State wants to make pre-conscription health assessments more efficient

Call-up selectees in Tallinn's Mustamäe District heading off for conscription. July 2019.
Call-up selectees in Tallinn's Mustamäe District heading off for conscription. July 2019. Source: Priit Mürk/ERR

The Estonian government has initiated a bill with which it wants to simplify the health assessment process for call-up selectees for conscription in the Estonian Defense Forces (EDF). The change would impact both the publishing of data from centralized medical records as well as the makeup of the EDF's medical commissions.

The bill would cease the operations of the current three-member medical commissions as separate administrative bodies and transfer the right to assess call-up selectees' health to doctors appointed by the Defense Resources Agency (KRA) and EDF instead.

In a significant change, the bill would grant doctors default access to data in Estonia's centralized Health Information System (TIS), although people would retain the right to optionally prohibit access to it. Currently, access to TIS data by the Ministry of Defense's medical commissions is prohibited by default.

Merle Ulst, director of the KRA's Department of Persons Liable to National Defense Obligation, told ERR that while under current law, the members of a medical commission are appointed by the minister of defense, once the proposed changes enter into effect, it will be the director general of the KRA who will appoint and sign contracts with these doctors.

According to Ulst, the change would increase the efficiency of the health assessment process as it would no longer always be necessary to involve several specialists in assessing the health of a call-up selectee.

"If someone who has been called up for conscription has a health problem due to which they don't meet health requirements, then an assessment by the relevant specialist will suffice," she explained. "For example, if they're identified to have a medical condition that falls within the scope of an internist, then going forward, they won't also have to have their health assessed by a psychiatrist as well."

According to plan, call-up selectees will still be required to undergo assessment by at least two separate specialists — a family doctor or internist and a psychiatrist — and other specialists will only be involved as needed.

"The goal of the medical assessment is to ensure that the state of an individual's health is assessed objectively, regardless of whether they themselves have any complaints," Ulst said. "Several mandatory health examinations will continue to be conducted prior to conscription too, such as bloodwork and an EKG."

Further testing is done as well if needed, she added.

Doctor: Current system very resource intensive

Triinu-Mari Ots, a family doctor and director of Laagri Family Medical Center with over 20 years of experience serving on medical commissions, said that the legislative amendment will make the health assessment process for call-up selectees more rational, as medical commissions in their current form are very resource intensive, particularly in light of the current healthcare worker shortage.

According to Ots, the likelihood of a significant health problem going undetected under the new system will remain incredibly slim.

"That risk won't increase so long as there's even just one doctor who will continue to take a long look at the call-up selectee," she said.

"We recognize cases in which someone has a serious medical issue, but — as is the case everywhere — the opportunity for error remains," she continued. "That's not the commission's fault, however, but rather that of work left undone by society, because people's health awareness, including that of call-up selectees, should be better, and until one turns 18, a young person's health should be monitored by their family, school nurse and family doctor. An 18-year-old, however, should be a sensible adult already, who understands the importance of taking responsibility for their own health."

The doctor noted that even now, medical commissions aren't screening selectees for all possible health concerns.


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Editor: Aili Vahtla

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