Public primary healthcare service network planning in Finland: a document analysis of principles, justifications, and future directions

BACKGROUND: Maintaining accessible primary healthcare (PHC) services requires evidence-informed decision-making, especially during health system reforms, which can implicitly or explicitly affect PHC service networks. Following a large-scale administrative reform, Finnish wellbeing services counties are reshaping their local service networks. We investigated the principles guiding PHC service network planning, justifications for service network adjustments, and views on future PHC service provision. METHODS: = 31) concerning PHC service networks were systematically identified and extracted from county websites. We followed the READ approach and utilized document analysis with inductive content analysis. RESULTS: Public PHC service network planning focused on travel times and accommodation for external, mainly population-related factors. All counties were also implementing tiered service provision. Service network changes were justified by workforce challenges, particularly in remote areas, and poor condition of premises. Additionally, centralization was argued to enable higher standards of care. Financial aspects were not strongly emphasized. Future PHC centered around digital and mobile care services, which were seen as prerequisites for reducing physical services, while detailed long-term planning was largely absent. CONCLUSIONS: The counties' service network analyses highlighted the complexity of planning and a concurrent balancing act between accessibility, service quality, workforce availability, and physical premises. The strenghtening of acccessibility and availability was emphasized, while the service provision was adapted to the available resources. Our findings can support evidence-informed planning and implementation of health system reforms which affect PHC and provide a basis for further research on PHC service networks and accessibility.