The Kotitori model has not yet been transferred to any other municipalities in Finland. However, it was expressed by Mawell Care that all of the large cities in Finland have been interested in this new model of service delivery. However, in order to be feasible, the Kotitori model requires a sufficiently large population base. Tampere is a relatively large city with some 200 000 inhabitants and thus provides a population base large enough for a service market in which multiple providers may operate and even compete. The context is also urban, which lets one assume that there is slightly more purchasing power in the population compared to the more rural areas. Thus, the transferability of Kotitori is restricted to the cities with sufficient demand and supply for private in-home care services.
The transferability of the Kotitori model is also fairly strong internationally. However, in addition to sufficient demand and supply also the market should consist of small providers with diverse service profiles. The model might be beneficial also for countries with interest in developing integrated care as the model also has the potential to integrate the services from both the health care and the social service sectors.
7 Conclusions
The main difficulty in evaluating the Kotitori model is a lack of reliable data. In order to say something about the cost-effectiveness of the Kotitori model compared to the traditional model, the demographic and socio-economic factors of the elderly population should be taken into account in the analysis. In addition, an attempt should be made to analyse what has happened to the need for the services among the older citizens living in the area for which Kotitori is
responsible.
The integrator model in which the citizens are also provided the option of purchasing private services creates an opportunity for the city to transfer a part of the costs of care to the citizens. The model makes it increasingly possible for the city to tighten the criteria for the municipal in- home care services and support services as the citizens’ access to private services is supported via the integrator model. Within this development it has to be ensured that the most vulnerable client groups are not excluded from the system. In its current form the Kotitori model does not yet answer the major challenge of the Finnish social care system: how to support the access of vulnerable client groups such as elderly people to the services they need and prefer.
Kotitori is marketed as a “One-stop shop” of in-home care services, referring to a marketplace in which older people are provided with information on private services. For the elderly people who cannot afford private services, Kotitori does not, in its current form, provide added value
compared to the traditional system. “One-stop shop” does not involve primary and secondary health care services or the service from other sectors of the city. The model might benefit all citizens better if in addition to municipal in-home care services and private services, elderly people were also able to access to health care services via Kotitori.
The city of Tampere has potentially been one of the biggest beneficiaries of the Kotitori model. The model involves substantial agreement on consultation and development work of the in-home care provision of the city. The development work includes the development of the processes and working culture at the systemic level but also the development of the technological architecture
of the city. In addition, the Kotitori model provides the city with a benchmarking opportunity and tool to develop its operations with this knowledge.
The Kotitori model benefits especially the small providers by strengthening their voice and increasing their power in negotiations with the city. It has indeed been able to attract small providers to its network. A more coherent network provides a more apt framework for the exchange of ideas and good practices and to search for new sources of synergy with other providers. However, the effect on employment in the region is potentially fairly marginal. It may be asked if Kotitori is only regarded as one platform of advertising among providers, rather than as a substantial source of new customers.
Nationally and also internationally, the transferability of the Kotitori model is rather strong. However, in order to be beneficial, the market should consist of small providers with diverse service profiles. The model might be beneficial also for countries with an interest in developing integrated care as the model also has the potential to integrate services from several sectors of society.
8 Data
The primary data of this case study are X informant interviews conducted in January and February 2012 by the researchers. The informants represent key stakeholders regarding the establishment and operation of Kotitori. The informants represent following stakeholder groups:
- Customers, i.e. senior citizens and their relatives (indirectly) - Kotitori case managers
- The integrator (Mawell Care and Nordic Health Care Group)
- Administrative level of the city of Tampere (service purchasing director and director of development of well-being services)
- Kotitori in-home care contractors
In addition, the researcher have employed their previous knowledge on Kotitori as well as interview data collected for the purposes of another research project to the extent it included information on Kotitori the researchers were provided with the key policy documents concerning the establishment of Kotitori by the city of Tampere. Finally, the researchers have employed the data provided by The Statistics Finland and SOTKAnet-data base.
References
Anttonen A & Häikiö L (2011) Care ’going market’: Finnish elderly-care policies in transition. Nordic Journal of Social Research, 2 (special issue).
Kröger T (2011) Returning the Nordic welfare municipality. Central regulation of social care under change in Finland. International Journal of Sociology and Social policy, 31(3/4): 148-159.
Laki julkisista hankinnoista 2007/348 (The Laws of Public Procurement). http://www.finlex.fi/fi/laki/ajantasa/2007/20070348, last accessed 13.4.2012. Ministry of Social Affairs and Health. (2012).
http://www.stm.fi/en/social_and_health_services/social_services
Taxpayers’ Association of Finland. Tilastoja Kotitalousvähennyksen käytöstä (Statistics on the Use
of Tax Deductions). http://www.veronmaksajat.fi/fi-
FI/tutkimuksetjatilastot/tuloverotus/kotitalousvahennys, last accessed 2.4.2012.
The City of Tampere. (2007). Kotitori-hanke. Rakennusvaiheen 1.1.2006-31.3.2007 raportti (Kotitori-project. Report on the Development Phase 1.1.2006-31.3.2007 of Kotitori).
The City of Tampere. (2010). Vanhusten kotihoidon uudet ratkaisumallit. Kotitori-hankkeen toteuttamisvaiheen 4/2007-10/2009 loppuraportti (New Solutions for Home Care Services for the
Elderly. Report on the implementation phase 4/2007-10/2009 of Kotitori).
THL (2011a): Private social service 2010. Statistical report 25/2011. National Institute for Health and Welfare, Helsinki. http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr25_11.pdf
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Appendix
Appedix figure 1 A basic process of getting in-home care for an elderly person in the traditional system Boxes with grey backgrond: An active role of the city/the case manager
Boxes with white background: Responsibility of the elderly person
Approved
Chooses a private provider/providers and pays out-of-pocket/and with voucher
Contacts the provider
An old person in a need for
in-home care services MUNICIPALITY
Applies for income support
Not approved
Role of the relatives and friends
Contracted out in-home care Voucher
Municipal in-home care is coordinated by a case manager
In-home care provided by the municipality Delivery alternatives
The person is not eligible for public in-home care services
The old person, a relative, a friend, a neighbor, hospital,
social/health care professional Contact Case manager of the area the person lives
The person is eligible for in-home care services funded by the municipality
“Mapping” the services
Appedix figure 2 A process of getting in-home care for an elderly person in the integrator model Boxes with grey filling: An active role of the integrator
Boxes with white filling: Responsibility of the elderly person
Not approved
Approved
Contract with a provider
PROVIDER NETWORK
Kotitori case manager
Contact
The old person, a relative, a friend, a neighbour, a hospital, social/health care professional
Contact
e-Kotitori
City of Tampere Case manager of the city
Contacts to a particular provider
The customer pays (out-of-pocket) and gets the services
The elderly person is not eligible for public home care services
The elderly person is eligible for public in-home care services