County hospitals may be cut in future

Emergency care.
Emergency care. Source: Margus Muld/ERR

An aging population and its concentration in bigger cities such as Tallinn and Tartu forces a review the current hospital network. As a result, it may be possible that in a few decades from now, treatment at the current level may be suspended in the smaller counties.

Estonia's populace is aging quickly; the elderly have more health issues and there are more and more of those who have to deal with several chronic diseases at the same time. The current health care system won't handle the workload.

"These issues, chronic diseases, are curable, diagnosable, preventable on the primary level, health awareness and prevention measures are mainly introduced by family doctors," draftsman of the hospital network development plan Jaanus Pikani said. 

The new draftsmen of the development plan wish to transform smaller hospitals into so-called community hospitals, which would be a part of the primary level, i.e. the family doctor system.

"Many countries have already implemented this system where the treatment is led by general or primary level doctors, not specialists. There isn't a 24/7 reception, but the accessibility to treatment is enough to prevent people from going to emergency care departments," Pikani said.

The hospitals would be primarily meant for patients with chronic diseases and the main workload would be on nurses. This solution could be implemented in Haapsalu, Paide, Jõgeva and Põlva.

In the case of the second proposed option, the development of the primary care and the hospital network is planned separately, the organization of hospital treatment would remain the task of the local hospital. Each region would have its own central hospital to cover the need for specialist care.

"On-site admission of internal medicine would remain in these hospitals and the ambulance should be strengthened so that those patients who need specialist care can be taken to where this level is," Pikani said. 

The change in the hospital network also creates the need for a change in the current training system; it would be necessary to significantly increase the number of family doctors as well as expand the skills.

"Then we will review the order of training for doctors, further increase the order of training for family doctors, change the residency program for family doctors, maybe it will be necessary to change the training of doctors in general," head of the Ministry of Social Affairs' Health System Development Department Agris Koppel said. 

Although the deadline for the new development plan is 2040, the head of the Estonian Family Medicine Association Le Vallikivi said, it is necessary to change the training order in the coming years because it takes ten years to train one doctor.

"At the moment, when only a quarter of the residency orders are for family doctors, such a perspective is not even conceivable, because this perspective doesn't cover the need for family doctors," Vallikivi said.

Starting on Tuesday, the options of the new development plan will be presented to the representative organizations of doctors, and in January it is hoped that an agreement will be reached on which solution to start implementing.


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Editor: Roberta Vaino

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