The Finnish health system provides universal coverage for a wide range of services and enjoys high public satisfaction. Nevertheless, performance has been mixed: infant mortality is low, life expectancy is high for women but below OECD average for men, health inequalities are large across socio-economic groups and regions, and efficiency has been declining in recent years. A rapidly ageing population, costly medical technology and rising patients’ expectations will strain resources going forward. Therefore, reforms aimed at enhancing efficiency are essential to ensure that high quality health care continues to be provided in a economically sustainable way and that health inequalities are reduced. As the fragmentation of health care provision is a major source of inefficiencies, planned reform to restructure municipalities and services should improve efficiency and quality of care, provided enough mergers are achieved to bring municipalities to a sufficient size. Announced reforms in service provision should improve the balance between primary and specialised care. Further measures to increase user choice and information and enhance prevention and health promotion will be needed to optimise the performance of the system.