1. Estonian Health Care System Jevgenia Makarova Kristel Kaur Tallinn 2006

3. Geographical and historical figures Area: 45.215 km² Bordered by the Russian Federation to the east and Latvia to the south Population: 1,4 million Male: 46 % female: 54 % Urban: 69 % rural: 31 %

4. Geographical and historical figures Life expectancy: male: 66,3 years female: 76,7 years Birth rate: 8,7 / 1000 population Average salaries: 500 Euro Average pension: 150 Euro

5. Geographical and historical figures 1940 occupation of Estonian Republic by USSR 1991 independence of the Estonian Republic total reform of the health care system Todays number of acute hospitals: 19

6. North-Estonian Regional Hospital Inpatient and outpatient treatment. 24-hour first aid. 613 beds altogether.

7. North-Estonian Regional Hospital Departments of general surgery, neurosurgery and neurology, cardiovascular surgery, cardiology and critical coronary care unit, trauma section and orthopedics, internal medicine, eyes, ear, nose and throat, thoracic surgery, urology, maxillae-facial surgery, intensive care unit.

8. North-Estonian Regional Hospital Consultative Clinic of the Mustamae Hospital. The doctors of this clinic work at the Mustamae Hospital.

9. North-Estonian Regional Hospital Psychiatric Hospital Inpatient and outpatient treatment of all mental diseases. There is also a modern paid department of non- psychotic disabilities with sauna, private rooms etc where it is possible just to cure your stress or any other problems.

10. East-Tallinn Central Hospital There are the biggest Gynecologic and Maternity Clinic in Estonia and one of the best equipped and modern eye disease centers in Estonia. Also has trauma center.

11. Tallinn Children's Hospital Inpatient and outpatient departments of pediatrics, ear-nose and throat diseases, traumatology and orthopedics, surgery, hemato-oncology. All the doctors are highly educated and speak English.

12. Tartu University Clinicum

13. Clinic of Cardiovascular and Total Surgery Surgical Clinic Ear Clinic Eye Clinic

14. Children's Clinic Women's Clinic

15. Cardiology Clinic Lung Clinic Dermatology Clinic Neurology Clinic Psychiatric Clinic Internal Diseases Clinic Dental Clinic

16. Traumatology Clinic

17. Medicover Swedish-Estonian Medical Center (private) 24-hour Hotline for emergency medical care; medical exams for adults and children; screenings and diagnostic tests; mammograms; annual flu shots; dentists(including 24-hour emergency dental care); ambulance service; home visits; gynecological and pregnancy care, etc.

18. Family Physician All persons insured with the Health Insurance Fund have a family practitioner. A person not residing in Estonia may also visit a family practitioner.

19. A person needs a referral from the family practitioner to visit a medical specialist. No referral is needed to visit a psychiatrist, gynaecologist, dermatovenerologist, ophthalmologist, dentist, pulmonologist (for tuberculosis treatment), infection specialist (for HIV/AIDS treatment), surgeon or orthopaedist (for traumatology).

20. The amount of the patients financial participation in the following cases: out-patient examination – a family practitioner can charge a visit fee of up to EEK 50, when making a home visit; specialised medical care – a visit fee up to EEK 50; transportation by ambulance in the case of emergency – free of charge; hospitalisation – an in-patient fee of up to EEK 25 per day and for up to 10 days per hospitalisation.

21. There is no in-patient fee: for children below the age of 19; in cases related to pregnancy and childbirth; in the case of intensive care.

22. It is possible to register with a family physician by submitting an application to the physician selected. It is also possible to change the physician; to this end one should submit an application to the new family physician. When visiting the new physician one should present an abstract of his/her medical record.

23. Primary care During the Soviet era, paediatricians worked as primary care doctors in special childrens polyclinics. It was common for patients to bypass polyclinics and health centres, visiting specialists directly.

24. Primary care is organized as the first level of contact with the health system.

25. Each family doctor has a list of registered patients. These lists cannot contain fewer than 1200 or more than 2000 patients (except in specific cases such as occur in some rural areas or on some islands). The average patient list size is 1600.

26. Family doctors usually operate in rented premises (sometimes in facilities which used to be polyclinics), although some doctors have taken out loans to build new facilities.

27. Family doctors are required to have at least 20 visiting hours a week, and practices should be open for at least 8 hours a day. In primary care, patients should be able to see their family doctor on the same day for acute problems; patients with chronic conditions have the right to see their family doctor within three days.

28. The 2002 results show that all patients with acute problems are able to access their family doctor on the same day, and that 97% of patients with chronic conditions see their family doctor within three days.

29. The national immunization programme is defined by the Minister of Social Affairs and implemented by the Health Protection Inspectorate. Immunization is the responsibility of family doctors, although school doctors are also allowed to undertake it.

30. All family doctors are required to work with at least one family nurse, even though there is a shortage of trained family nurses.

31. Nursing will take place in cooperation with the patient's GP and with a social worker from the municipal government if necessary.

32. Home nursing and care services are offered only in Tallinn.

33. The services are free for patients in the extent allocated from the budget of the City of Tallinn.

34. Target group: Patients who have left nursing hospitals or long- term treatment wards or other hospitals who need nursing care and not active treatment. Patients in whose case nursing care prevents hospitalisation Patients who are unable to move Chronically bedridden patients with serious physical problems People with reduced mobility Patients who have complicated nursing care needs that cannot be met by social workers or family members Terminally ill and dying patients

35. Patients in an acute psychotic state will not be taken in nursing care.

36. Performed procedures: Distribution and administration of medicaments Taking blood pressure Reading pulse Measuring temperature Measuring blood sugar with a glucometer Inserting a catheter in the bladder, inserting a permanent catheter, maintenance of catheters Change of dressing and care for ostomy Micro-enemas Removal of stitches from wounds Removal of casts Prevention of bedsores Care for wounds, incl. bedsores Position therapy Rehabilitation therapy at home Counselling

38. Nursing schools and their curricula have been developed to meet the standards of vocational high school and a bachelors degree.

39. Besides basic nursing training, Estonian medical schools also offer higher vocational training for midwives, optometrists, pharmacists, mid-level health protection specialists, radiology technicians, physiotherapists, dental technicians and lab technicians, as well as vocational-level training for long-term nursing specialists.

40. University of Tartu Faculty of Medicine for nurses with some work experience. These graduates are seen as the main resource for further training of basic and specialist nurses.

41. Nurses professional associations have been working to standardize the different nursing specialties.

42. The greatest shortage of nurses is in specialist areas, such as surgical nurses. Reasons for the shortfall include poor salaries, high levels of work-related stress, low job satisfaction and low professional status.

43. Nurses professional associations have been working to standardize the different nursing specialties.

44. Some efforts have been made to raise the status of nurses by increasing their responsibilities and introducing continuing education to the profession. The new Health Services Organization Act gives nursing care a legally well-defined status on a par with primary, specialist and emergency care.

45. In hospitals, nurses and nursing are increasingly being acknowledged independently, by doctors as well as by patients.

46. Thank you for your attention!