According to Maris Jesse, deputy director at the Central Health Insurance Fund of Estonia, the situation in Estonian hospitals is not as dramatic as newspapers have reported it. "The problem concerns mostly Tallinn, where there is more hospital capacity than needed for today's modern health care delivery," she announced.
Jesse said that competition among hospitals which wanted to survive reforms was very intense. "The only solution to avoid the situation where big Tallinn hospitals claim they've run out of health insurance contracts is to start hospital reforms quickly by merging hospitals and cutting overlaps in services," she said.
Last year, the state budget allotted almost 4.12 billion kroons ($231 million) for health insurance, this year the sum is 4.14 billion kroons. Next year's budget will increase by 316 million kroons, according to Sigrid Tappo, spokesperson for the Ministry of Social Affairs.
"The ministry's opinion is that money should be spent more effectively. Some hospitals overlap each other and some have management problems. It's a yearly problem that money is used up before the year ends," said Tappo.
According to Andres Maesalu, chief doctor at the Tallinn Central Hospital, the hospital offers as many services as the budget agreed to in the contract with the sick fund foresees.
"For the sum we have to guarantee emergency help and dispensary treatment. These are our two primary tasks. After we have provided these services we start treating inpatients - patients who have registered themselves for hospital treatment," said Maesalu.
He said that 1,000 patients are waiting in line for treatment in the wards of central hospital. "They have registered themselves, but most don't need treatment this year. Anybody who needs emergency treatment gets it at once ," said Maesalu.
Maesalu said that the contract with the health insurance fund didn't specify where the money should be spent. He said that the waiting list in the ophthalmology clinic of the central hospital is the longest because other hospitals don't offer such service. In the eye clinic patients are registered for next June, said Maesalu.
Maesalu said that the problem shouldn't be solved through the establishment of private hospitals because public hospitals have sufficient capacity.
"We need the funds. We should give patients the opportunity to finance part of their treatment and increase the present 5 kroon fee per visit," said Maesalu. He said that the health insurance fund should also specify how much of the resources should be spent on scheduled treatment.
Peep Podder, chief doctor at Nomme Hospital, said that the health insurance fund is blaming bad reforms for the disorder, but the actual reasons is a lack of tax payments. He said that far too many reforms had been implemented and someone should be responsible for the wrong steps taken.
Podder said that taxe-collection was better when employers had to pay 13 percent of an employee's health insurance separately. Now that they pay the health-insurance tax together with a 20 percent social tax, following the tax board's conclusion that the social tax would be collected more efficiently if paid together with the health-insurance tax, the exact opposite has occurred, he said.
Podder said that Nomme Hospital doesn't have lines so long as other hospitals. "We allocatethe budget at the beginning of the year. Unfortunately, the amount of resources is very small, smaller than the actual need of our patients," said Podder.
According to Podder it is not right that doctors have to decide whether a patient gets treatment or not. "It's the task of the health insurance fund to make those unpopular decisions and say which services should be charged for and which should be free," said Podder.
Tappo said that the Ministry of Social Affairs approves most of the ideas proposed by the health insurance fund. "The health insurance fund will be turned into a public institution and become more independent next year," said Tappo.
According to Daniel Vaarik, spokesman from the Ministry of Finance, the ministry didn't like the idea of separating the health insurance fund from the Ministry of Social Affairs because the state would lose control over the fund.
Podder suggested patients should pay for the less important treatments themselves. He said that some patients should go to family doctors rather than specialists at Nomme Hospital, because patients sometimes visit specialists for the wrong reasons and waste a lot of valuable time and money.
He also warned that if the state didn't start dealing with preventing problems like alcohol abuse, cigarette smoking and drug addiction, the amount of treatment required would grow dramatically. "People waiting on the list for stationary treatment should also be treated at once, because their problems get worse and would thus become more expensive to treat," he said.
Podder said that the Board of Social Welfare and Health Care of Tallinn had sent the hospital a note asking it to form a committee to start dealing with paid services.
Ene Tomberg, manager of the Social Welfare and Healthcare board, has assured the public the situation is not so dramatic.
"The hospitals know how much resources they have for treating patients," said Tomberg. "The task of the health insurance fund is to transfer that money to the hospitals. The hospitals have had more work than predicted."
She said that if all the taxpayers paid their health insurance money to the tax board as required there wouldn't be any delays in getting treatment.
"The only way to get out of this is to make every citizen pay taxes properly," said Tomberg. "And, of course, increase the budget for variable costs like electricity for example," she added.