Free movement in Health Care : Estonian perspective of the Finnish-Estonian

case

Maris JesseFormer 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 1999Estonia Finland

Average Life Exp. 70,7 years 77,3

GDP per capita 3 484 € 22 465 €

Total Health Expenditure per capita 219 Euro € 1 536 Euro €

Per 100 000 popDoctors 321 305Nurses 587 1361*

(*overestemated)Source : NOMESCO - 2000

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