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Coxa Hospital, Tampere, Finland


  • Coxa Hospital, (specialising in joint replacement) faced problems in common with many hospitals throughout Europe:
    • Increasing demand
    • Shortage of capital to upgrade and extend facilities
    • Duplication of services by other local and competing hospitals
  • The hospital created a public private partnership to withdraw from State ownership and take greater control over its management and financing
  • The hospital established three types of stakeholders (shareholders)
    • Municipalities (representing local government and the public)
    • Local hospitals – as part of an agreement to rationalise and consolidate elective services at Coxa
    • Private equity
  • Coxa raised commercial loans against a ‘commercial’ business plan for the design and procurement of the building
  • The business model was based on the principle of whole systems delivery of care utilising a model of integrated and systemised care pathways (over 200 covering the range of procedures delivered)
  • The hospital was designed around the systemised care pathway models
  • All patients are diagnosed, treated and receive rehabilitation with pre-agreed care plans (pathways). All healthcare agencies involved with the patient subscribe to and follow the commonly agreed predictive pathways. Initial diagnosis and rehabilitation is localised as far as practical – monitored by comprehensive clinical governance principles
  • Performance has been exceptional:
    • Improved clinical outcomes and faster access for patients
    • Lower capital costs – and scope for future development
    • Improved satisfaction, patients and staff



  • Capital investment directly related to current and anticipated clinical technologies and models of care – coupled with ongoing freedoms of action
  • Population based and measurable health gain through horizontal and vertical integration of care



  • Ensuring sustainability of co-relating orthopaedic trauma



Sructural Fund relevance – very high


  • Whole systems population based investment and care delivery


Download the detailed description of the case study from here.

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