Analysing the Performance of Meso-level Care Systems Including Long and Short Term Services

Research output: ThesisDoctoral ThesisCollection of Articles


Different managerial logics are relevant when managing individual care organisations, networks of interrelated care organisations, or national health systems. Individual care organisations and national health systems are often referred to as the micro and macro levels of management,whereas the networks of different organisations as the meso-level. The regional social and health care reform currently taking place in Finland will further accentuate the role of the meso-level of management. Meso-level social and health care systems have, however, received less attention inregistry-based studies than micro and macro level systems. Also, the literature on social and health care management has not focused at length on meso-level managerial issues. This thesis applies a systems approach on social and health care management to shed light on themanagerially relevant mechanisms on the meso-level. The goal of this thesis is to create ananalytical framework of meso-level social and health care system and test its applicability when analysing these systems with national routinely collected registry data. As an empirical context, this thesis studies the Finnish meso-level care system for older people. A nationally collected data set includes social and health care use of over 300,000 individuals aged over 74 years, in 65 Finnish municipalities, and is complemented with sociodemographic background information, including marital status and income level. The sub-studies included in this thesis analyse diverse meso-level system mechanisms that take place in the meso-level caresystem. The synthesis part of the thesis gathers findings from the sub-studies to create, via inductive analysis, meso-level logics of management. The results imply that the meso-level system's manager must find a balance between the costs of individual long-term states and the use of short-term services. Coordination between organisations and homogenous criteria for care can reduce the need for urgent care and the over- and under-carethat stem from discrepancy between long-term need for care and services provided. A meso-level framework enables comprehensive analysis of both the patient and system level service use distribution. This analysis is especially relevant for the care system of older people, which concerns diverse actors and time scales for care processes. The detailed definition, establishment, and management of the analytical framework must, however, be established in collaboration with all the actors within the system. Additionally, similar meso-level mechanisms might be transferable from the care management context of older people to mental health services and child welfare services, and the generalisability of the results and frameworks to these contexts of care should be considered.
Translated title of the contributionLyhyt- ja pitkäaikaispalveluita sisältävien mesotason hoito- ja hoivajärjestelmien suorituskyvyn analyysi
Original languageEnglish
QualificationDoctor's degree
Awarding Institution
  • Aalto University
  • Lillrank, Paul, Supervising Professor
  • Linna, Miika, Thesis Advisor
Print ISBNs978-952-64-1105-7
Electronic ISBNs978-952-64-1106-4
Publication statusPublished - 2022
MoE publication typeG5 Doctoral dissertation (article)


  • health economics
  • systems approach
  • registry study
  • social and health care
  • meso-level
  • elderly care


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