It's unclear exactly how the proposed cuts to the Estonian health care system will be implemented.

TALLINN — The Estonian Health Insurance Fund will have to choose Monday whether to lose salary-seeking Estonian doctors abroad or let patients suffer as they scale back medical services in the face of significant budget cuts for 2010.

The fund has been told it needs to shave another billion krooni (€63.9 million) of its budget, which is used to treat patients using the state health system. It is the second time this year they have been asked to cut one billion krooni from the budget. This summer, the original budget estimate was 13 billion krooni, which has to be whittled down to 11 billion.

“Right now we are considering cutting the cost of health services so hospitals could be cheaper, but the doctors are against it. They say if they cut the price, the salaries will go down and they will leave Estonia and go to Europe,” Evelin Koppel, press secretary of Estonian Health Insurance Fund told Baltic Reports.

“The doctors are saying to use more reserves. We have four billion krooni of reserves, but there are limits in the legislation that say we can only use so much in one year,” Koppel said adding that a change in legislation would jeopardize the country’s chances of entering the eurozone in 2011.

Half of the one billion krooni deficit can be financed using the reserves, but that still leaves around 500 million krooni to be found from elsewhere.

Katren Rehemaa of the Estonian Medical Association, a trade union for doctors, confirmed to Baltic Reports that doctors are threatening to leave the country should the fund cut their wages.

“It’s difficult to say how many and when would leave, but the potential is big because, especially with young doctors who even want to stay in Estonia, if they cut jobs they won’t have a place to work and of course the other thing is salary,” Rehemaa said.

“We suggest to use this money that is in the reserves. We think it is enough to manage next the three or four years,” she said.

Currently the legal maximum hourly wage for doctors working in the state system is just 112 krooni (€7.16) per hour.

“Normally they earn around 18,000 krooni per month, but unofficial sources say they earn 24,000 krooni. Doctors say the salaries in Europe are higher and the borders are open so they could leave to Finland or Sweden tomorrow,” Koppel said.

Despite the salaries being relatively low compared to Western countries, the wages are above normal Estonian averages, Koppel said.

“We want to do everything possible so that the quality so people can still get health insurance and people don’t suffer. That’s why we want to cut prices,” she said.

Some doctors say the closure of hospitals and cutting of wholesale services is likely. Cutting the price of health services would also likely create longer waiting lists for patients and more patients would be turned away without proper diagnosis, doctors warned.

Revenue for the health fund is collected from personal income tax, but with rising unemployment the fund has lost a large part of its funding.