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One Visiting Doctor’s Experience on Healthcare … There and Elsewhere!

[By Dr. David Edward Marcinko; FACFAS, MBA, CMP™]


As readers and colleagues know, I’m a great fan of the Finnish culture, lifestyle and people. I’ve visited the country several times, touring and speaking, meeting with government, academia and local industry leaders and politicians in Helsinki, Tempere, Seinajori, Turku, Oulu and Northern Lapland, among other places; and especially Rovaniemi which is home to the world’s most northern branch restaurant of McDonald’s. Of course, the famed Arktikum there is also very comprehensive museum of arts, science and technology. Every time my wife and I visit, we learn more about the language, the arts and tradition.

Recent Visit to Finland

On our most recent month-long visit to Finland, we were able to visit a Japanese Honbu [karate gymnasium], meet several black-belt Taido karate students, and even take an actual class to stay in shape. I’ve been an avid runner for more than 30 years so aerobic cardio-vascular output was not-problematic. The trip was also remarkable for the many insights into the challenges of the Finnish healthcare system, their plans for eHRs and their emerging interest in American medical care. I’ve also made several friends and new colleagues, ingested cold raw dead-fish stew, and mastered the Finnish railway system. And so, my national healthcare service impressions follow; along with a bit more about the art and science of Taido styled karate.

Taido in Finlandkarate-mac

Prior to our departure, we asked my daughter’s karate instructor, Sensei Uchida in Atlanta, GA, about the possibility of attending a Taido work-out in Finland. We were surprised when he informed us that the country has the largest number of Taido students in the world, second only to Japan. This interesting fact was later confirmed by the Finnish Athletic Association. The reason is that this form of exercise is covered under the country’s national health insurance system and is available to all citizens, free of charge. But, of course, income taxes are very high.

In fact, we learned that just the city of Helsinki itself, had nine Honbu’s to choose from and we selected what proved to be the most interesting, indeed! Another American instructor, Sensei Brent, mentioned that he visited the country a few years ago and still has some Taido friends from there, too.

The Taido Karate Honbu

Built during World War II to protect the population living in the City of Tempere from bombs, the Gymnasium in North East Helsinki is built into the side of a huge granite mountain, not unlike our own Stone Mountain here in Atlanta. Since it was originally constructed as an air-raid shelter during WW II, with many snaking corridors and smaller caverns, it is cool all year round with many miles of tunnels maintaining an even 56 degree temperature, just like natural underground caves. No air conditioning is needed for the short summers, and no heating system is needed for the very long winters.

Enter the Health Gymnasium

As we entered the “Health Gymnasium” as it was known, it was as if we were walking into a long tunnel through the woods, about 100 yards long. This entrance to the bomb shelter was really a railroad track line that was still visible after all these years. It was guarded by two huge iron doors several stories high. Inside, was a general reception area where we were directed to the actual Taido Honbu, itself, known as Budo # 6. As we walked through the long winding corridors, we noted that the walls were solid granite, painted white, and that each studio was separated only by a color-coded curtain; much like long rows with individual partitions. There was no graffiti and, although there was no sound-proof protection, the entire Gymnasium was surprisingly quiet.

A Linguistics Error

As we walked along, we noted studios for fencing, gymnastics, boxing and kickboxing, table tennis, ballet, weight lifting, volleyball, rowing and many different types of Karate and other martial arts, like Aikido, Bando Thaing, Capoei, Gatka, Hapkido, JuJitsu, Judo, Kendo, Kung Fu, Sumo and of course Tai Kwon Do. But alas, no Taido Honbu! We were horrified. Did we make a linguistic error! Was the term Taido misinterpreted as a generic terms for all these others types of martial arts or Karate forms? My daughter Mackenzie’s enthusiasm was crushed [after seven years of intensive study, with both national and international competition] as she is a black-belt candidate still in need of some teaching and karate internship credits to reach her ultimate goal. After-all, she brought her Gi [uniform] a long way to not to be able to use it. So, back to the reception area we went, inquiring again in our rudimentary Finnish. Fortunately, the problem was not a language faux-pau at all, but a one of timing. In our excitement, we had merely arrived an hour too early. Soon, the sign on one of the larger partitioned studios was changed to “TAIDO”, and students began filling-in, talking, laughing and giggling before class, just like they do in Atlanta.

Teaching Introductions

The class was comprised of blue, green and brown belt student [there are eight belt ranks], even though we took care to register for the same rank as daughter, Mackenzie. But, it was for about a dozen young adults, ages 18-30, and evenly split between guys and gals! No children. One student had been taking classes for about two years (she averaged 3-4 classes per week), while another was in his ninth year (able to participate only about once or twice per week). Nevertheless, Mac was agreeable to work-out with the adults, under the leadership of Sense Arie, who spoke English and was very cordial to us. When he then asked us what we had learned, we quickly listed Untai, Sentai and Hentai hokis [ritual movements; a Hoki is a pattern of techniques originally put together for mental and physical health and as a practice form of “free fighting.”], as he replied, “that will be sufficient for today”. No doubt, he and the other students were as curious about us, as we were about them. Introductions were made to all students, including moms, dads, grand-moms and grand-dads. We then settled down to watch Mackenzie and the class.

