Tallinn makes proposals to state for merging healthcare systems

TALLINN - In its response to the development intent prepared by the Estonian Ministry of Social Affairs for the integration of the healthcare and social system, the City of Tallinn emphasized that a comprehensive overview of the healthcare and social services provided to people is undoubtedly necessary, but the proposed solution does not meet the desired goals.

The city estimates that achieving this and keeping it running sustainably requires a detailed plan and additional funding.

According to Deputy Mayor Karl Sander Kase, the Tallinn Welfare and Healthcare Department unfortunately cannot support the current plan.

"It is important to consider that several concerns have arisen regarding the development intent, both among interest groups and the Health Insurance Fund. It is unreasonable to create an additional and duplicative management level if we cannot offer a solution to long service and treatment queues in the social and healthcare system. Too fast a pace of time and not taking into account the specificities of local governments will not bring new quality," he said.

According to the feedback from the Welfare and Healthcare Department, a municipality-based approach should be used instead of the county-based approach seen in the original plan. This will avoid the creation of excessively large and diverse areas of activity and ensure that smaller municipalities have the opportunity to form cooperation areas.

"In the case of Tallinn, the county level is clearly not relevant. The population of Tallinn is 71.1 percent of the population of Harju County. Tallinn has its own specifics and this requires a different approach. From a county perspective, other issues emerge in other regions that probably do not occur in the city, such as public transport," Kase said.

The city believes that it is important to include educational institutions in the cooperation between different parties so that potential problems can be detected early. Cooperation with the Unemployment Insurance Fund and a clear connection with the Social Insurance Board have also not been covered. The proposal also emphasizes the need to include the person in need of assistance in the preparation of the plan, so that the approach is more human-centered and increases the likelihood of the plan's success.

The development intent prepared by the Ministry of Social Affairs raises, among other things, questions about the rights of various parties, the division of roles, and data exchanges, the confusing or incomplete solution of which creates unnecessary additional work in the system.

For example, the development plan does not clarify how the roles and responsibilities are divided between the health promotion specialist and the municipal social worker. If the problem for people is likely not the regular consumption of health services, but the sustainable consumption of social services, then health promotion specialists could be placed in the social field.

The city also sees that effective participation in the new system requires additional support for social and healthcare workers and financial resources to strengthen the social sectors of local governments.