Estonian Human Development Report

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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. | 46
2.7. National public health care services The majority of preventive activities aimed at the entire population of Estonia are undertaken through the public health strategies supervised by the Ministry of Social Affairs and the National Institute for Health Development. Furthermore, monitoring and supervision regarding infectious diseases and environmental health is performed by the Health Protection Inspectorate which grew out of the Soviet-era Sanitary and Epidemiology Service. As of 2009, all strategies related to this area are formally combined in the Public Health Development Plan 2009–2020. The development plan includes five thematic categories, which are related to increasing social cohesion and equal opportunities, guaranteeing children a healthy and safe development, creating an environment supportive of health, facilitating healthy lifestyles, and ensuring the sustainability of the health care system. The priorities, strategic objectives, and sets of measures defined for the purpose of achieving the overall goals of the development plan are also broken down according to these categories (Public Health Development Plan, 2008). Vaccination or immunization is one of the economically most profitable public health measures for protecting residents against infectious diseases. For example, with the help of vaccination, poliomyelitis has been eliminated in Europe and smallpox has been wiped out in the entire world. The rate of immunization of children in Estonia is very high (Figure 2.7.1.) and therefore the incidence of infectious diseases avoidable through vaccination, for example viral hepatitis B, has decreased considerably, or, as in the case of measles, rubella, diphtheria, and tetanus, has remained at a constantly low level. The majority of the specific applied activities are carried out through categorized public health strategies which include: • The National Strategy for the Prevention of Drug Addiction Until 2010 • Estonian National Strategy for the Prevention of Cardiovascular Diseases 2005–2020 • 2006–2010 Strategic Development Plan for Physical Movement Activities • HIV and AIDS Strategy for 2006–2015 • National Cancer Strategy for 2007–2015 • 2008–2012 National Strategy for Combating Tuberculosis Services related to public health Several strategies directly fund various services. For example, the HIV and AIDS strategy provides funding for different damage reduction services aimed at drug addicts, such as syringe exchange programs and methadone substitution treatment. The strategy related to cardiovascular diseases funds counselling for quitting smoking; the physical activities’ development strategy provides financial backing for medical services for young athletes; the cancer strategy supports counselling for giving up tobacco products; the tuberculosis combating strategy funds directly supervised tuberculosis treatment, etc. Many services aimed at preventing diseases are also funded by the Estonian Health Insurance Fund. The implementation of these programs is part of the public health strategies. In 2007, the Supervisory Board of the Estonian Health Insurance Fund confirmed the long-term priorities for promoting health and preventing diseases. The pertinent projects are implemented based on these priorities. Such projects include the following activities: • pre- and post-pregnancy counselling; • counselling during pregnancy crises; • pre-birth screening for the prevention of chromosome diseases; • screening related to the hearing of newborn children in larger maternity hospitals; • phenylketonuria and hypothyroidism screening among newborn children; • rehabilitation of children who have lost a close family member; • provision of school health care services in all general education schools and vocational schools which operate on the basis of basic education; • counselling of young people regarding reproductive health and the prevention of sexually transmitted diseases; • screening for the early detection of cervical cancer among women aged 30–59; • additional study and testing of high-risk people who are aged 30–60 and have insurance for the prevention and early detection of cardiovascular diseases; • screening for the early detection of breast cancer among women aged 50–62; In the case of services aimed at the entire population of specific target groups it is important for them to reach all of those concerned, regardless of their socio-economic status, place of residence or level of education. An important flaw in many public health services is their insufficient reach and uneven coverage. The availability of services aimed at small and clearly defined target groups is usually very good, for instance in the case of services directed at pregnant women and newborn chil- Figure 2.7.1. Rate of immunization of children by age (%) 1 y.o. – 14 y.o. 7 m.o. – 14 y.o. 7 m.o. – 3 y.o. 1-year-olds 2-year-olds 98 98 95 95 97 Diphtheria, tetanus Poliomyelitis Measles Rubella 98 45 29 95 97 98 95 97 Source: Health Protection Inspectorate 98 Hib Whooping cough Measles, mumps, rubella Mumps 96 96 96 96 Viral hepatitis B Haemophilus influenza type B 47 |
Page 1 and 2: Estonian Human Development Report
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Page 5: 4.2. Ethnic differentiations in sat
Page 9: Preface This year, the Estonian Hum
