The System of Occupational Health Services in Finland

1. What does the term "Occupational Health Services" refer to in your country?

Occupational health services (OHS) means the activities of occupational health care (OHC) professionals and experts that the employer has a duty to arrange by law and which are used to promote the prevention of work-related illnesses and accidents, the healthiness and safety of the work and working environment, the functioning of he workplace community and the health, working capacity and functional capacity of employees.

2. What are the main objectives of OHS in your country?

The main objectives of OHS as stated in Occupational Health Care Act (1383/2001) are as follows:
1) the prevention of work-related illnesses and accidents;
2) the healthiness and safety of the work and the working environment;
3) the health, working capacity and functional capacity of employees at the different stages of their working careers;
4) and the functioning of the work community

3. What are the most important legal bases for OHS in your country? Which ILO conventions are ratified?

Legislation

Primary Health Care Act 66/1972.
Occupational Health Care Act since 1979.
New Act 1383/2001 since 1.1.2002.
Occupational Safety Act 299/1958.
Sickness Insurance Act 364/1963
Act on Health Care Professionals 559/1994.
Act on the Supervision of Occupational Safety and Health and Appeal in Occupational Safety and Health Matters (131/1973).
Act on Occupational Diseases and Accidents at Work

Lower level orders

Government Decree (No 1484) on the principles of good occupational health care practice, the content of occupational health care and the qualifications of professionals and experts.
Government Decree (No 1485) on medical examinations in work that presents a special risk of illness.
Decision of Ministry of Labour on factors that cause a risk of cancer (838/1993)

Other legislation with implications to OHS

Act on protection of privacy in working life 477/2001
Act on the Status and Rights of Patients 785/1992

Ratified ILO Conventions
Finland has been a member of ILO since 1920. Altogether 95 Conventions have been ratified (79 in force).

ILO Convention No 155 on Occupational Safety and Health was ratified in 1985
ILO Convention No 161 on Occupational Health Services was ratified in 1987

Until now (April 2002) Finland had ratified 17 ILO conventions concerning OH&S, latest January 2000 Convention No 182 (Worst Forms of Child Labour Convention)

4. What is the structure of OHS in your country?

In Finland OHS is seen as a part of the primary health care system, but also as a part of the workplace health and safety system. It is the duty of an employer to arrange occupational health care, but entrepreneurs and other self-employed can arrange OHS on voluntary bases. The employer may organise OHS

1) acquiring the services he needs from a health centre (municipal)
2) arranging the OHS himself or together with other employees
3) acquiring the services from a unit or person entitled to provide OHS

Table 1. The percentage of OHS units, enterprises and employees served by OHS model in Finland in year 2000.

There were altogether almost 5300 persons working in OHS (Physicians, nurses, physiotherapists, psychologists and auxiliary staff). There were 1 700 physicians of whom 53 % worked on full-time bases (> 20 h/week), 2 100 nurses (89 % on full-time bases), more than 600 physiotherapists (59 % on full-time bases), near 200 psychologists (42 %) on full-time bases) and near 800 auxiliary staff (77 % on full-time bases). In addition a number of occupational hygienists, technical experts, agricultural advisors, opticians, dieticians, speech therapists, physical educators or the equivalent have been consulted by OHS units.

5. What are the main methods for improving OHS quality in your country?

The concept of "good occupational health practice" was introduced in 1994 in the Decision of Council of State 950/1994. According to that Decision continuos monitoring of the quality and effectiveness of the services is expected to be done by the OHS personnel. National recommendation of the quality management in social and health care sectors was given in 1995 and was renewed 1999.
In the new Occupational Health Care Act there is also a paragraph of the quality improvement in OHS "in accordance with good occupational health care practice the OHS shall include.... 9) assessment and monitoring of the quality and impact of OHS activities.

The qualifications of OHS professionals and experts are described in the Act and Government decision. Only qualified professionals and experts are allowed to work in OHS. The employer of an OHS professional or expert has a duty to ensure that this person attends continuing education to maintain his professional skills sufficiently often and no less than once every three years.

6. What are the main financial resources for OHS in your country?

The primary responsibility for funding of OHS lies with the employer. Employers are entitled to reimbursement for the necessary and reasonable costs of providing preventive services. Entrepreneurs and other self-employed persons who have arranged OHS for themselves also have the right. If an employer has provided curative services for its employees, its costs are also reimbursable if necessary and reasonable. The reimbursement is 50% of the costs, as specified by the Social Insurance Institution.

7. What is the obligatory education and training required for occupational physician in your country?

Occupational health care professionals
Physicians, nurses

Physicians working in OHS
Only occupational health care specialists may work as full-time licensed physicians in occupational health services. A person who works OHS in average of 20 or more hours per week is considered to be working full-time.
A licensed physician working part-time in OHS shall have taken a minimum of seven credits (study weeks) in OHC studies within two years of transferring to OHS.
A specialising physician is covered by the separate provisions in the Decree of the qualifications of specialist physicians (678/1998).

Public health nurses working in OHS
A licensed public health nurse working full-time in OHS shall be qualified public health nurse and shall have passed the specialist studies in occupational health care at a polytechnic or a minimum of seven credits (study weeks) in OHC studies within two years of transferring to OHS.
A person who works OHS in average of 20 or more hours per week is considered to be working full-time.

Occupational health care experts
Physiotherapists, psychologists, occupational hygienist, technical expert, agricultural advisor, optician, dietician, speech therapist, physical educator, or the equivalent.

An occupational health care expert means a person who

1) (physiotherapist) is qualified as licensed physiotherapist and has passed the specialist studies in OHC at a polytechnic or a minimum of seven credits (study weeks) in OHC studies within two years of starting the expert activities.

2) (psychologists) is qualified as a licensed psychologist and has passed a minimum of seven credits (study weeks) in OHC studies within two years of starting he expert activities.

3) (occupational hygienist, technical expert, agricultural advisor, optician, dietician, speech therapist, physical educator, or the equivalent) has an applicable university degree in occupational hygiene, a technical subject, agriculture, occupational vision, nutrition, speech therapy or physical education, or the equivalent earlier vocational qualification in the field, and sufficient knowledge of OHC, which means a minimum of one credit (study week) of supplementary training in OHC in accordance with the instructions of the Ministry of Social Affairs and Health.

8. What other important issues do you recognise as unique features of your OHS?

• Advisory board on Occupational Health Care (based on law)
• Tripartite negotiations in state level planning of OHS
• Legislation since 1978
• Curative services as part of the OHS
• Since 1990 the concept of Maintenance of Work Ability as part of OHS
• Finnish Institute of Occupational Health with six Regional Institutes
• Obligation for municipal health centres to arrange OHS