Telemedicine in Estonia

Estonia’s health and care system organisation

The main bodies responsible for planning, administration and regulation of healthcare in Estonia are the Ministry of Social Affairs, the Health Board, and the State Agency of Medicines.

Defined by the Health Services Organisation Act, healthcare providers are health care professionals or legal persons providing health services. Healthcare is divided into emergency medical care, general medical care, specialised medical care and nursing.

Family physicians are providers of general medical care. They may practice as sole proprietors or they may found companies that provide general medical care. Companies, sole proprietors or foundations which hold corresponding activity licences may provide specialised out-patient care. A company or foundation which holds a corresponding activity licence may own a hospital.

Nursing means out-patient or in-patient health services which are either provided by nurses and midwives together with family physicians, specialists or dentists, or independently.

The Government of the Republic establishes the procedure for co-operation in emergency medical care between the emergency medical staff, hospitals, rescue service agencies and police authorities. A company, sole proprietor, foundation or a state or local government rescue service agency which holds a corresponding activity licence may be the owner of an ambulance crew.

Through the Ministry of Social Affairs and its agencies, the state is responsible for development and implementation of overall health policy, including public health policy, and for supervision of health service quality and access. Its main function is regulation.

The Health Board’s main functions include the licencing of health care providers and the registering of health professionals, controlling the quality of health care provision (mainly by processing patient complaints), and funding and organising ambulance services. It is also responsible for ensuring adequate standards of hygiene and health protection. It enforces health protection legislation and is also responsible for communicable disease surveillance, national and local epidemiological services and implementation of Estonia’s national immunisation programme.

The State Agency of Medicines is responsible for the registration and quality control of drugs and for regulation of pharmaceutical trade (including imports and marketing). This agency also ensures the safety of donated blood and tissue transplants. It has some responsibility for the registration of medical technology.

Estonia’s health and care system financing

Health insurance in Estonia is organised by the Estonian Health Insurance Fund and its four local departments. The Estonian Health Insurance Fund is the only organisation in Estonia dealing with compulsory health insurance.

All persons insured with the Estonian 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 dentist, dermatovenerologist (for skin-related, sexually transmitted diseases), gynaecologist, infection specialist (for HIV/AIDS treatment), ophthalmologist, orthopaedist (for traumatology), psychiatrist, pulmonologist (for tuberculosis treatment), or surgeon.

In case emergency treatment is needed, a person may always go to the emergency reception or call an ambulance. The attending physician decides whether the patient needs in-patient treatment.

Only medicinal products included in the Estonian Health Insurance Fund’s list of medicinal products and registered in Estonia are compensated. Medicinal products are compensated according to the reference prices and price agreements when these exist. In other cases, the refund is based on the product’s retail price. Medicinal products are compensated on the basis of the diagnosis.

Estonia’s telemedicine strategy and legislation

Estonia’s national health authority launched a strategy for telemedicine in 2005. The regional authority has a chronic care management strategy that was launched in 2008.

As of December 2008, a nationwide Estonian health information system has been available for citizens and healthcare professionals. The information system includes certain data that is supposed to reflect the population’s health status, entered into the database either by the healthcare professional or by the patient him or herself. The content of the centrally stored information is governed by national legislation. This database is a part of the state information system. The Health Services Organisation Act and Associated Acts Amendment Act (accepted by the Parliament on 20 December, 2007) provide that, as of 1 September 2008, health care service providers are obliged to forward medical data to the Estonian National Health Information System.

To guarantee wide user acceptance of a central medical database, a foundation involving all main stakeholders in healthcare was created. The Estonian E-Health Foundation was established in October 2005 by the Ministry of Social Affairs and a range of other stakeholders. They include three main hospitals (Tartu University Hospital Foundation, North Estonia Medical Centre, and East Tallinn Central Hospital), the Estonian Hospital Association, the Estonian Family Doctors’ Association, and the Union of Estonian Emergency Medical Services.

The national authority has two strategies in other health-related or IT domains including telemedicine, called Health IT and IT/Digitisation, both launched in 2005. Estonia does not have legislation that deals with telemedicine specifically nor does it have legislation that in any way hinders or obstructs the implementation of telemedicine services.

This organisation has a strategy for telemedicine, launched in 2007. The organisation also has strategies for Health IT and IT/digitisation. Both were launched in 2007.