Hospital sector

Peeter LaasikAssistant Minister,2005-2007Ministry of Social Affairs, Estonia

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ESTONIA

Population – 1.356 million

Area 45 285 km²

Re-independence since 1991

Parliamentary republic

15 counties

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Health Care Reforms since 1991

A twofold process of change:from centralised and state-controlled health care delivery

system towards a decentralised one; from a general state funded system to one based on health

insurance.

Three main issues:launching of the health insurance systemintroduction of the family practitioners systemrestructuring and reorganising of health care system

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Main actors in the system

Ministry of Social AffairsNational health care agencies which come under the Ministry of Social Affairs:

Health Care BoardState Agency of MedicinesNational Health Protection InspectorateHealth Development Institute

Estonian Health Insurance FundCounty governmentsProviders of careResearch institutesAssociations

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Regulations in health care

The sphere of health care is mainly regulated by the Health Services Organization Act and by the Health Insurance Act.

The Health Services Organization Act stipulates the regulation and requirements for providing health care services, directing, financing health care, its supervision and the requirement for health care personnel’s registration. Health care service is an action taken by a health care employee for preventing, diagnosing and curing an illness, injury or poisoning with the purpose of alleviating discomfort, preventing the deterioration of conditions or the progression of diseases and restoring health.

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Health Services Organisation Act

Health care professionals are doctors, dentists, nurses and midwives if they are registered with the Health Care Board.

Number of…

…doctors: 5342

…dentists: 1390

…nurses: 10234

…midwives:515

All:17481(Health Care Board)

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Organisational form Legal form

Primary care sole proprietors or companies

Specialist care (outpatient) companies, foundations or sole proprietors

Specialist care (inpatient) joint stock company or foundation

Emergency Care company, sole proprietor, foundation or a state or local government rescue service agency

Independent provision of nursing

companies, foundations or sole proprietors

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Specialist care

HospitalsJoint stock companies or foundations

mainly owned by the state or municipality

seven types (regional, central, general, local, special, rehabilitation, nursing hospital)

Outpatient specialist carecompanies, foundations or sole proprietors

number of outpatient clinics has increased considerably

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Number of hospitals and outpatient clinics 1992 - 2002

5067687878797983107115118

625587

540525485

370342

300

246152147

0

100

200

300

400

500

600

700

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Hospital Outpatient health care

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List of acute care hospitals approved by the Government

2 regional hospitals (0.5 – 1 million inhabitants)

4 central hospitals (100 000 – 200 000 inhabitants)

11 general hospitals (30 000 – 80 000 inhabitants)

1 local hospitals (less than 40 000 inhabitants)

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Sources of financing

(2003 a 6831 Mkr)

Goverment 599 9%

Private 1673 24%

Loans 4 0%

Local goverment 99 1%

Health Insurance Fond 4456 66%

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Public health insurance

Social health insurance MandatoryBased on solidarity

Tax paid by employersproportional as a flat 13% surcharge on salaries paid to

employees

Coverage 94,7% of the populationwider than actual contributors

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Health Insurance Fund

Health insurance budget administrated by Health Insurance Fund

Autonomous bodylegal person in public law established by the Act

Supervisory board (15 members)

Management board (3-7 members)

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State budget

Emergency medical aid

Emergency care provided to persons not covered by health insurance

Medical aids for disabled persons

Capital investments

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Hospital sector – integrated care

The result a patient expects from the health care system is health. What the care process consists of is irrelevant to the patient.

Development plan for hospitals, emergency medical care and family doctors is currently being updated. This can only be done through cooperation.

One of the major problems for hospitals is the competition between them. This prevents the development of a natural path between the different stages of hospital care.

Tough competition leads to irrational use of resources.

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The problems on the patient’s level are the speed of reforms and lack of information. People do not know what kind of care is available at which hospital level and about of quality..

There is a lack of beds for nursing care, rehabilitation.

The problem on the political level is the unwillingness to continue reforms, since this implies change.

Some types of treatment may become unavailable in local hospitals

Jobs will be lost

The region’s image will suffer

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The hospital sector needs to be seen from the point of view of the patient’s needs. Continuity of treatment must be ensured. With detalisering of plans the roles of various hospitals are better defined, the quicker the hospitals can mutually cooperate.

Hospital sector:

1. Developing of county hospitals which are oriented to the needs of the inhabitants of the region.

2. Hi-tech hospital care.

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3. Integration within the hospital sector – (hi-tech hospital, county hospital, rehabilitation ho al)

4. From 1 April 2006 a patient may approach any hospital in Estonia for regular medical care.

5. In county hospitals, 91–98% of patients are from the county. The cities of Tartu and Tallinn have a clear regional importance.

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The share of outpatient surgery and outpatient treatment should be increased by way of decentralisation of simpler services. Hospitals are currently paid for: services, DRG, readiness fee for standby duties Actual devolepment of the hospital sector

There is a list of acute care hospitals. We are preparing a list of nursing care and medical rehabilitation hospitals.Cost-based pricing is ABC. We have a price committee that provides

the political input regarding health care. Prices are approved by the government.E-health will be applied in Estonia in 2008(digi-recept); a Estonia

digital picture bank is available since 2006.

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Next challenges

November 2007- development plan of public health

public health

health care

June 2008 –WHO conference –health system

health ministers of 53 countries

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Thank you for your attention!