Pre-conference: Governing health systems - Aligning national steering with regional responsibility (GOVH)

Tuesday 11 November, 09:00 – 17:00 Helsinki time
(with network lunch at 12:30)

Organised by

Ministry of Finance, Ministry of Social Affairs and Health, Finnish Institute for Health and Welfare (THL)

Background

Effective governance is the foundation of a well-functioning health system. It ensures accountability, transparency, and coordination, enabling health policies to achieve their intended outcomes. Governance becomes particularly complex in multilevel systems, where national strategies must align with regional autonomy, diverse stakeholder interests, and varying capacities for policy implementation. Balancing these elements requires well-designed governance models that support collaboration, coherence, and adaptability.

Multilevel governance in health care is inherently challenging due to the need to coordinate decision-making across different levels of government and multiple institutions. Policy design, resource allocation, and service delivery must be harmonized while allowing flexibility to address regional needs. These complexities can lead to governance dilemmas such as fragmentation, duplication of efforts, and conflicting priorities. Understanding how different countries navigate these challenges provide valuable insights for policymakers, researchers, health system experts and other relevant stakeholders.

This pre-conference brings together health system experts, researchers, civil servants, and other key stakeholders to explore governance models, mechanisms, and best practices. A key focus will be Finland’s health and social care reform in 2023, which transferred governance from municipalities to newly established wellbeing services counties. This transformation has significantly reshaped the way national authorities steer and support regional actors, raising important questions about how to ensure effective coordination, policy coherence, and service delivery.

Finland’s reform presents a unique case study for examining the design and implementation of multilevel governance models. The pre-conference will explore the processes, institutional arrangements, and tools used to align national objectives with regional autonomy. By analyzing Finland’s experience alongside international cases, this session aims to generate practical lessons for strengthening governance in multilevel health systems.

Programme

	Morning session: Governance models in multilevel health systems The morning session provides a conceptual foundation for understanding how governance functions and introduces key governance concepts and international reform trends, focusing on how countries balance national steering with regional autonomy. Alongside international case examples, the session offers an overview of Finland’s recent reform as an illustration of redesigning governance in a multilevel health system.
09:00 – 10:30	Governing multilevel health systems: Concepts and trends Welcome and brief introduction An overview of key governance concepts and mechanisms – TBC Achieving health system goals and implementing reforms through governance: Tracking reform trends – European Observatory on Health Systems and Policies Case Finland: Governance reform in a multilevel system Key elements and goals of the reform – Dr. Liina-Kaisa Tynkkynen, Finnish Institute for Health and Welfare Rationale and challenges of multilevel governance: Balancing regional autonomy and national steering in Finland – TBC
10:30 – 11:00	Coffee/tea break
11:00 – 12:30	International case studies on governance reforms Denmark – Prof. Karsten Vrangbaek, University of Copenhagen Sweden – Dr. Jean Luc af Geijerstam, Myndigheten för vård- och omsorgsanalys England – TBC Panel discussion: What can be learned from Finland’s and other countries’ experiences in designing and implementing multilevel governance systems? Participants include international experts. The audience will have the opportunity to ask questions.
12:30 – 13:30	Lunch break
	Afternoon Session: Finland’s Health and Social Service Reform – Evaluating the New Governance Model The second session focuses on the recent health and social service reform in Finland, with emphasis on the governance mechanisms for steering the wellbeing services counties and balancing national and regional roles. The session will highlight early experiences, emerging challenges, and potential solutions. Speakers will include Finnish experts.
13:30 – 15:00	Early observations on implementing large-scale governance reform in Finland Preliminary insights into the functioning of the new governance model – Dr. Marina Erhola, Ministry of Social Affairs and Health Panel discussion: Experiences on reform implementation and lessons for the future. Participants include representatives from wellbeing services counties, as well as from the key steering ministries: the Ministry of Social Affairs and Health and the Ministry of Finance. The audience will have an opportunity to ask questions and engage with the panelists. Concluding commentary – European Observatory on Health Systems and Policies Wrap up and conclusions
15:00 – 15:30	Coffee/tea and networking

Registration

The registration fee is EUR 80. Networking lunch and refreshments are included.