Estonian Human Development Report

Table 2.6.2. Use of specialized medical care services
in 2001–2007
Source: Estonian Health Insurance Fund
2001 2002 2003 2004 2005 2006 2007
Number of insured
individuals who
932 021 919 470 914 611 917 227 919 822 980 809 1000 702
received specialized
medical care
Out-patients 750 533 744 367 740 153 771 070 786 178
Day care 40 036 45 612
In-patients 181 488 175 103 174 458 169 703 168 912
Figure 2.6.4. Residents’ assessment of the availability
of medical care (Deprivation of medical care, %)
30
25
20
15
10
5
0
Northern Central
Estonia Estonia
Source: Statistics Estonia
North-Eastern
Estonia
Family physician care
Specialized medical care
Dental care
Western
Estonia
Southern
Estonia
Figure 2.6.5 Waiting period for seeing a medical
specialist, %
2002
2003
2004
2005
2006
2007
2008
13
10
11
22
20
18
26
Same day
5–7 days
8
12
7
7
11
10
9
7
13
Longer than a month
7
12
16
11
14
12
10
14
12
1–2 days
8 days to two weeks
Do not know
3–4 days
3–4 weeks
Source: Insured Patients’ Satisfaction Survey. Estonian Health Insurance
Fund & the Ministry of Social Affairs of the Republic of Estonia 2008
8
14
14
16
17
approximately 180 times a year per 1000 residents, while
the corresponding indicator in the Nordic countries is
about 100 cases per 1000 residents (Health Care Board).
Although emergency medical care should mean providing
care related to health problems that require immediate
medical intervention, people use the service for a significantly
wider variety of reasons. According to the Health
Insurance Fund survey Patsientide hinnangud tervisele
ja arstiabile 2008. a (Patients’ Evaluations of Health and
Medical Care in 2008), 37% of the population prefers to
call emergency medical care professionals in the case of an
unexpected health problem occurring in the evening, at
night, or on the weekend. At the same time, a special fam-
14
16
17
17
16
10
10
17
15
12
14
14
31
25
22
14
19
10
13
2
2
1
1
2
3
3
ily physician consultation hotline (phone number 1220)
has been in operation since 2005 and should provide sufficient
help in solving problems limited to initial consultation
or visiting the doctor on the following day. While 7%
of respondents used the hotline service in 2005 and 17%
used it in 2007, in 2008, this percentage has dropped to
12% (Aaviksoo & Koppel 2008, Estonian Health Insurance
Fund). People often prefer to call an ambulance because
they will be certain to receive help and the help will be
provided quickly. Among people who used the emergency
medical care service within the last 12 months, 85% were
satisfied or very satisfied with the ambulance crews.
The number of people who have received specialized
medical care has increased in recent years, especially with
regard to out-patient and day care services (Table 2.6.2.).
In 2007, 61% of all insured individuals used out-patient
services.
The assessment of Estonian residents regarding
the availability of medical care has remained relatively
unchanged during recent years. A little over a half of the
respondents constantly rate the availability of medical
care in Estonia as good or rather good according to the
annual satisfaction survey organized by the Health Insurance
Fund and the Ministry of Social Affairs (Estonian
Health Insurance Fund/Ministry of Social Affairs, 2008).
The availability of medical care in Estonia is affected
by one’s place of residence, rather than whether one lives
in a rural or urban area. The ratio of ambulatory services
per person, which has been increasing slowly but steadily,
differs by up to 60% in different regions. According to data
from 2005, this ratio was 7.9 visits per resident in Tallinn
and 4.6 visits per resident in Rapla County. The ratio was
higher than average (6.1) only in Harju County, Tartu
County, Pärnu County, and Saare County (Statistics Estonia,
2008). There have also been earlier descriptions of a
nearly twofold difference in the frequency of hospital care
between different counties (Kunst, 2002). According to a
2005 population survey, the highest percentage of Estonian
residents did not receive medical care in North-Eastern
Estonia (Figure 2.6.4.). Of the people who required
treatment in the region, 30% did not receive dental care.
The availability of family physician care was best in Central
Estonia, where only 3.4% of the respondents reported
not being able to receive care from their family physician
when they needed it.
Attempts have also been made in recent years to reduce
the length of the waiting lists. The general principle of
operation of the Health Insurance Fund is to increase the
volume of cost-effective services (e.g. family physicians’
appointments) within the limited financial means and
to reduce the size of waiting lists involving the most serious
and noticeable problems (endoprosthetics, cataracts).
Meanwhile, the waiting period for “common” doctors’
appointments is being gradually lengthened (Aaviksoo
& Paat, 2007). For example, the percentage of people who
were able to get a doctor’s appointment on the same day
has fallen by 15% in 2008, or more than twice when compared
to 2002. During the same period, the number of
people who must wait for a medical specialist’s appointment
for more than a month has increased 3.1 times, from
10% in 2002 to 31% in 2008 (see Figure 2.6.5.). As a result,
most Estonian residents will experience deterioration in
the availability of specialized medical care in the short
term due to the restrictions in place.
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