Primary health center unit closures following the Finnish administrative reform: A multilevel analysis of determinants

BackgroundTo address the growing care demands, many current health system reforms are aiming to strengthen primary healthcare (PHC) services and their accessibility. However, especially larger structural reforms can also influence where PHC services are provided. Following the recent Finnish administrative reform, the new wellbeing services counties are currently centralizing their PHC service networks, resulting in closures of PHC service points. Our aim was to examine the determinants of PHC center unit closure decisions. MethodsHealth center unit closure decisions were systematically extracted from policy documents. Publicly available municipality and county-level register data were utilized, encompassing population characteristics, geographics, as well as service network and reform-related factors. Multilevel logistic regression was conducted to analyze the factors associated with closures in the area of a municipality. ResultsOut of 295 municipalities, 82 were facing health center unit closures, with 45 left without a unit (previously four). A higher number of current (public) health centers (OR: 15.17, CI: 5.51-41.80), a better medical desert index value (OR: 1.90, CI: 1.27-2.83), and the county being a new actor with no previous joint administration (OR: 10.95, CI: 1.15-104.33) were associated with closure decisions. In contrast, greater municipal population growth (OR: 0.21, CI: 0.08-0.53) and a higher number of private clinics (OR: 0.22, CI: 0.05-0.94) were associated with lower odds of closures. ConclusionsThe planned health center unit closures appear reasonably well targeted. Counties with no previous collaboration between municipalities face accumulated service reform needs, leading to more significant changes in their PHC service networks. Similar future structural reforms should consider previous administrative structures, which can influence accumulated local service reform needs, and the current service networks to facilitate the implementation process.