Estonian Health Care System

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Estonian Health Care System

• Jevgenia Makarova
• Kristel Kaur
• Tallinn 2006

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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

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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

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Geographical and historical figures

• 1940 occupation of Estonian Republic by
• USSR
• 1991 independence of the Estonian
• Republic
• ? total reform of the health care system
• Todays number of acute hospitals 19

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North-Estonian Regional Hospital

• Inpatient and outpatient treatment. 24-hour
  first aid.
• 613 beds altogether.

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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.

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North-Estonian Regional Hospital

• Consultative Clinic of the Mustamae Hospital.
• The doctors of this clinic work at the Mustamae
  Hospital.

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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.

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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.

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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.

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Tartu University Clinicum
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• Clinic of Cardiovascular and Total Surgery
• Surgical Clinic
• Ear Clinic
• Eye Clinic

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• Children's Clinic
• Women's Clinic

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• Cardiology Clinic
• Lung Clinic
• Dermatology Clinic Neurology ClinicPsychiatric
  ClinicInternal Diseases ClinicDental Clinic

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• Traumatology Clinic

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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.

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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.

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• 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).

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• The amount of the patients 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.

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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.

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• 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.

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Primary care

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

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

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• 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.

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• 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.

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• 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.

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The 2002 results show that all patients
withacute problems are able to access their
family doctor on the same day, and that97 of
patients with chronic conditions see their family
doctor within threedays.
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• 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.

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• All family doctors are required to work with at
  least one family nurse, even
• though there is a shortage of trained family
  nurses.

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

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• Home nursing and care services are offered only
  in Tallinn.

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

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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

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

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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

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• Nursing schools and their curricula have been
  developed to meet the standards of vocational
  high school and a bachelors degree.

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• 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.

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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.

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

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• 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.

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

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• 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.

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

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• Thank you for your attention!