Primary healthcare service network planning in Finland: A document analysis of principles, justifications, and future directions

Background Maintaining accessible primary healthcare (PHC) services requires efficient, evidence-informed decision-making. This is especially relevant in the context of health system reforms, which can implicitly or explicitly affect PHC service networks. However, research on local service network planning remains scarce. Following a large-scale administrative reform, Finnish wellbeing services counties are reshaping their local service networks, offering an opportunity to analyze the planning and decision-making of new public actors. We investigated the counties’ principles guiding PHC service network planning, justifications behind the service network adjustments, and views on future PHC service networks and service provision. Methods Publicly available policy documents (n = 31) concerning PHC service networks and service provision were systematically identified and extracted from county websites. We followed the READ approach and utilized document analysis with inductive content analysis. Results Our analysis resulted in ten categories. The principles guiding PHC service network planning focused on travel times and distances as well as accommodation for external, mainly population related factors. All counties were also implementing tiered service provision. The local service network changes were justified by poor workforce availability and condition of premises, particularly in remote areas. Additionally, centralizing service provision to larger units was argued to enable higher standards of care. Notably, financial aspects were not especially emphasized in the documents. Future of PHC care provision centered around digital and mobile care, which were seen as prerequisites to reduce physical services. However, detailed long-term planning was largely absent. Conclusions Diverse themes emerged from the counties’ service network analyses, highlighting the complexity of PHC service network planning. The local structural reforms were driven by multiple concurrently prevailing factors, which were thoroughly considered. The counties underlined their attempt to strengthen PHC accessibility and improve the standards of care while adapting the level of service provision to the given budgets. Nationally, our analysis can promote diffusion of best evidence-informed planning practices. Internationally, the planning and implementation processes of similar reforms can utilize our results to help maintain or improve accessibility to PHC services. Lastly, subsequent research on health systems and policy examining service networks can incorporate our findings.