The report reviews the actions undertaken in the context of the National Health Care project as evaluated by the Monitoring Group. The report is the group’s fourth assessment of the progress of the project.

The Monitoring Group has paid attention in particular to the following complexes of issues:

1) It is important to secure the prerequisites for health, to promote health and to prevent disease. Attention is drawn especially to the circumstance that the awareness of the Health 2015 programme is not sufficient to enable using its objectives as a basis of municipal decision-making and as a component of municipal strategies. The group states that a precondition for achieving the objectives of the Health 2015 programme is to gain a comprehensive perspective on health promotion. Health must be understood as a principle steering choices at all levels in the public sector, private sector and in citizens’ own activities. It is important to develop models and co-operation of a new type in order to facilitate putting the evidence-based information into practice (e.g. health benefits of physical activity in children).

2) The group is of the opinion that law amendments concerning access to non-urgent care are necessary, but draws attention to the law’s financial impact in municipal economy. Enforcement of the law is a challenging task for the local authorities and will probably lead to development and reorganisation of functions in municipalities. Information and training is needed about the timetable of the new legislation. Assessment of the impact of the legislation should be arranged. The group follows how the access to care and treatment is realised as well as the impact of the reform on municipal economy.

3) It is important to stress issues pertaining to primary health care and its development. It is vital to seek solutions to the problems of primary health care in order to ensure that people obtain quality health services in time. It is hoped that the new legislation will reduce the inequality of population in regard to the availability of services in different parts of the country. Attention should be paid to continuity of care and to information flow between various actors. Telephone services and electronic services should be developed. The Monitoring Group draws attention to the abundance of projects. The development can be steered in the desirable direction by project financing, but short-term financing does not necessarily support long-term activity. Project financing should be directed to larger project complexes with proper priorities. Projects and their evaluation should be co-ordinated urgently.

Key words: access to care, assessment, health care, health promotion, preventive health policy