Health and social services reform highlights the need for collaboration in a fragmented system – systemic cooperation still needs building

The Finnish health and social services system consists of multiple sectors whose functions differ yet remain closely intertwined.

In her recent doctoral thesis, Marina Kinnunen examines how the roles and collaboration of the public, private, and third sectors, occupational health services, and private health insurers have changed following the health and social services reform, and how their cooperation could be managed more effectively as a coherent whole.

– The inspiration to write the dissertation stemmed from a touch of irritation. As the County Director of the Wellbeing Services County of Ostrobothnia, I have seen how easily the actors in the health and social services system are set against each other, even though in reality they are interdependent in many ways. I wanted to investigate the roles different actors play in our shared system and what is required to lead their collaboration as an integrated whole, Kinnunen explains.

Prepared over many years, the health and social services reform took effect at the beginning of 2023, transferring the responsibility for organising health and social services from municipalities to the wellbeing services counties. According to Kinnunen’s research, the reform made the interdependence between different actors and the need for collaboration far more visible than before.

– Cooperation does take place, and the need for it is recognised, but so far it has not become a shared and established operating model across the entire health and social services system. Collaboration varies by region and still relies heavily on local practices and personal relationships between individual actors.

Decisions made by one health and social services actor affect the others

According to Kinnunen, the next developmental step for the health and social services system is not merely to increase collaboration. What is essential is how cooperation is structured and managed at the system level.

– Systemic governance of collaboration means that the roles of different actors, their mutual relationships, trust, cooperative structures, and coordination are examined and reconciled as a coherent entity. Because the decisions of one actor affect the others, the system must be viewed as an integrated whole.

The dissertation’s empirical data consists of expert interviews and the strategic documents produced by the wellbeing services counties. The study highlighted several prerequisites for building effective collaboration.

– The mere need for collaboration does not generate cooperation on its own. Actors must recognise each other’s roles and trust that everyone has their own distinct purpose in the shared system. If the role of a particular actor goes unrecognised or is not trusted, it becomes very difficult for collaboration to evolve into a permanent operating model.

Dissertation

Kinnunen Marina (2026) Kohti systeemistä sotea? Toimijoiden yhteistyön systeeminen hallinta pirstaleisessa sosiaali- ja terveydenhuoltojärjestelmässä. Acta Wasaensia 594. Doctoral dissertation. University of Vaasa.

Publication PDF

Public defence

The public examination of D.Sc. (Econ.) Marina Kinnunen’s doctoral dissertation ”Kohti systeemistä sotea? Toimijoiden yhteistyön systeeminen hallinta pirstaleisessa sosiaali- ja terveydenhuoltojärjestelmässä” will be held on Friday 25 September 2026 at 12 at the University of Vaasa, auditorium Nissi.

It is possible to participate in the defence also online: 
https://uwasa.zoom.us/j/66284329725?pwd=k9eX3weltA8ZPkbXkAekXEDwLItseV.1
Password: 395736

Professor Outi Kanste (University of Oulu) will act as opponent and Professor Harri Jalonen as custos. 

The defence will be held in Finnish.