Finland

• Coxa Hospital, (specialising in joint replacement) faced problems in common with many hospitals throughout Europe:
  • Increasing demand
  • Shortage of capital to upgrade and extend facilities
  • Duplication of services by other local and competing hospitals
• The hospital created a public private partnership to withdraw from State ownership and take greater control over its management and financing
• The hospital established three types of stakeholders (shareholders)
  • Municipalities (representing local government and the public)
  • Local hospitals – as part of an agreement to rationalise and consolidate elective services at Coxa
  • Private equity
• Coxa raised commercial loans against a ‘commercial’ business plan for the design and procurement of the building
• The business model was based on the principle of whole systems delivery of care utilising a model of integrated and systemised care pathways (over 200 covering the range of procedures delivered)
• The hospital was designed around the systemised care pathway models
• All patients are diagnosed, treated and receive rehabilitation with pre-agreed care plans (pathways). All healthcare agencies involved with the patient subscribe to and follow the commonly agreed predictive pathways. Initial diagnosis and rehabilitation is localised as far as practical – monitored by comprehensive clinical governance principles
• Performance has been exceptional:
  • Improved clinical outcomes and faster access for patients
  • Lower capital costs – and scope for future development
  • Improved satisfaction, patients and staff

• Capital investment directly related to current and anticipated clinical technologies and models of care – coupled with ongoing freedoms of action
• Population based and measurable health gain through horizontal and vertical integration of care

• Ensuring sustainability of co-relating orthopaedic trauma

• Whole systems population based investment and care delivery

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