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Consolidation of national supervisory agencies

Country: 
Estland
Partner Institute: 
PRAXIS Center for Policy Studies, Tallinn
Survey no: 
(13) 2009
Author(s): 
Paat, Gerli and Ain Aaviksoo
Health Policy Issues: 
Public Health, Politischer Kontext
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein ja ja nein nein

Abstract

In January 2009 the Cabinet approved a draft regulation for establishing the Health Board by uniting 3 separate agencies: the Health Protection Inspectorate, the Health Care Board and the Chemicals Notification Centre. The establishment of the Health Board should, according to the authors of the draft, improve the quality of services and medical care, the effectiveness of quality control, but also the public health preparedness in situations of public health emergencies.

Purpose of health policy or idea

The exact motivation behind the creation of the Health Board is not clearly articulated. Initially, when the idea of the establishment of the Health Board was introduced, possible cost savings were not discussed, but the increase of the effectiveness of control agencies. However, cost savings were convenient to relate with the draft proposal. It is possible that the motivation behind the establishment of the Health Board by uniting three agencies (Health Protection Inspectorate, Health Care Board and Chemicals Notification Centre) might be that the Health Protection Inspectorate has had the strongest position among these agencies (compared for instance to the Health Care Board) and seeking to increase the quality of health related services. By creating the Health Board, on the one hand this could solve the administrative and political problems and on the other hand seeks to achieve sound control and oversight on health care services.

Main points

Main objectives

According to the draft, the objectives of the establishment of the Health Board are:

  • to avoid duplication and fragmentation of tasks,
  • to reduce the administrative burden and improve the availability and quality of services for the target groups
  • to find new and more effective ways to fulfill core functions in the situation of limited resources

Type of incentives

No specific incentives foreseen.

Groups affected

Pharmacies, health care providers

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell traditionell innovativ
Kontroversität unumstritten recht kontrovers kontrovers
Strukturelle Wirkung marginal recht fundamental fundamental
Medienpräsenz sehr gering gering sehr hoch
Übertragbarkeit sehr systemabhängig sehr systemabhängig systemneutral

 

Political and economic background

The Government Action Plan for the period 2007 - 2011 attaches great importance to the proper implementation of the early detection system of diseases. It is assumed that a prerequisite for the improvement of population health is to take the implementation of health policy to a qualitatively new level. According to the Ministry of Social Affairs (MoSA) there is a need for a stronger executive agency, which has the necessary capacity, resources, and competence to implement the policies. For this purpose, the MoSA has started to restructure its area of government in order to establish an institution in the area of public health jurisdiction, which is the leading and coordinating body that is based on generally accepted precaution principles in its activities, health risk assessment and notification of health risks and is oriented to high-quality health and health care.

The Health Protection Inspectorate is currently conducting mainly national level control of infectious diseases and environmental health. Currently there are 304 employment positions in the Health Protection Inspectorate. The Health Care Board responsibilities include registration of health care workers, licensing and supervision of healthcare service providers, organizing ambulance services and emergency preparedness according to its field of competence, and supervision of occupational health and safety service provision. There are 33 employment positions in the Board. The Chemicals Notification Centre is responsible for the supervision of handling of substances related to chemical hazards, risk assessment of population and environmental health, carrying out market control according to the Biocides Act, including collection and processing of information on biocides, cosmetics and other chemicals in the market. The Chemicals Notification Centre currently employs 15 persons.

The proposed Health Board will have five core tasks: control of healthcare service provision, surveillance and control of communicable diseases, monitoring of environmental health, chemical safety and the safety of medical devices. A new office is planned for a total of 306 posts.

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein ja ja nein nein

Origins of health policy idea

The motivation behind the establishment of the Health Board is not yet clear. Currently, the Health Protection Inspectorate is operationally very strong. The roots for their strong position are stemming from the san-epid control system of public health during Soviet times. The present Health Care Board officially started its activities in January 2002 under the administrative command of MoSA. Before that its tasks were performed directly by MoSA and the reorganization aimed at reinforcing the surveillance function. Unfortunately, the establishment of the Health Care Board didn´t change the situation and frequently the Health Care Board is accused of poor control of the quality of health care services. Therefore it is likely that the intention to strengthen this role could also be the motivation behind the establishment of the new Health Board. Among the areas of health supportive living, working and learning, one of the activities would be to enhance the environment for health risk assessment, management and reporting systems, which is currently dealt with by the Health Protection Inspectorate. At present, health protection is still executed in a relatively straightforward way focusing mainly on the activities related to supervision and control. Unfortunately, collection of information on the hazards and performing associated risk assessments get little attention. Similarly, poor attention is paid to the development and implementation of necessary measures to raise the awareness of citizens on the risks associated with the living and learning environment and how everyone may change their behavior in order to reduce environmental health risks.

The aim of the draft is to put the laws in force to unify the Health Care Board and Chemicals Notification Centre with the current Health Protection Inspectorate by 1st of January, 2010. Necessary amendments to the implementing legislation are to be prepared in parallel with the draft law and will be enforced by 1 January 2010. 

Initiators of idea/main actors

  • Regierung: The tasks laid out in the draft are the responsibility of MoSA, together with its agencies under the area of their government.
  • Leistungserbringer
  • Patienten, Verbraucher
  • Internationale Organisationen

Approach of idea

The approach of the idea is described as:
new: The Health Board will help to better organize the current work of various agencies and reduce the administrative burden.

