Exploring primary care access in Finland: a mixed-methods study in the context of the updated waiting-time guarantee.

Abstract

Prompt primary care (PC) access is salient for equitable care. Finland has a high level of unmet health needs, characterized by stark socioeconomic disparities and accounted for by long waiting times. In September 2023, Finland updated its legislation regulating waiting times to non-urgent general practitioner (GP) consultations, reducing the maximum waiting time to 14 days. Hereafter, PC access statistics improved. We assessed patients' views towards PC access after the policy update and how they reflect against national statistics. This is an exploratory sequential mixed-methods study in rural North Karelia, Finland. Interviews with patients and staff (n = 40) and observations (150+ hours) were conducted in a public PC centre in January-March 2024. Data on GP consultations including waiting times were obtained annually from individual-level national registers in 2017-24. Older patients with chronic health needs stated increased difficulties in navigating an increasingly digital PC and lack of access to in-person consultations. Staff reported an accelerated need for 'gatekeeping' access to GP consultations due to lack of resources. The number of all GP consultations increased 1.69-fold from 2017 to 2024, but in-person ones reduced 0.60-fold. A change in definition explained the improvement of waiting time statistics. A more robust waiting-time guarantee in Finland took place in tandem with austerity measures and a rapid shift to telemedicine. Improved PC access statistics conflict with local experiences and ignore reduced provision of in-person GP consultations, thus hiding the associated equity impacts. Our results call for investing in more nuanced monitoring of policy changes.