Transcript Estonian Health Care System

Estonian Health Care System
Jevgenia Makarova
Kristel Kaur
Tallinn 2006
Geographical and historical figures
• Area: 45.215 km²
• Bordered by the Russian Federation to the
east and Latvia to the south
• Population: 1,4 million
• Male: 46 % female: 54 %
• Urban: 69 % rural: 31 %
Geographical and historical figures
• Life expectancy:
male: 66,3 years female: 76,7 years
• Birth rate: 8,7 / 1000 population
• Average salaries: 500 Euro
• Average pension: 150 Euro
Geographical and historical figures
• 1940 occupation of Estonian Republic by
USSR
• 1991 independence of the Estonian
Republic
→ total reform of the health care system
• Today’s number of acute hospitals: 19
North-Estonian Regional
Hospital
Inpatient and outpatient treatment.
24-hour first aid.
613 beds altogether.
North-Estonian Regional
Hospital
Departments of general surgery,
neurosurgery and neurology,
cardiovascular surgery, cardiology
and critical coronary care unit,
trauma section and orthopedics,
internal medicine, eyes, ear, nose
and throat, thoracic surgery,
urology, maxillae-facial surgery,
intensive care unit.
North-Estonian Regional
Hospital
Consultative Clinic of the
Mustamae Hospital.
The doctors of this clinic work at
the Mustamae Hospital.
North-Estonian Regional
Hospital
Psychiatric Hospital
Inpatient and outpatient treatment of
all mental diseases. There is also a
modern paid department of nonpsychotic disabilities with sauna,
private rooms etc where it is possible
just to cure your stress or any other
problems.
East-Tallinn Central Hospital
There are the biggest Gynecologic and
Maternity Clinic in Estonia and one of the
best equipped and modern eye disease
centers in Estonia.
Also has trauma center.
Tallinn Children's Hospital
Inpatient and outpatient departments of
pediatrics, ear-nose and throat diseases,
traumatology and orthopedics, surgery,
hemato-oncology.
All the doctors are highly educated and
speak English.
Tartu University Clinicum
Clinic of
Cardiovascular and
Total Surgery
Surgical Clinic
Ear Clinic
Eye Clinic
Children's Clinic
Women's Clinic
Cardiology Clinic
Lung Clinic
Dermatology Clinic
Neurology Clinic
Psychiatric Clinic
Internal Diseases
Clinic
Dental Clinic
Traumatology Clinic
Medicover Swedish-Estonian
Medical Center (private)
24-hour Hotline for emergency medical care;
medical exams for adults and children;
screenings and diagnostic tests; mammograms;
annual flu shots; dentists(including 24-hour
emergency dental care); ambulance service;
home visits; gynecological and pregnancy care,
etc.
Family Physician
All persons insured with the Health
Insurance Fund have a family
practitioner.
A person not residing in Estonia may
also visit a family practitioner.
A person needs a referral from the family
practitioner to visit a medical specialist.
No referral is needed to visit a psychiatrist,
gynaecologist, dermatovenerologist,
ophthalmologist, dentist, pulmonologist
(for tuberculosis treatment), infection
specialist (for HIV/AIDS treatment),
surgeon or orthopaedist (for
traumatology).
The amount of the patient’s financial participation
in the following cases:
• out-patient examination – a family practitioner
can charge a visit fee of up to EEK 50, when
making a home visit;
• specialised medical care – a visit fee up to EEK
50;
• transportation by ambulance in the case of
emergency – free of charge;
• hospitalisation – an in-patient fee of up to EEK
25 per day and for up to 10 days per
hospitalisation.
There is no in-patient fee:
• for children below the age of 19;
• in cases related to pregnancy and
childbirth;
• in the case of intensive care.
It is possible to register with a family
physician by submitting an application to
the physician selected. It is also possible
to change the physician; to this end one
should submit an application to the new
family physician.
