More money goes to health insurance

An extra 13.2 percent or 550 million kroons ($33.95 million) will be added to next year's health care funding allocation under a new health insurance law passed by Estonia's Parliament on June 19.

The law passed by 59 votes in favor, one vote against and no abstentions. It means the national health insurance system will be more patient focused, said Social Affairs Minister Siiri Oviir.

"The old law has lagged behind reality. It is working against the opportunities afforded by the health protection system and the needs of patients," said Oviir.

In practice the main change is that more money will be allocated to covering medical services while slightly less will be spent on compensating people for the cost of medicines.

When the law comes into effect on Oct. 1 hospitals will be able to set a daily fee of up to 25 kroons per day for accommodating resident patients. Children and pregnant women, however, will still stay for free.

The maximum fee payable for seeing a general practitioner will be 50 kroons for a home visit. But the age until which patients can consult doctors free of charge will rise from 18 to 19.

Right up to the last minute the law threatened to unsettle the governing coalition with Oviir threatening to step down should the Center Party faction block the proposed law.

Around 600,000 of Estonia's 1.4 million population currently pay a 13 percent medical insurance tax as part of their social tax payments. The 5 billion kroons collected in this way annually does not cover the medical costs of pensioners - a group increasing in size, as well as the unemployed and children, according to Ivi Normet, head of health policy at the Social Affairs Ministry.

"None of the existing health care systems (in any country) can provide complete compensation for the possible costs of medical treatment. We have to decide what to take and what to leave and these choices are painful," said Normet.

"Defining priorities in health insurance is difficult because the medical treatment options are constantly changing and in most cases becoming more expensive."

The new law has received a mixed reception.

Andres Lehtmets, chairman of the Estonian Doctors' Association, was less than enthusiastic.

"Unfortunately matters of health care are a political issue in Estonia. Doctors just have to do their best in accordance with a particular law," said Lehtmets.

Trade union leaders also remain critical, particularly of the state's continued refusal to pay for dental treatment for those with low incomes. "Some people cannot save enough money to go to the dentist even once a year," said Kadi Parnits, head of the Confederation of Estonian Trade Unions.

But the Union of Estonian Hospitals and a number of doctors' and nurses' groups have welcomed the changes. "The law creates the only real opportunity to provide professional medical services and to raise doctors' and nurses' wages," said Urmas Sule, president of the Union of Estonian Hospitals.