Expanding choice of primary care in Finland: much debate but little change so far

•The Finnish government appointed in May 2015 announced that it will explore and expand choice models as part of the ongoing health and social care reform.•Earlier policy initiatives have promoted choice as a means to enhance continuity of care, loyalty and trust.•The more recent initiatives emphasize choice models that are accompanied by provider competition.•In most municipalities, better integration of care for patients with multiple care needs is a more important priority than the promotion of choice.

“Putting the patient in the driver's seat” is one of the top issues on the health policy agenda in Finland. One of the means believed to promote patient empowerment and patient centeredness is the introduction and further expansion of choice policies with accompanying competition between public and private service providers. However, the Finnish health care system has a highly decentralized administration with multiple funding sources and three different types of providers that people can seek primary care from (municipal health centers, occupational health care services, and private sector providers). This complicates the implementation of choice at the level of primary health care. In this paper, we describe the current policy debates and initiatives promoting the expansion of the choice of primary care provider in Finland. We examine the legislation and policies that have contributed to the current, complex service system in Finland. In light of this examination, we critically discuss the current debate on choice policies as well as the introduction of choice in the context of primary health care.