TALLINN - Estonian physicians have demanded guarantees that the government keep its promise to increase wages and said they would consider ripping up their contract with the Estonian Health Insurance Fund, a move that could lead to a 10-euro fee per visit to the family doctor.
Despite the wage increase agreed upon by the Estonian Health Insurance Fund and the Estonian Family Doctors Society last week, doctors wanted guarantees that the increase would materialize and stated the government should be prepared to step down if it is unable to fulfill its promises.
The Family Doctors Society said on Dec. 17 that the government has not approved the new service price list of the Estonian Health Insurance Fund, which should contain the wage raise negotiated earlier this autumn, hinting at a possible lack of funds.
Both the fund and the society were to sign the 2005 cooperation agreement on Dec. 30, but as of Dec. 21 it was uncertain whether the doctors and the state would reach a deal.
Pursuant to the current agreement with the Estonian Health Insurance Fund, a majority of family doctors see their patients for free, with the visits being paid for by the nation's healthcare system, which in turn is essentially funded by employers.
As of June 2004, the Estonian Health Insurance Fund, the organization that pays the medical services of those with the national medical insurance, listed 1.27 million people as eligible for health insurance.
Kulvar Mand, deputy minister of social affairs, said the government should approve the new price list of the Estonian Health Insurance Fund by Dec. 30. "The new price list includes the wage increase for family doctors. Everything from the state side is clear: The money has been found, and there are no obstacles from our side to sign the agreement," said Mand.
"Today signing the agreement is only a matter of will. If [the agreement] is not signed, the reason will only be the lack of will [from the doctors' side], as the state has provided all the conditions [for signing]," added Mand.
However, if the physicians and the Estonian Health Insurance Fund do not reach an agreement, patients will have the opportunity of keeping the receipt for the 160 kroon (10 euro) visit and receiving reimbursement - in part by the Estonian Health Insurance Fund and in part by the local governments.
"Family doctors assure that they will continue seeing patients next year regardless of whether there will, or will not be, an agreement with the Estonian Health Insurance Fund. Patients who are not able to pay for their treatment can ask the local government and the Estonian Health Insurance Fund for compensation," the Estonian Family Doctors Society stated Dec. 17.
A family doctor in Estonia is a physician providing patients with basic treatment and issuing referrals to surgeons, oncologists and other specialist doctors. Doctors can register as private entrepreneurs or can be employed by a hospital. He or she is allowed to serve 1,200 - 2,000 patients in the nearby area, though family doctors may exceed their patient limit voluntarily.
In Tallinn alone, where 240 family doctors were registered as of Dec. 20, about 70 family doctors have over 2,000 people on their registry each. As of December 2004, there were 783 family doctors with about 1,500 auxiliary medical personnel working in Estonia.
Accessibility of medical care has become a major headache for the Estonian government in recent months. Queues at in-patient treatment wards in hospitals in the southern part of the country can be up to one-year long, while in Tallinn people are used to having to wait for weeks to see a gastroenterologist and other narrow specialists.
The crisis in the nation's healthcare system had somewhat diffused by the end of September, when the medical workers associations canceled the planned strike after reaching a compromise with the government on a wage increase over the next two years.
The specialist doctor's minimum hourly salary will gradually increase from the current 50 kroons to 75 kroons by 2006. Nurses and auxiliary personnel will be getting 39 kroons and 23 kroons per hour, respectively, by 2006. Yet the negotiated specialist doctor's wage raise did not consider family doctors, which led to last week's argument.