Cancer medicines assessment and funding in Finland: contextual judgement and institutional boundaries in a multi-channel system

Abstract

In Finland, the health technology assessment (HTA) and healthcare funding model has been described as a multi-channel system, with separate procedures for outpatient and hospital medicines. Recent literature has highlighted the importance of context-sensitive judgement in healthcare decision-making. This study examines how the Finnish multi-channel HTA and funding system shapes cancer medicines decision-making, especially in situations where context-sensitive judgement may be required. This qualitative interview study was based on semi-structured thematic interviews with 16 Finnish experts representing diverse professional backgrounds relevant to the assessment and funding of cancer medicines in Finland. The interviews were conducted in spring 2025. The data were analysed using deductive qualitative content analysis. The theoretical framework utilised in the study was derived from the neo-Aristotelian Phronesis Model (APM). Pattern-matching was used to explore tensions and correspondence between the findings and the APM framework. Shared aims and values, as well as assessment practices that support comprehensive evaluation, such as multiprofessional collaboration within decision-making bodies, were identified as strengths of the system. Weaknesses included structural barriers to collaboration and information exchange between decision-making bodies. Additionally, national-level processes were perceived as insufficiently responsive to outlier cases, and decision-making may in many cases be constrained by siloed budgets and limited access to price information. The institutional arrangements of the healthcare system may either support or hinder room for contextual judgement. While harmonising or unifying the multi-channel model could improve equity, coordination, or system-level efficiency, it may not in itself address the need for context-sensitive ethical judgement in healthcare decision-making. Our findings highlight the importance of strengthening coordination without losing flexibility.