factors affecting development
DESCRIPTION
Imaging in Estonia – incentives to integrate Peeter Ross, MD President Estonian Society of Radiology MIR 2009 Riga. Factors affecting development. Compulsory health insurance since 1992 Health insurance tax – 13% (paid by employer) Income tax – 21% (flat tax) Fee for service or DRG - PowerPoint PPT PresentationTRANSCRIPT
Imaging in Estonia – incentives to integrate
Peeter Ross, MDPresident
Estonian Society of Radiology
MIR 2009Riga
Imaging in Estonia – incentives to integrate
Peeter Ross, MDPresident
Estonian Society of Radiology
MIR 2009Riga
Million inhabitants
Estonia 1,34
Latvia 2,23
Lithuania 3,56
Factors affecting development
Factors affecting development
• Compulsory health insurance since 1992– Health insurance tax – 13% (paid by employer)
• Income tax – 21% (flat tax)
– Fee for service or DRG– 5,0% of GDP for healthcare in 2005 and 2006
• Health care service providers are municipal, governmental or private– All public hospitals are incorporated into private law
• Wide range of e-services and high bandwidth connectivity– Internet
• 75% of population (15-74 years) use regularly internet (2009)• Wide spectrum of mobile internet services
Radiology. Current figuresRadiology. Current figures• Approximately 200 radiologists (+34 residents)
– 149 radiologist per one million inhabitants• Country-wide PACS
– Radiologists– Referring physicians
• Equipment– X-ray - 143 (one unit per 9 400 inhabitants)
– CT - 19 (70 000)
– MRI - 10 (135 000)
– Angiography - 5 (270 000)
– Mammography - 6 (225 000)
– Nuclear medicine - 5 (270 000)
Last decade developmentNumber of units
Last decade developmentNumber of units
Last decade developmentUnits per 1 million
inhabitant
Last decade developmentUnits per 1 million
inhabitant
IT solutions in radiologyIT solutions in radiology• Country-wide PACS
– 39 radiology departments all over Estonia are connected– Accessible for radiologists and referring physicians– Radiology images
• Work in progress– Non-radiology images (endoscopy, eye fundus, dermatology etc.)
– ECG
• Additionally 6 hospital PACS´es• Estonian country-wide Health Information System
– Referrals and Reports
Economic growth in Estonia
Economic growth in Estonia
Economic growth in Estonia
Economic growth in Estonia
Incentives of different parites
Incentives of different parites
• Interested parties– State
• Health care policy• Guarantee radiology services for citizen
– Health Insurance Fund• Effectiveness (reduce costs)
– Society of Radiology• Professional working environment• Quality• International cooperation
– Major health care providers• Competitive services
Important events (1)Important events (1)
• 1991 – Establishment of Estonian Society of Radiology– Specification of radiology procedures– Accreditation of departments– Sertification of radiologists
• 1992 – Compulsory Health Insurance• 1994 – Radiation Act (modified 2004)– 1998 – Decree of Minister of Social Affairs
regarding use of ionizing radiation in health care
Important events (2)Important events (2)• 1997 – Primary care reform• 2000 – Estonian Hospital Master Plan 2015
– Decreasing the total number of hospitals from 68 to 15 by 2015
• 2001 – Health Services Organization Act – Hospitals are either foundations or joint-stock
companies• 2001 – Estonian Radiology Master Plan 2015• 2005-2009 – Acquiring resources to triple the number
of CT, MR and angio units• 2006 – Foundation of Estonian PACS
Estonian Radiology Master Plan 2001-2015
Estonian Radiology Master Plan 2001-2015
• Conditions for the radiology department in central or regional hospital by 2005 – Availability of X-ray, ultrasound, CT, MRT, NM, interventional
radiology– Electronic referral and report– Electronic archiving of radiology exams – country-wide PACS– Implementation of clinical-radiological meetings– Support from biomedical engineers– Implemented quality system of radiology service
Estonian Radiology Master Plan 2001-2015
Estonian Radiology Master Plan 2001-2015
• Definition of radiologists workload– By examination units
Structure of radiologists work time
Planning of procedures 5%
Time for procedures 15%
Reporting of images 20%
Cooperation with other clinicians 40%
Continous medical education 10%
Teaching 2% (up to 25%)
Others (radiation protection etc.) 8%
Important decisions in relation to economy
Important decisions in relation to economy
Important decisions in relation to economy
Important decisions in relation to economy
Consolidation of resources –
increase in purchasing
power
Important decisions in relation to economy
Important decisions in relation to economy
Consolidation of resources –
increase in purchasing
power
ConclusionsConclusions
• Economic recession fosters health care reforms• Reform options
– Policy change– New reimbursement schemes– Innovation
• It is important for radiology community to be involved in development of health care policy