Class Comparisons

Like the Finnish healthcare system, the Taido karate class itself had several similarities and several differences compared to what we are used to, in Atlanta, GA.

1. First, the students and instructors wore the same colored GIs; solid black pants with roughly woven white tops. The GIs also were fancier with many epilates, patches and insignias. The belt color-coded system of the States was not used. Shoes were left outside, all bowed as a sign of respect upon entry, and lined up according to rank. There were no mirrors, horizontal warm-up bares, and virtually no padding in the mats on the floor! The epithet OUS, was replaced by a loudly shouted, EEEE!

2. Second, it was a longer class; an hour and a half, with a ten minute break in-between. Warm-ups were also longer and a bit more strenuous and aerobic orientated; running backwards, sideways and with lunges often performed in-between the hoki’s.  But again, this was an adult class.

3. Third, the class was subdivided into smaller groups like our own, to practice kicks and punches initiated by sound or hand movement, as reaction-time was tested and improved. Mac’s partner had to kneel for her to reach his out-stretched hands, and she in turn had to raise her hands high overhead, as palms were used as targets. Her older partner worked with great diligence to best his younger opponent.  

Finally, the ritualized hoki’s terminated a bit differently than our own, and they were performed much more slowly; almost ritualistically and with great concentration. And, form was a bit more casual than what were are used to, and not as sharp or precise as American Sensei Uchida or Sensei Matsuaki usually demands. 

Health Status of Finlandersfinnish-american-students

Health services are available to all in Finland, regardless of their financial situation. Public health services are mainly financed from tax revenues. The child mortality rate in Finland is one of the lowest in the world; the infant mortality rate is below 4% and the life expectancy for a girl born now is 81 years, for a boy it is 73 years. Much like the US, the life expectancy of Finnish men has deteriorated by cardiovascular disease, excessive consumption of alcohol and accidents. Cardiovascular mortality has declined in response to effective health and nutritional education in recent decades but excessive blood cholesterol levels and obesity remain common in Finland. Smoking and drug abuse are significantly less frequent in Finland than in Europe on average. But, alcoholism and depression are national concerns because of the dark, prolonged and harsh winter climates. The aim of Finnish health policy is to lengthen the active and healthy lifetimes of citizens, to improve quality of life, and to diminish differences in health between population groups. Prevention receives particular emphasis in primary health care.

Finnish Healthcare System

The larger health care system in Finland is attracting international attention. For example, the European Observatory on Health Care Systems just launched a report examining Finland’s health system alongside that of other European countries. The system also has certain special features compared with systems in other countries. The main responsibility for organizing and financing health care is delegated to 448 local municipalities, which have exceptionally small and homogenous population bases, by US comparison. Another special feature is the existence of parallel financing and delivery systems alongside the municipal service system. The Finnish health care system survived the severe economic crisis of the 1990s fairly well, even though marked cuts were made in many public-sector budgets. As a result, it has emerged stronger today. The quantity and quality of health care services were largely maintained by improved management, efficiencies, electronic connectivity and resource allocation. A number of other initiatives are now developing in different directions.

Finnish Medical Association

On a more grass-roots level patient-care basis, the Finnish Medical Association [FMA] collaborates with various authorities and decision-making bodies in relation to the development of personalized medical care in Finland. It pursues patient initiatives and issues a number of statements each year with the aim of improving health care and related legislation, and puts forward plans to ensure a sound financial basis for provision of health services. For example, the national strike by physicians in 2001 drew national attention to the critical lack of resources provided for health care. The FMA plays a significant role in establishing a general patient insurance scheme and developing a family-doctor [US medical-home concept] system for Finnish health centers and practitioners. The Association promotes the rights of patients to have access to the treatment they need promptly. But, the possibilities for choosing a doctor and place of treatment need to be improved.

Contemporary Profile of a Health System in Transition

The Finnish healthcare system, much like the domestic healthcare system, is undergoing a period of reflection, modernization and reform. A special report, known as the Health Care Systems in Transition (HiT) series, profiles and analyzes the health care systems of over 40 European countries, Australia, Canada and the USA. The report for Finland was written by Ms Jutta Järvelin, Researcher at STAKES (the National Research and Development Centre for Welfare and Health), and in collaboration with the Finnish Ministry of Social Affairs and Health and the Observatory. STAKES is a center of expertise overseen by the Ministry of Social Affairs and Health.

On Finnish Longevity

Finnish super-centenarian Aarne Armas “Arska” Arvonen, the oldest Finnish male ever, just passed away at age 111 on January 1, 2009. He was the last living person in Finland who was born in the 1890s, and the third oldest man in Europe. He was also the seventh oldest man in the world. At the time of his death, Aronen was considered among the 20 oldest verified men to have ever lived in Europe.


The formal report, Health Care Systems in Transition – Finland [Vol. 4, No 1. 2002]; Copenhagen, European Observatory on Health Care Systems, 2002 is available on the European Observatory on Health Care Systems website:



The report can also be ordered from the European Observatory on Health Care Systems, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen, Denmark, tel. +45 39 17 1363, fax +45 39 17 1818.

e-mail: observatory@who.dk

And, additional more current information can be obtained from:

Researcher Jutta Järvelin

STAKES, tel. +358 9 3967 2254

e-mail: jutta.jarvelin@stakes.fi and,

WHO e-mail: vge@who.dk


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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com


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