Evaluating the Impacts of Administrative Reforms in Public Social and Healthcare to Democracy: Case Finland

Effective and equitable social and healthcare services are important for the functioning of democracy. Most scholarship on the relations between democracy and social and healthcare services has focused on the level service provision. Less attention has been paid to the democratic governance of social and healthcare services and the broader role of these services in democratic regimes. In this presentation, we focus on the impacts of administrative reforms of public social and healthcare systems to democracy. More specifically, we evaluate the impacts of the Finnish social and healthcare reform to democracy. A major social and health service system reform was implemented in Finland in 2023. The reform introduced macro-level administrative integration of public social, healthcare, and rescue services. The responsibility for organizing these services was transferred from ca. 300 municipalities to 21 well-being services counties, with special arrangements in Helsinki and the Uusimaa region. The reform introduced a new layer of public administration with representative and direct democratic institutions, including regional elections and an obligation to advance direct citizen engagement in the counties. Our evaluation draws on a multi-level governance perspective and utilizes multiple secondary research and primary data sources. We focus our evaluation to structural changes in the relations between regional and state-level governance, and the practices of governing at the regional level. We assess the structural and practical outcomes of the reform to democracy on Dryzek's (1996) three dimensions of democracy: scope, franchise, and authenticity. We find that the Finnish reform has mixed impacts on democracy across structural and pratical aspects of governance and different dimensions of democracy. Adding a new layer of public policy-making and administration has in structural terms broadened the scope and franchise of democracy by bringing democratic institutions to previously administrative and managerial domains of the service system. The broader base for financing services has in part strengthened the authenticity of democracy, but the increased state-level administrative and financial control has also significantly curtailed the authenticity of democratic decision-making in structural terms. In practice, the scope of democratic debate and decision-making has been broad within the mandate of the counties. The franchise has significantly strengthened during the first years of the reform, but remains fragmented or somewhat shallow. The authenticity of democratic governance appears as weak in many key respects at the county level. In conclusion, we argue that the Finnish social and healthcare reform of 2023 has strengthened democracy by bringing public services more broadly under versatile forms of democratic control, but also weakened the authenticity of democratic decision-making. This involves many risks, as weak authenticity may compromise the political sustainability of the service system and lead to broader popular disappointment with democracy. The case study shows that administrative reforms in public social and healthcare may have major impacts on democratic regimes and that close attention must be paid to the different aspects of reforms and dimensions of democracy when assessing these impacts.