organisations concerning the treatment guarantee. The research material comprises documents from government and organisations, data from interviews with experts, and articles from the Helsingin Sanomat daily newspaper. Content analysis occasionally shifts to discourse analysis in the course of the study. The government authorities expected the treatment guarantee as a major health care reform, but according to the experts' interviews it did no turn out that way partly due to the weak implementation. National government authorities and public health organisations differ in use of the concept of a treatment guarantee. The public health organisations were not concerned about a usage threshold for use the concept of a treatment guarantee. Government authorities had different practices in use the concept. At the beginning of the research period, the Ministry of Social Affairs and Health , unlike other government authorities, shunned the concept. When the matter was dealt with in Parliament, however, the opposition referred to the concept of a treatment guarantee. Perceptions about the content of the treatment guarantee varied among the actors, and its application changed during the research period. Narrowly speaking it meant that access to treatment was only provided within a certain time frame. The treatment guarantee was usually written without mentioning the patient. If the patient was mentioned in the documents from the government and public health organisations he or she was usually referred to as an object. There were signs of imminent change in the preparatory documents of the Health Care Act in 2010. The documents still described the patient as an object, but they were also described as an actor. In documents from public health organisations, the patient was perceived as an active player in a generally positive way. In documents from the government, the patient was positively perceived as an object. In parliament, when the legislative process for the treatment guarantee drew to a close, members of parliament began speaking more about the economy and less about the patients, nor were the patient viewed as a potential voter. Public health organisations discussed the empowerment of patients just before the reform, but the trend quickly diminished after the legal reforms were initiated in March 2005.These organisations wrote about the treatment guarantee as a patient right as late as 2006. According to the data from experts interviews the treatment guarantee did not give protection to patient.
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