Health Insurance Fund starts analysis of coronavirus-related expenditure

Kuressaare hospital patients transported to the mainland.
Kuressaare hospital patients transported to the mainland. Source: Margus Muld/ERR

The Estonian Health Insurance Fund (EHIF) launched a number of analyses and checks this week to assess coronavirus-prompted reorganizations in treatment and the availability of medical care. This includes an audit of Kuressaare Hospital.

Member of the management board of the Health Insurance Fund Maivi Parv said with the coronavirus having caused several changes and additional costs to hospitals, family doctors and dentists, the Health Insurance Fund is conducting multiple analyses and checks to determine if the use of funds has been targeted and whether or not treatment guidelines have been followed.

One of the analyses launched examines the consequences of suspension in scheduled treatment and whether or not the decision has increased the number of patients requiring hospitalization due to severe illnesses, such as infarction and ischemic stroke, Parv said.

The board will also check if certificates for sick leave have been issued on justified grounds.

An audit will also be carried out at Kuressaare Hospital on Estonia's large western island of Saaremaa to obtain an overview of treatment of coronavirus patients. The results of the audit will become clear in about a month.

The audit will be conducted by the Health Insurance Fund in cooperation with representatives of the North and South medical headquarters and the Estonian Society for Infectious Diseases. In the next review stage, treatment of coronavirus patients in other hospitals will be assessed as well.

Supplementary reporting will also be carried out with regard to the funding of first-level family medicine centers, which have been on call during the outbreak. Family medicine centers' expenses also grew in relation to increased use of personal protective equipment and reorganizations required for receiving coronavirus patients.

As several dental care clinics were also closed to curb the outbreak, designated clinics only provided emergency dental care, which also necessitated increased use of personal protective gear, the costs of which the Health Insurance Fund plans to compensate on the basis of documentation. 

The organization and provision of remote consultation will also be reviewed as part of the checks to be carried out into treatment documentation.

Several audits lie ahead

As the coronavirus has brought many changes and additional costs to hospitals, family doctors and dentists, the EHIF will carry out a number of analyzes and inspections.

"We will start in Kuressaare, because there are a considerable number of medical records there. In parallel, or next, we will do it in the following hospitals, where there have been corona-positive patients," said Parv.

The final stage of the audit will examine the activities of family doctors with coronavirus patients. Compliance with treatment guidelines and agreed criteria is assessed on a random basis.

"Whatever these results are, we get confirmation that they have either been well treated or there have been shortcomings. The audit's finding does not apply to one particular hospital, it is a lesson for the whole system. We are in a special situation today where all parties had to make decisions very quickly," said Parv.

The work organization, remuneration system, various guidelines and instructions will be reviewed to see if they worked or why they didn't.

"We're going to audit on an emergency basis, based on compliance agreements. If we have clarifying questions, we may want to expand the audit. We have to realize that the pace of work there has been three times more intense than usual. The results of the audit are all useful for the future, [to show] what we have to do differently, [or] change," said Parv.

The analysis also looks at the impact of suspending scheduled treatments.

"The EHIF is analyzing whether the suspension of planned treatment increased the hospitalization of patients with certain acute illnesses, such as a heart attack or stroke," he explained.


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Editor: Helen Wright

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