|Economic slowdown shaping healthcare system|
|Implemented in this survey?|
EU Structural funds will have a strong impact on the acute and long-term care hospitals in Estonia. The capital investments into infrastructure will boost the grantees’ capacity for development especially since funding for the provision of healthcare services paid by health insurance is diminishing. ESF money for public health activities will also help to fill the gaps of the contracted public budget, but also initiate a few new programs targeting alcohol abuse and workplace health.
Since 2004 structural assistance from the European Union has been one source of financing the healthcare system in Estonia. The aim of using EU structural funds is to foster sustainable development in Estonia.
In the health domain, the Estonian government has given priority to the development of the healthcare and welfare infrastructure using European Regional Development Fund (ERDF) money. In the
second period of funding (2007-2013) public health activities have been added through the European Social Fund (ESF) to also promote a healthier labor force.
Altogether the funds channeled to the health system from European structural funds are 185,1 million Euros from ERDF and 15,5 million from ESF. Meanwhile, the Estonian Health Insurance Fund (EHIF) has cut its public funding by 8% in 2009 as compared to 2008. There will be a further cut in 2010 by 6% compared to the 2009 budget. It is important to note that EHIF money is predominantly used for operating costs; capital investments usually have been paid from additional public sources.
The main challenges for Estonia that the structural fund investments are aimed at are:
Thus, the key goals that the structural fund investments should achieve as defined by respective documentation are the following:
|Medienpräsenz||sehr gering||sehr hoch|
The funding will not change the healthcare financing system as this seems to be functioning well, as such.
Infrastructure investments are usually just a part of EHIF financing of services according to the price list. Now, in a situation where EU funding will be available only for three hospitals out of 27, these three have a great comparative advantage. Some of the hospitals will receive funding from the nursing care investment measure financed through EU structural funds. The others will have to do with the amount paid by EHIF for services offered, containing an investment component - a sum that the three hospitals receiving EU funds will get on top. The other hospitals are not happy about this, one has sued against the funding decision.
The nursing and care services investment from EU Structural Funds cover just a small portion of the actual need, even though a very important one, taking into consideration the ageing population and plans to increase the retirement age to 65.
|Implemented in this survey?|
The main stakeholders and participants involved and affected by the policy for using EU structural funds included the government (especially the Ministry of Social Affairs), hospitals, local governments and others.
|Minister of Finance||sehr unterstützend||stark dagegen|
|Government||sehr unterstützend||stark dagegen|
|Ministry of Social Affairs||sehr unterstützend||stark dagegen|
|Care providers||sehr unterstützend||stark dagegen|
|Hospitals receiving support||sehr unterstützend||stark dagegen|
|Hospitals not receiving support||sehr unterstützend||stark dagegen|
|EHIF Council||sehr unterstützend||stark dagegen|
In the implementation of all these measures, the Ministry of Social Affairs has been the main actor. At the beginning of the year (survey 13) hospitals and interest groups were very active and visible in their statements in public. With each subsequent reduction of costs these groups have become more silent - worn off. As the Estonian healthcare system is relatively transparent and its governance centralized (EHIF), the implementation of changes has been quite successful. There have been winners (the ones which will receive EU support for investment) and losers - all other care providers.
|Minister of Finance||sehr groß||kein|
|Ministry of Social Affairs||sehr groß||kein|
|Care providers||sehr groß||kein|
|Hospitals receiving support||sehr groß||kein|
|Hospitals not receiving support||sehr groß||kein|
|EHIF Council||sehr groß||kein|
All three measures associated with the welfare and healthcare systems are implemented within programs under the administration of state agencies or MoSA. Furthermore, open calls directed to local governments and social partners for additional activities within the above mentioned fields have been launched. Several implementation schemes are used: framework programs including yearly operational programs with specific budgets and action plans; periodic programs and open calls.
By 15 May 2009, seven programs were being implemented (with 7-8 proposed additional programs) and two regulations for open calls have been approved (three more regulations for open calls are in progress)
An indicative list of the planned activities:
1. Development of the healthcare infrastructure
2. Development of the welfare infrastructure
3. ESF Activities
In spring 2009, the Ministry of Finance ordered a rapid mid-term assessment of the use of structural funds against the changed macroeconomic environment. Apart from initial technical goals as set by the operating program, the evaluation assessed the planned use of money against five specific priorities that should be addressed in the economic crisis:
The estimated effects of the measures for given priorities in a short, mid- and long term horizon include the following aspects:
Capital investments into infrastructure generally have long-term goals. Hence their short-term effect on health behaviour or health status is limited. From the mid-term perspective, improving living and work conditions definitely has a positive impact on the health status and behaviour of persons admitted to orphanages or special care homes. Furthermore, improved infrastructure for nursing and care services has a positive effect on the health of target population groups by modernizing the standard of service provision. The improvements in the infrastructure of acute care hospitals have only modest effect on this priority.
The short-term effect of capital investments on poverty risk is small. In the long run, the investments should promote the efficiency and quality of acute care, nursing and long term care, welfare services and at least have an indirect effect on the coping of risk groups.
The centralization of acute treatment and the development of high-tech healthcare services can potentially increase the quality and efficiency of services. However, this does not have a direct effect on the accessibility of health services in Estonia.
The effectiveness of investments depends substantially on the choices made on other healthcare and social policy issues and factors (balanced regional accessibility of health services, efficiency of investments on the level of particular institution, the financing guidelines of a particular service etc.). Additionally, besides wages, an important motivational factor of personnel is modern working conditions. This is critical also in health care and maintaining personnel as a critical resource (medical specialists and nurses) in needs appropriate investments in Estonia.
All measures for supporting capital investments in healthcare and welfare services are directed to improving population health status, reducing inequality and developing the ability of especially risk groups to cope independently.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
The financing of EU structural funds will contribute to the implementation and development of different healthcare and welfare priorities. Public health money is largely spent on filling the gaps of reduced government funding (e.g. HIV/aids prevention); possibly some new initiatives will arise in the field of alcohol abuse prevention and workplace health promotion. The latter two are important and so far underfunded areas in Estonia - therefore the impact is noteworthy, although the full potential of the structural funds is probably not achieved.
|Economic slowdown shaping healthcare system|
Process Stages: Umsetzung
Gerli Paat, Siret Läänelaid, Ain Aaviksoo