estonian health care system jevgenia makarova kristel kaur tallinn 2006

Estonian Health Care System

Jevgenia MakarovaKristel Kaur

Tallinn 2006

Geographical and historical figures

• Area: 45.215 km²

• Bordered by the Russian Federation to the

east and Latvia to the south

• Population: 1,4 million

• Male: 46 % female: 54 %

• Urban: 69 % rural: 31 %

Geographical and historical figures

• Life expectancy:

male: 66,3 years female: 76,7 years

• Birth rate: 8,7 / 1000 population

• Average salaries: 500 Euro

• Average pension: 150 Euro

Geographical and historical figures

• 1940 occupation of Estonian Republic by

USSR

• 1991 independence of the Estonian

Republic

→ total reform of the health care system

• Today’s number of acute hospitals: 19

North-Estonian Regional Hospital

Inpatient and outpatient treatment. 24-hour first aid.

613 beds altogether.

North-Estonian Regional Hospital

Departments of general surgery, neurosurgery and neurology, cardiovascular surgery, cardiology and critical coronary care unit, trauma section and orthopedics, internal medicine, eyes, ear, nose and throat, thoracic surgery, urology, maxillae-facial surgery, intensive care unit.

North-Estonian Regional Hospital

Consultative Clinic of the Mustamae Hospital.

The doctors of this clinic work at the Mustamae Hospital.

North-Estonian Regional Hospital

Psychiatric Hospital

Inpatient and outpatient treatment of all mental diseases. There is also a modern paid department of non-psychotic disabilities with sauna, private rooms etc where it is possible just to cure your stress or any other problems.

East-Tallinn Central Hospital

There are the biggest Gynecologic and Maternity Clinic in Estonia and one of the best equipped and modern eye disease centers in Estonia.

Also has trauma center.

Tallinn Children's Hospital

Inpatient and outpatient departments of pediatrics, ear-nose and throat diseases, traumatology and orthopedics, surgery, hemato-oncology.

All the doctors are highly educated and speak English.

Tartu University Clinicum

Clinic of Cardiovascular and Total Surgery

Surgical Clinic

Ear Clinic

Eye Clinic

Children's Clinic

Women's Clinic

Cardiology Clinic

Lung Clinic

Dermatology Clinic Neurology ClinicPsychiatric ClinicInternal Diseases ClinicDental Clinic

Traumatology Clinic

Medicover Swedish-Estonian Medical Center (private)

24-hour Hotline for emergency medical care; medical exams for adults and children; screenings and diagnostic tests; mammograms; annual flu shots; dentists(including 24-hour emergency dental care); ambulance service; home visits; gynecological and pregnancy care, etc.

Family Physician

All persons insured with the Health Insurance Fund have a family practitioner.

A person not residing in Estonia may also visit a family practitioner.

A person needs a referral from the family practitioner to visit a medical specialist.

No referral is needed to visit a psychiatrist, gynaecologist, dermatovenerologist, ophthalmologist, dentist, pulmonologist (for tuberculosis treatment), infection specialist (for HIV/AIDS treatment), surgeon or orthopaedist (for traumatology).

The amount of the patient’s financial participation in the following cases:

• out-patient examination – a family practitioner can charge a visit fee of up to EEK 50, when making a home visit;

• specialised medical care – a visit fee up to EEK 50;

• transportation by ambulance in the case of emergency – free of charge;

• hospitalisation – an in-patient fee of up to EEK 25 per day and for up to 10 days per hospitalisation.

There is no in-patient fee:

• for children below the age of 19;

• in cases related to pregnancy and childbirth; 

• in the case of intensive care.

It is possible to register with a family physician by submitting an application to the physician selected. It is also possible to change the physician; to this end one should submit an application to the new family physician.

When visiting the new physician one should present an abstract of his/her medical record.

Primary care

During the Soviet era, paediatricians worked as primary care doctors in special children’s polyclinics. It was common for patients to bypass polyclinics and health centres, visiting specialists directly.

Primary care is organized as the first level of contact with the health system.

Each family doctor has a list of registered patients.

These lists cannot contain

fewer than 1200 or more than 2000 patients (except in specific cases such as

occur in some rural areas or on some islands).

The average patient list size is

1600.

Family doctors usually operate in rented premises (sometimes in facilities

which used to be polyclinics), although some doctors have taken out loans to

build new facilities.

Family doctors are required to have at least 20 visiting

hours a week, and practices should be open for at least 8 hours a day. In primary

care, patients should be able to see their family doctor on the same day for acute

problems; patients with chronic conditions have the right to see their family

doctor within three days.

The 2002 results show that all patients with

acute problems are able to access their family doctor on the same day, and that

97% of patients with chronic conditions see

their family doctor within three

days. 0

5

10

15

20

25

30

35

40

1stday

2ndday

3rdday

The national immunization programme is defined by the Minister of Social Affairs and implemented by the Health Protection Inspectorate. Immunization is the responsibility of family doctors, although school doctors are also allowed to undertake it.

All family doctors are required to work with at least one family nurse, even

though there is a shortage of trained family nurses.

Nursing will take place in cooperation with the patient's GP and with a social worker from the municipal government if necessary.

Home nursing and care services are offered only in Tallinn.

The services are free for patients in the extent allocated from the budget of the City of Tallinn.

Target group:• Patients who have left nursing hospitals or long-

term treatment wards or other hospitals who need nursing care and not active treatment.

• Patients in whose case nursing care prevents hospitalisation

• Patients who are unable to move • Chronically bedridden patients with serious

physical problems • People with reduced mobility • Patients who have complicated nursing care

needs that cannot be met by social workers or family members

• Terminally ill and dying patients

Patients in an acute psychotic state will not be taken in nursing care.  

Performed procedures:

• Distribution and administration of medicaments

• Taking blood pressure • Reading pulse • Measuring temperature • Measuring blood sugar with

a glucometer • Inserting a catheter in the

bladder, inserting a permanent catheter, maintenance of catheters

• Change of dressing and care for ostomy

• Micro-enemas • Removal of stitches from

wounds • Removal of casts • Prevention of bedsores • Care for wounds, incl.

bedsores • Position therapy • Rehabilitation therapy at

home • Counselling

Nursing schools and their curricula have been developed to meet the standards of vocational high school and a bachelor’s degree.

Besides basic nursing training, Estonian medical schools also offer higher vocational training for midwives, optometrists, pharmacists, mid-level health protection specialists, radiology technicians, physiotherapists, dental technicians and lab technicians, as well as vocational-level training for long-term nursing specialists.

University of Tartu Faculty of Medicine for nurses with some

work experience.

These graduates are seen as the main resource for further training of basic and specialist nurses.

Nurses’ professional associations have been working to standardize the different nursing specialties.

The greatest shortage of nurses is in specialist areas, such as surgical nurses. Reasons for the shortfall include poor salaries, high levels of work-related stress, low job satisfaction and low professional status.

Nurses’ professional associations have been working to standardize the different nursing specialties.

Some efforts have been made to raise the status of nurses by increasing their responsibilities and introducing continuing education to the profession. The new Health Services Organization Act gives nursing care a legally well-defined status on a par with primary, specialist and emergency care.

In hospitals, nurses and nursing are increasingly being acknowledged independently, by doctors as well as by patients.

Thank you for your attention!