Overlaps and accumulation in the use of rehabilitation services.

The Finnish rehabilitation system is considered fragmented and multisectoral, and thus it may produce 'multiclients' receiving inefficient and overlapping services. This paper addresses the overlaps and accumulation in the delivery of rehabilitation services in Finnish rehabilitation subsystems. Data were drawn from several administrative registers on the use of rehabilitation services during the years 2004 and 2005 in one hospital district area in Midwest Finland. To analyze the differences in use of rehabilitation services between the patient groups, cross-tabulations, logistic and linear regressions were used. Altogether 15 189 persons in the study area used rehabilitation services during 2004 and 2005; 9% of rehabilitees used services provided by two or more subsystems. These multiclients used 25% of all rehabilitation services. Men of working ages and living in larger municipalities were more likely to be multiclients. The proportion of multiclients among all rehabilitees was smaller than expected. However, these multiclients used a larger proportion of rehabilitation services. In the case of multiclients, the problems most likely occur in the rehabilitation process, as the services provided by different subsystems most probably are not linked together. To improve the performance of the rehabilitation system, more attention should be paid to integrating the subsystems.

Use and distribution of rehabilitation services: a register linkage study in one hospital district area in Finland.

This study focuses on a large set of rehabilitation services used between 2004 and 2005 in one hospital district area in Finland. The rehabilitation system consists of several subsystems. This complex system is suggested to produce arbitrary rehabilitation services. Despite the criticisms against the system during decades, no attempts have been made to study the performance of the system as a whole. Register data from several subsystems were linked to study the use and characteristics of rehabilitation services and users. Data consisted of 10 153 persons. We analysed differences in rehabilitation service use between age and sex groups and municipalities. Totally, 5.4% of the population used rehabilitation services in the studied 2 years. Medical rehabilitation was the most common type, users' mean age was 52.6 years, and 52.2% were women. Remarkable differences were detected between municipalities in usage rates in all rehabilitation types. The size of the population in home municipality had a varying relation to utilization in different rehabilitation types. We found differences in the service use within age groups, sex or home municipality. This study cannot rule out the possibility that these differences indicated inequitable distribution of services or whether they are explained by different needs.