TALLINN — Estonians could be looking at visit fees, certificate fees or even the reduction of reception hours after the Estonian Health Insurance Fund implements a 6 percent budget cut on family doctors decided this week.
Despite opposition by Estonia’s Society of Family Doctors and the Association of Patients, the fund went ahead with the budget cut to avoid a potential cash shortfall as the economic crisis continues. The fund, which covers the medical care of all Estonians, is replenished by 33 percent tax paid by employers for each employee. The amount of money entering fund has decreased alongside the job losses caused by the crisis.
“This spring we already had to reduce the contract capacity with hospitals by 5 percent comparing to 2008, and next year the the contract capacities should stay the same as this year. In addition to changing the price limit of health care services, the Estonian Health Insurance Fund is planning to cut its operating costs as well,” Evelin Koppel, public relations manager of Estonian Health Insurance Fund told Baltic Reports.
Exactly what will make up the cuts has yet to be determined.
Disagreements over how to cut
The Society of Family Doctors is concerned that the 6 percent fee will create accounting chaos because contracts were signed without the cut being taken into account.
“It will bring a chaos into the plans. Everything is precisely calculated,” Rutt Kalda, head of the Society of Family Doctors told Baltic Reports said.
Both the Society of Family Doctors and Association of Patients support letting doctors determine how to cut costs at their own practice rather than mandating the cuts from above.
“We need to save on something, either wages or developments, such as information technology, or some services, so there is no way to solve it without anyone having to suffer. We are tied to contractual obligations, and if we have less money then we must start saving,” Kalda said.
The Society of Family Doctors and supports establishing a visit fee, but family doctors say its needed to cover labor costs instead of the 6 percent budget cut.
“The visit fee has been an issue even before the budget cut. It’s important, as it would cover the pay of one nurse, even if it’s just part-time nurse. We desperately need our workforce, but the funding system by the Estonian Health Insurance Fund does not enable us to recruit extra staff,” Kalda said. “The visit fee would be one of the options to cover the pay of nurse, but of course it won’t cover the 6 percent cut.”
The fund is loathe to introduce such a fee because it would require changing legislation.
“According to current legislation, the family doctors cannot ask a patient to pay any fees other than a home visit fee and document issuing fee. This legislation has not been changed and we certainly do not support any visit fees the family doctors may want to establish,” Koppel said.
The Association of Patients is also against introducing a visit fee, arguing that the average Estonian already pays enough in taxes for medical care as it is.
Other proposals are less operating hours at clinics and introducing fees for health certificates such as disability parking passes.
The Society of Family Doctors supports reforming the certificate payment system.
“There are various forms and certificates we have to submit to tens of different agencies on top of our main work. The doctors don’t get paid for such activities and often they don’t have the time, but it needs the doctor’s attention and contribution. As these duties are not directly connected to providing aid, the certificate system needs to be rearranged,” Kalda said.
Meanwhile the Association of Patients says less reception hours are acceptable.
“It’s logical that the reception times should also be reduced by six percent. Anything more would be disproportionate,” Pille Ilves, spokeswoman for the association told Baltic Reports.
