How is a large-scale reform perceived by citizens in Finnish primary health care?

We build on the anthropology of health systems and policy to study how Finland’s 2023 health and social services reform has been perceived and experienced by citizens, and how these perceptions reflect broader societal shifts. We draw on interviews (n=65) and 11 months of ethnographic fieldwork completed from January to November 2024 in Finnish primary health care in three regions. Citizen reactions towards the reform were mixed, ranging from fear to distrust and from indifference to cautious acceptance. Older citizens, in particular, view the reform as a turning point which alters the relationship between them and public healthcare services, and more broadly between citizens and the state. This perception has been amplified by austerity politics and measures taken during reform implementation, mainly closing of local health care centers, swift transition to remote care, and lack of citizen engagement during the implementation process. We introduce the concept of exceptionalism complacency to critique the assumption that universal health care in Nordic countries is inherently stable. In Finland, this complacency manifests itself as the tendency of politicians, policymakers, administrators, and sometimes researchers to take citizens’ trust for granted, as system-focused analyses of the reform, and as a disregard of local needs in policy implementation. There is a risk that this might fuel resentment towards public institutions and the reform by leaving more vulnerable citizens behind. Citizens’ experiences regarding changes in health care should therefore be carefully monitored. • We use ethnographic research to study citizen experiences of reform in Finnish primary health care • Citizen views in three regions were closely linked to austerity during reform implementation • Particularly older citizens described the reform as a societal shift challenging fairness and solidarity ideals • We introduce the term exceptionalism complacency to contextualize our findings • Exceptionalism complacency may lead to a disregard of citizen perspectives and in taking citizens’ trust for granted