By analysing access to health services, this paper explores the formation of health citizenship in Finland in the twentieth century. Health citizenship is seen as a part of social citizenship, which emphasises the citizen’s rights to social security. The article constructs four different historical layers of health citizenship, each of which emphasise different dimensions of accessibility and involve different inclusive and exclusive tensions. The article shows the change of focus from promoting the acceptability of medical knowledge and health services, to regional availability of the services in the 1920s–1950s, and to universal affordability in the 1960s–1980s. The reforms of the 1990s respond to a new logic of individual responsibility and result in increasing hierarchies of health citizenship. Elements of the previous historical layers still have a presence in the contemporary health care. Finnish development indicates the interconnectedness of civil, political and health citizenship.
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