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Estonian Health Care System. Jevgenia Makarova Kristel 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 %.

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estonian health care system

Estonian Health Care System

Jevgenia Makarova

Kristel Kaur

Tallinn 2006

geographical and historical figures
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 figures4
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 figures5
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
North-Estonian Regional Hospital

Inpatient and outpatient treatment. 24-hour first aid.

613 beds altogether.

north estonian regional hospital7
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 hospital8
North-Estonian Regional Hospital

Consultative Clinic of the Mustamae Hospital.

The doctors of this clinic work at the Mustamae Hospital.

north estonian regional hospital9
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
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
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.

slide13
Clinic of Cardiovascular and Total Surgery

Surgical Clinic

Ear Clinic

Eye Clinic

slide14
Children's Clinic

Women's Clinic

slide15
Cardiology Clinic

Lung Clinic

Dermatology Clinic Neurology ClinicPsychiatric ClinicInternal Diseases ClinicDental Clinic

medicover swedish estonian medical center private
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
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.

slide19
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).

slide20
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
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.
slide22
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
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.

slide25
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.

slide26
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.

slide27
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.

slide28

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.

slide29
The national immunization programme is defined by the Minister of SocialAffairs and implemented by the Health Protection Inspectorate. Immunizationis the responsibility of family doctors, although school doctors are also allowedto undertake it.
slide30
All family doctors are required to work with at least one family nurse, even

though there is a shortage of trained family nurses.

slide31
Nursing will take place in cooperation with the patient's GP and with a social worker from the municipal government if necessary.
slide33
The services are free for patients in the extent allocated from the budget of the City of Tallinn.
target group
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
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

Performed procedures:
slide38
Nursing schools and their curricula have been developed to meet thestandards of vocational high school and a bachelor’s degree.
slide39
Besides basicnursing training, Estonian medical schools also offer higher vocational trainingfor 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
University of Tartu Faculty of Medicine for nurses with someworkexperience.

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

slide41
Nurses’ professional associations have been working to standardize thedifferent nursing specialties.
slide42
The greatest shortage of nurses isin specialist areas, such as surgical nurses. Reasons for the shortfall includepoor salaries, high levels of work-related stress, low job satisfaction and lowprofessional status.
slide43
Nurses’ professional associations have been working to standardize thedifferent nursing specialties.
slide44
Some efforts have been made to raise the status of nurses by increasing theirresponsibilities and introducing continuing education to the profession. Thenew Health Services Organization Act gives nursing care a legally well-definedstatus on a par with primary, specialist and emergency care.
slide45
In hospitals, nursesand nursing are increasingly being acknowledged independently, by doctorsas well as by patients.