as a result hospitals face a relatively soft budget constraint and hospital costs are squeezing municipal budgets potentially constraining municipalities to cut on other valuable items including primary care and social services municipal reform if implemented successfully should alleviate these problems finland needs to increase hospital concentration and develop special units to take care of remote areas based on a careful evaluation of the tradeoff between proximity and appropriate scale to deliver effective treatments there is increasing international evidence of a link between hospital size and quality of care indicating the presence of minimum volume thresholds for effectiveness of care