When visiting the new physician one
should present an abstract of his/her
medical record.
Primary care
During the Soviet era, paediatricians
worked as primary care doctors in
special children’s polyclinics. It was
common for patients to bypass
polyclinics and health centres, visiting
specialists directly.
Primary care is organized as
the first level of contact with
the health system.
Each family doctor has a list of registered
patients.
These lists cannot contain
fewer than 1200 or more than 2000
patients (except in specific cases such as
occur in some rural areas or on some
islands).
The average patient list size is
1600.
Family doctors usually operate in
rented premises (sometimes in
facilities
which used to be polyclinics),
although some doctors have taken
out loans to
build new facilities.
Family doctors are required to have at
least 20 visiting
hours a week, and practices should be
open for at least 8 hours a day. In primary
care, patients should be able to see their
family doctor on the same day for acute
problems; patients with chronic conditions
have the right to see their family
doctor within three days.
The 2002 results show
that all patients with
acute problems are able
to access their family
doctor on the same day,
and that
97% of patients with
chronic conditions see
their family doctor within
three
days.
40
35
30
25
20
15
10
5
0
1st
day
2nd
day
3rd
day
The national immunization
programme is defined by
the Minister of Social Affairs
and implemented by the
Health Protection
Inspectorate. Immunization
is the responsibility of family
doctors, although school
doctors are also allowed to
undertake it.
All family doctors are
required to work with at
least one family nurse, even
though there is a shortage
of trained family nurses.
Nursing will take place in
cooperation with the
patient's GP and with a
social worker from the
municipal government if
necessary.
Home nursing and care
services are offered only in
Tallinn.
The services are free for
patients in the extent
allocated from the budget of
the City of Tallinn.
Target group:
• Patients who have left nursing hospitals or longterm treatment wards or other hospitals who
need nursing care and not active treatment.
• Patients in whose case nursing care prevents
hospitalisation
• Patients who are unable to move
• Chronically bedridden patients with serious
physical problems
• People with reduced mobility
• Patients who have complicated nursing care
needs that cannot be met by social workers or
family members
• Terminally ill and dying patients
Patients in an acute
psychotic state will not be
taken in nursing care.
Performed procedures:
• Distribution and
administration of
medicaments
• Taking blood pressure
• Reading pulse
• Measuring temperature
• Measuring blood sugar
with a glucometer
• Inserting a catheter in the
bladder, inserting a
permanent catheter,
maintenance of catheters
• Change of dressing and
care for ostomy
• Micro-enemas
• Removal of stitches from
wounds
• Removal of casts
• Prevention of bedsores
• Care for wounds, incl.
bedsores
• Position therapy
• Rehabilitation therapy at
home
• Counselling
Nursing schools and their curricula
have been developed to meet the
standards of vocational high school
and a bachelor’s degree.
Besides basic nursing training,
Estonian medical schools also offer
higher vocational training for
midwives, optometrists, pharmacists,
mid-level health protection specialists,
radiology technicians,
physiotherapists, dental technicians
and lab technicians, as well as
vocational-level training for long-term
nursing specialists.
University of Tartu Faculty of
Medicine for nurses with some
work experience.
These graduates are seen as the
main resource for further training of
basic and specialist nurses.
Nurses’ professional associations
have been working to standardize
the different nursing specialties.
The greatest shortage of nurses
is in specialist areas, such as
surgical nurses. Reasons for the
shortfall include poor salaries,
high levels of work-related stress,
low job satisfaction and low
professional status.
Nurses’ professional associations
have been working to standardize
the different nursing specialties.
Some efforts have been made to
raise the status of nurses by
increasing their responsibilities and
introducing continuing education to
the profession. The new Health
Services Organization Act gives
nursing care a legally well-defined
status on a par with primary,
specialist and emergency care.
In hospitals, nurses and nursing are
increasingly being acknowledged
independently, by doctors as well as
by patients.
Thank you for your
attention!