Alueellinen yhdenvertaisuus maakunnallistuvissa sosiaali- ja terveydenhuollon rakenteissa

Abstract

Yhdenvertaisuus on keskeinen sosiaali- ja terveyspalvelujen uudistusta ohjaava tavoite, mutta ilmiön alueellinen ulottuvuus on jäänyt usein katveeseen. Artikkelissa haastatellaan kahdessa maakunnallisessa sote-organisaatiossa ja eri palvelualueilla johtotehtävissä olevia viranhaltijoita. Millaisena alueellinen yhdenvertaisuus näyttäytyy uudistuvien sote-rakenteiden toimintaa ohjaavissa periaatteissa, rakenteissa ja toimintakäytännöissä? Entä kuinka se konkretisoituu palvelujen tuottamisessa?

The welfare state can be considered one of the most significant equality projects of Finnish society. However, its original aim of ensuring equal and universal access to public welfare services, irrespective of social status or domicile, is now being threatened by a shortage of resources. Rural residents in particular are increasingly concerned about their security of access to adequate social care. Recent reforms have sought to address the resource problem by moving towards a provincial organization of services. In this article, we examine how spatial equality is manifested in regional social and health care organizations in two provinces. Based on 12 expert interviews carried out in two different organizations, spatial equality is defined as securing access to the same treatment regardless of where people are domiciled. This includes operational structures that take into account the regional dimension, the provision of services based on a uniform set of criteria, and different ways of providing services that overcome the challenges posed by regional diversity.Based on the results, spatial equality is pursued under various cross-pressures – including the pressure to harmonize services and still provide them in a manner appropriate to each area. To support spatial equality, organizations should be able to create and act according to a system that is grounded in place-sensitive information. In line with the calls made in our interview material, we call for explicit public debate on how far the objectives of spatial equality should be pursued.