Transcript Maris Jesse
Free movement in Health Care : Estonian perspective of the Finnish-Estonian case Maris Jesse Former Chairman of Management Board Estonian Health Insurance Fund Estonia and Finland •Distance 80 km •Transport : • By boat 90 minutes over 10 times a day with 12–20 € • By Helicopter 18 min. 14 times a day every hour with 70-200 € •Similar languages •Close ties between medical organisations •Close proportion of health care expenditure of GDP : • Finland 6,9 % in 1999 • Estonia 6,5 % in 1999 Facts of Life - Health Care in 1999 Estonia Finland Average Life Exp. 70,7 years 77,3 GDP per capita 3 484 € 22 465 € Total Health Expenditure per capita 219 Euro € Per 100 000 pop Doctors Nurses 321 587 Source : NOMESCO - 2000 1 536 Euro € 305 1361* (*overestemated) Scenario : Estonian doctors and nurses to Finland • Income differences of professionals 7-10 times • In 2000 Estonian doctors average monthly salary 530 € • Nurses average monthly salary 270 € • How many will go and for how long ? • No data available about present situation and also not about intentions of professionals • Motives to work abroad -General study in Dec/2000 • Higher Income - 96 % • To broaden sight – 87 % • Professional development – 78 % Scenario : Estonian doctors and nurses to Finland • First wave to Finland during 1989-1991 • Reasons for return : family ties and will to use gained experience in Estonia • Some still remain in Finland • Second wave currently in progress • To substitute for Finnish doctors having freely moved onward to the west • Mostly planned only as temporary employment • Young professionals ? Opinions : Estonian doctors and nurses to Finland • Not seen as a threat neither by officials nor by medical professionals • In a small country like Estonia a necessity for professional development • Medical profession opinion-leaders see as opportunity to argue for increase of health care financing Scenario : Finnish doctors and nurses to Estonia • Finnish medical students study in Estonia • No data on somebody working in Estonia permanently • Increasing long-term co-operation in highly specialised care • Finnish specialist consults and/or operates in Estonia, e.g. Pediatric surgery, liver-transplantation • Financed by Health Insurance Fund Scenario : Estonian patients to Finland • Health insurance pays for treatment not available in Estonia • 5 cases for 65 000 € in Finland in 2001 • No data on people paying out-of-pocket, presumingly marginal • Estonian health care satisfaction study 2001 • 87 % of respondents having visited a specialist evaluated as very good or good • 70 % of all respondents evaluated quality as very good or good • High level of co-payment in Finland an obstacle Scenario : Finnish patients to Estonia •Spas along Estonian sea coast-line and on islands : •77 % of guests foreing, mostly Finnish •Day price 17-54 € Scenario : Finnish patients to Estonia • Dental treatment • Up to 10 % of patients in central Tallinn • Implants, protheses etc • Plastic surgery • Cardiac surgery 1989-1992 • Time of long waiting-lists • Contract between Finnish Heart Association and a hospital in Estonia • Appr. 100 Finnish patients were operated in Estonia • Failed due to a error during blood-transfusion leading to large-scale negative media-coverage in Finland • Preliminary interest raisen again Current expectations and opinions for post-accession period in Estonia : • Movement of health professionals is vital for a small country like Estonia • Becoming a member-state simplyfies movement of professionals, but would not change current numbers • Threat of “brain-drain” is seen as negotation power for increased health finance • Painful memories from first attempt at international competition in health care • Co-operation valuable to doctors and patients in both countries