Page 12 and 13: CHAPTER 1 Estonian Human Developmen
Page 14 and 15: Figure 1.1.3. Life expectancy in co
Page 16 and 17: Figure 1.2.2. Life expectancy at bi
Page 18 and 19: to reality. The greatest inaccuracy
Page 20 and 21: Figure 1.2.9. Internal migration ev
Page 22 and 23: 12. Marksoo, A. 1992. “Dynamics o
Page 24 and 25: Table 1.3.1. PISA 2006 study result
Page 26 and 27: Table 1.3.2. Number of students in
Page 28 and 29: 1.4. The gross domestic product and
Page 30 and 31: Figure 1.4.3. Estonian GDP (right a
Page 32 and 33: 1.5. Changes in the Estonian Human
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Page 36 and 37: Table 2.2.4. Differences in life ex
Page 38 and 39: Figure 2.4.1. Healthy life years of
Page 40 and 41: Figure 2.4.4. Various accidents, tr
Page 42 and 43: 2.5. Lifestyle and behaviour as a s
Page 44 and 45: Figure 2.5.5. Smoking in Estonia in
Page 46 and 47: Figure 2.6.1. Overview of the compo
Page 50 and 51: dren. The majority of services are
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Page 56 and 57: CHAPTER 3 Quality of life and life
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Page 60 and 61: Table 3.2.4. An assessment of the e
Page 62 and 63: Figure 3.2.4. Difference in the job
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Page 72 and 73: Figure 3.5.1. Percentage of teenage
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Page 78 and 79: Figure 3.6.2. Subjective quality of
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Page 82 and 83: Figure 3.7.1. The placement of Euro
Page 84 and 85: Figure 4.2.1. Life satisfaction by
Page 86 and 87: Table 4.2.1. Factors forming genera
Page 88 and 89: Annexes Annex 4.2.1. Socio-demograp
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Table 4.5.2. The prospects of non-E
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Figure 4.5.4. Certainty of Estonian
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mote equal opportunities. At the (e
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CHAPTER 5 Quality of life in a cons
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Figure 5.2.1. GDP and AIC per capit
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Figure 5.2.3. Distribution of consu
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Figure 5.2.4. Indexes of environmen
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Table 5.3.1. Comparison of countrie
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Figure 5.3.3. Comparison of types o
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Table 5.3.5. Connections between po
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Table 5.4.1. Who and what are the f
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Table 5.4.3. Young people’s asses
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Figure 5.4.6. Time spent on the con
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Table 5.4.6. The perception of prob
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5.6. Summary To briefly summarize t
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Table 6.2.1. Objective and subjecti
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Figure 6.2.4. Relationship between
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Figure 6.2.7. Difference between th
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Figure 6.3.1. GDP, government secto
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Figure 6.3.3. Employed 15-74-year-o
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Figure 6.3.8. Percentage of social
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References 1. Aaviksoo, A., G. Paat
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Figure 6.4.1. Labour market flexibi
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Figure 6.4.3. Creations of jobs ind
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Figure 6.4.5. Public expenditures o
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Figure 6.4.6. Ratio of the particip
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6.5. Cities as development engines
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Table 6.5.2. Existence of developme
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have been underfinanced or are not
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Table 7.1. Factors that favour and
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Table 7.2. Potential economic devel
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Authors Chapter 1 Ene-Margit Tiit,
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Margit Keller (PhD) is a Senior Res
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Special prizes Estonian Human Devel
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Estonian Human Development Report H
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Estonian Human Development Report H
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Estonian Human Development Report T
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Honorable mentions Estonian Human D
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Estonian Human Development Report P
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Estonian Human Development Report A
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Estonian Human Development Report T
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Estonian Human Development Report

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