|Implemented in this survey?|
In April 2006 the Minister of Social Affairs launched the revision of Estonian Hospital Master Plan ? the cornerstone of hospital reform in Estonia. The revision of the plan is among others targeting smaller hospitals in less populated areas, which currently do not belong to the privileged short-list of 19 out of 52 hospitals, which is used for preferred contracting by health insurance and capital investments from EU structural funds.
The main purpose of the policy is to make amendments to the development plan of Estonian hospitals reform. In April the Minister of Social Affairs formed a commission consisting of representatives of the Ministry of Social Affairs, The work of Commission is based on political assumption that the planned hospital network is not proper and sufficient for Estonia in the light of accessibility and responsiveness of health care services.
The expected end-result will be redefined list of hospitals and definitions for different type of hospitals that forms the base for investments and health services contracts. No other incentives are foreseen as of today.
|Medienpräsenz||sehr gering||sehr hoch|
The revision of the hospital network strategy documents is needed continuously, but it must base on clear needs and structure. Today the aim and expected outcomes of the work planned to do by the commission assembled by the Ministry of Social Affairs stay unclear. The volume of work and the time for that seem to be inadequate to reach for new knowledge of how to plan and regulate the hospital sector in
HMP2015 and HMP2002 are strategic documents forming the conceptual and legal base for hospital reform, which is aiming at the reduction of the number of active care beds in In April 2005 the new
new coalition government came into power. In their common governing programme there is statement about developing the principles of free patient choice of specialised care in Estonia and Europe to
ensure higher accessibility to health care services. The Assistant Minister of Health of the Ministry of Social Affairs has referred to studies showing unequal access to hospital care depending on
one's place of residence and consequently made also sentiments for the need of more flexible hospital system in Estonia.
There are no general policy documents that the current policy draws upon, and the main public reason for the initiation of the policy has been stated that the previous one was drafted 6 years ago and "that during this time structure of morbidity has changed, medical technology, knowledge about health care organisation, databases and level of analysis have improved".
Abovementioned typology of hospitals and the Master Plan behind it is used for long-term funding contracts by EHIF, but also for investments using EU structural funds money. Thus the idea has hidden agenda to broaden the circle of providers that are entitled to increased funding.
The policy was directly introduced by new political power by populist left-lining party - Central Party (Keskerakond in Estonian).
The change is also motivated through the strategic goals of the Ministry of Social Affairs ? ?better health car eservices accessibility and quality?
|Implemented in this survey?|
The idea has been in the air for years after the preparation of first Estonian Hospital Master Plan 2015, because there remained interest groups that were not satisfied with the decreasing volume
and importance of Estonian hospital sector. Their argument goes that the diminishing number of hospital beds and concentrating of inpatient services affects the accessibility of inpatient care
services in The main purpose of the revision of Estonian Hospital Master Plan 2015 is to change the set of principles and indicators used for planning of hospital sector, but also to propose the
Ministry of Social affairs to change legislative acts which regulate the hospital sector.
The commission will work in cooperation with and under the control of the Ministry of Social Affairs and no professional analytical competence is used.
Previously there have been discussions about changing the remuneration system of hospitals and implementing the budget-based (or capitation-based) payment system instead of the contracting of volume and price of health care services.
The approach of the idea is described as:
amended: The aim of commission is to revise the Estonian Hospital Master Plan 2015 which have been the basis for hospital network development during last 5 years. Also, changes in legislative acts are expected to take place is new strategical principles are accept
Most of the stakeholders have expressed their confusion about the need for commission and the purpose of the Hospital Master Plan revision as the objectives are not very well clarified by the Ministry of Social Affairs. The general understanding is that there is needed only fine-tuning in planning of specialty services rather than change of basic principles of hospital development. The conflict is not on the level of structural planning of hospital sector but need for additional resources for hospital capital investments and development.
|Estonian Country Doctors Board||sehr unterstützend||stark dagegen|
|Estonian Hospital Association||sehr unterstützend||stark dagegen|
|Estonian Medical Association||sehr unterstützend||stark dagegen|
|Estonian Health Insurance Fund||sehr unterstützend||stark dagegen|
|Minister of Social Affairs||sehr unterstützend||stark dagegen|
The aim of the revision of Estonian Hospital Master Plan 2015 is to change the principles for planning and regulating the hospital sector and it means that some legislative changes could be take place as result of the work. It can mainly affect the number and types of hospitals which are in hospital list approved by the Government, but also it can change the requirements for hospital renovation and building.
|Estonian Country Doctors Board||sehr groß||kein|
|Estonian Hospital Association||sehr groß||kein|
|Estonian Medical Association||sehr groß||kein|
|Estonian Health Insurance Fund||sehr groß||kein|
|Minister of Social Affairs||sehr groß||kein|
The time-frame of the commission work is very short and it is assumed that the process will not succeed by the autumn 2006 as wanted by the Ministry of Social Affairs. The crucial constrain is
that the hospital network is very complex and just some descriptive overview based on cross-sectional aggregate statistical do not give right perspective. Also, as the problem to be solved has
not been defined it is difficult to come to common agreement on the solution or proposed changes by different stakeholders.
However, the committe is supposed to meet 2-3 times and analytical department of the Ministry of Social Affairs is providing basic analysis for decision-making. The results are plenned to be presented on an annual Health Care Conference in November 2006. It has not been stated, but can be assumed, that about the same time, the issue should be in the Government for deciding.
Currently there are politically difficult times for controversial decisions. Presidential elections take place in August 2006 and next parliamentary elections are due in March 2007.
The process of revision of Estonian health care strategy documentation is not set in place and it is not the aim of this activities also.
As rational objectives of the revision of Estonian Hospital Master Plan 2015 have not been defined then it would be rather difficult to evaluate the outcome or impact of the commission work. The
initiative has potential for strong long-term effects if the final outcome of it will be broadening of the circle of hospitals eligible for capital investments using money from EU structural funds.
As the Government Regulation on hospital types is also the basis for prefernetial purchasing of active care from listed hospitals by EHIF, the change in this list also may influence the one driver of
restructuring active care beds into long-term care beds in rural areas.
The possible results are changes in principles of planning hospital network and changes in status of some hospitals in Estonia. But if it improves or affects health care services accessibility, or quality or has any effects on costs of health care services, is really to early to assume.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
The effect on cost-efficiency can be decided once the decisions based on the work of the Commission will be made. At the health care system level both increase and reduction in hospital care costs
are possible scenarios based on the available information.
Although one goal behind the idea is more equitably developed hospital network, it is possible that the harmonization will be towards lower common denominator of hsopitals, because very small counties cannot offer necessary patient pool to maintain adequate quality level in the long run.
Agris Koppel, Ain Aaviksoo