Health Care after Semashko Estonian experience to share

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Health Care after SemashkoEstonian experience to
share

• JANE ALOP, MA, MPH
• Estonian Health Insurance Fund

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• ESTONIA
• population 1 342 409 (01.01.2007)
• 95 persons
• with EHIF or state health insurance
• 48,5 taxpayers
• 800 family physicians
• 66 hospitals incl
• 3 regional hospitals (one university hospital)
• 800 beds each
• 4 central hospitals
• 11 general hospitals
• 21 nursing hospitals

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Expectations and interest in developing HC
healthy people
SOCIETY
PROVIDER
PATIENTS
Help patients
Visit doctor ASAP
Develop the speciality
Get well paid
Best doctor on the earth
Have a good working conditions
Nice enviroment in hospital
..
Cheap drugs
PURCHASER
New technology
More and better services, less money
..
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????????
What are the priorities of development HC?
Who should be the initiator of unpopular
reforms and changes?
Who are able to lead up the changing process?
What are the best methods?
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Priorities

• Health care reforms in Estonia
• the early 1990s to secure health care funding
  (introduction of health insurance,
  purchaser-provider split and system of contracts)
• the late 1990s to improve the health system
  efficiency (PHC reform, hospital reform)
• new century to improve the health service
  quality (clinical guidelines, clinical audit,
  performance indicator, P4P) and public health
  (health promotion)

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The initiator

• New (changing) political and economic situation
  in Estonia
• politicians - health insurance
• government (Ministry of Social Affairs) PHC
  reform and hospital reform
• providers - doctors, hospital managers,
  specialists assotiations
• purchaser implementation of DRG
• PATIENT

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The leader

• Estonian Health Insurance Fundsince 1992
• ensure the effective and purposeful use of health
  insurance money
• maintain the database necessary for providing
  health insurance benefits
• participates in the planning of health care and
  gives opinions on the drafts of legislative
  provisions
• examines the quality and necessity of services
  partially or fully compensated for by the Health
  Insurance Fund

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The method

• Legislation health insurance
• Funding taxation, health insurance fund
• Different networks Health Promoting Hospital
• Different projects Performance Assessment Tool
  for Quality Improvement in Hospitals
• .

Are they enough effective?
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What you can do better!

• Implement your (health) political decisions!
• Complete your initialized reforms!
• Take care of good cooperation between different
  stakeholders and projects!
• Engage patient actively!

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Good Luck! jane.alop_at_haigekassa.ee