Stakeholder positions

MoSA has been in the leadership in the creation of the idea and the idea has been accepted by the Health Protection Inspectorate, the Health Care Board and the Chemicals Notification Centre managers. In order to better understand the various stakeholders' interests and for resolution of potential conflicts a working group has been formed, composed of leading officials of the Ministry and other interested parties. Currently there is not yet any feedback from the providers of various health services, patients and other parties close to the originators to the idea.

Initially the plans were an even larger consolidation but for instance the National Institute for Health Development preserved its main functions thanks to strong internal opposition to the idea.

Actors and positions

Description of actors and their positions
Regierung
Ministry of Social Affairssehr unterstützendsehr unterstützend stark dagegen
Coalitionsehr unterstützendunterstützend stark dagegen
Leistungserbringer
Pharmaciessehr unterstützenddagegen stark dagegen
Patienten, Verbraucher
Patientssehr unterstützendneutral stark dagegen
Internationale Organisationen
European Commissionsehr unterstützendneutral stark dagegen

Influences in policy making and legislation

The draft for the establishment of the Health Board consists of 46 paragraphs, with 45 amendments to different legislative acts, mostly related to the restructuring of agencies under the area of MoSA government. Changes are mainly technical in nature and in essence, only seven legislative acts will have significant changes, laid out below in more detail.

Legislative outcome

pending

Actors and influence

Description of actors and their influence

Regierung
Ministry of Social Affairssehr großsehr groß kein
Coalitionsehr großgroß kein
Leistungserbringer
Pharmaciessehr großgering kein
Patienten, Verbraucher
Patientssehr großneutral kein
Internationale Organisationen
European Commissionsehr großgering kein
Ministry of Social AffairsCoalitionEuropean CommissionPatientsPharmacies

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The unification of three agencies is motivated by the organisational problems among these agencies and the unification seeks to strengthen the implementation of tasks. However, financial support to implement the changes has been rather limited. All three institutions will be consolidated with all respective functions maintained. By law the new Health Board is the government agency which carries out the functions of supervision and state coercion prescribed by law. Thus, the future functions of the Office include both management and state supervision functions.

The Health Board will work in five main activity areas:

  1. health care services,
  2. communicable diseases surveillance and epidemic control,
  3. environmental health protection,
  4. chemical safety,
  5. medical devices safety

The basic structure of the Health Board will follow the above-mentioned key areas. The basic organizational functions, analysis and development of operational guidelines are in the same structural unit and, therefore, are more consistent. In order to avoid conflict of interests, a separate surveillance unit will be established, whose primary function is the coordination of the monitoring in all activity areas of the agency, resolving disputes, compilation of decisions on general procedures and processing of procedures in regional departments.

Monitoring and evaluation

No formal evaluation has been conducted so far. The Health Board is a governmental institution under the area of government of MoSA, with directing functions and duties to carry out state supervision over population health protection and administrative coercion.


The Agency is directly accountable to the Minister of Social Affairs, who in accordance with the procedures laid out in law, co-ordinates and its activities and carries out the supervisory control. The evaluation of activities can be conducted only after the establishment of Health Board.

Review mechanisms

keine Angaben

Dimensions of evaluation

Struktur, Prozess

Results of evaluation

 

Expected outcome

Expected outcomes are manifold, mainly related to population health: e.g. better citizen and consumer-oriented quality of services; environmental health risk assessment and awareness-rising of citizens on the risks in the living and learning environment; increased preparedness for public health emergencies including the preparedness and means to create high-quality precautionary measures in case of an emergency. Important expectations are also related to improved control of medical treatment quality.

It is only to be seen if there will be increased effectiveness from the internal optimisation of operations. There will be a direct reduction of auxiliary staff from 3 different institutions and the restructuring of the work of local/regional offices. It is also anticipated that greater specialization allows to increase the processing quality and output of respective public services.

Impact of this policy

Qualität kaum Einfluss relativ starker Einfluss starker Einfluss
Gerechtigkeit System weniger gerecht four System gerechter
Kosteneffizienz sehr gering neutral sehr hoch

The decision to establish the Health Board was done in a haste and the motivation behind that is not very clearly communicated to the public. Although one aim of the draft is to achieve cost savings, this was not the original plan. Cost savings seem to be conveniently associated with the draft and the real motivation behind the draft might as well be the dissatisfaction with the performance of the present Health Care Board. The establishment of united agency seeks to improve the quality of health surveillance.

References

Sources of Information

  • Health Care Board, Health Protection Inspectorate and Chemicals Notification Centre associated with the Government of the Republic Act and other laws in the draft Act to amend. Aril 2009. (Also available online at http://eoigus.just.ee/).
  • Koppel A, Kahur K, Habicht T, Saar P, Habicht J, Ginnenken E. Estonia Health system review. Health Systems in Transition 2008.
  • Programme of the Coalition for 2007-2011. www.valitsus.ee/?id=1468.
  • Health Care Board. www.tervishoiuamet.ee/
  • Health Protection Inspectorate. www.tervisekaitse.ee/?lang=1
  • Ministry of Social Affairs. www.sm.ee 

Author/s and/or contributors to this survey

Paat, Gerli and Ain Aaviksoo

 

Empfohlene Zitierweise für diesen Online-Artikel:

Paat, Gerli and Ain Aaviksoo. "Consolidation of national supervisory agencies". Health Policy Monitor, April 2009. Available at http://www.hpm.org/survey/ee/a13/3