Kert Kingo (EKRE), Signe Risalo (Reform), Tanel Kiik (Center), Helmen Kütt (SDE), Marelle Erlenheim (Parempoolsed), Irja Lutsar (Eesti 200) and Lea Danilson-Järg (Isamaa) all took part in the third "Valimisstuudio" debate on issues related to healthcare.

Access to healthcare

Representing the Conservative People's Party of Estonia (EKRE), Kert Kingo said, that access to healthcare in Estonia's big cities is not as much of a problem as it is in rural areas, where there are no health centers and gaining access to family doctors can be difficult.

Kingo called for the entire medical system to be taken apart to find out exactly what the cause of all  the problems is. One option, she foresees, is to find alternatives to health insurance. "The Health Insurance Fund (Haigekassa) has been focused on making a profit and as a result, services have suffered. There has to be a solution, and every individual should be able to choose from where or whom they buy these services," Kingo said.

"We know that doctors and nurses are in short supply. What has been done to produce more of them? What has been done to ensure that those who do become doctors stay in Estonia to do their job?" Kingo asked.

Virology professor Irja Lutsar, who is running for Eesti 200, said that the healthcare system must be set up in a way that makes it simple to navigate for people when they are sick and require medical assistance.

Minister of Social Protection Signe Riisalo (Reform) said, that her party is committed to creating emergency medical centers, which should reduce the burden on both emergency and specialized care services.

She also advocated for an increase in the provision of e-medical services. According to Riisalo, family medical centers should be strongly encouraged to develop different areas of expertise.

Riisalo added, that hospital emergency rooms could accept patients, who have been referred there by family doctors, either in person or following a consultation via telephone.

Helmen Kütt of the Social Democratic Party also stressed the importance of primary healthcare and family doctors.

Minister of Justice Lea Danilson-Järg (Isamaa) pointed to the revenues generated as a result of economic growth as a potential source of funding for primary healthcare. "This is the foundation of our healthcare system, and sufficient resources must be provided to take the burden off the emergency rooms and specialists. People need to be able to get to a family doctor quickly," said Danilson-Järg.

She also called for a reduction of unnecessary bureaucracy. "Doctors should definitely be freed from paperwork. Digital solutions in the field of health, with instructions for patients, would help with this," Danilson-Järg said.

According to former Minister of Health and Labor Tanel Kiik (Center), the amount of money channeled into healthcare has to be increased. "A fair state is expensive. If we want to guarantee the same level of healthcare as the Nordic countries for example, then we need to put in an additional two to three percent of our GDP. That means €1 billion a year," Kiik said.

The family doctor system definitely needs strengthening and additional funding, Kiik said. However, Kiik said, that as things stand, there are no staff available to set up new support centers.

Marelle Erlenheim (Parempoolsed) said, that setting up support centers across Estonia cannot be the solution. "Because there are not lines in front of the emergency rooms everywhere (in Estonia)," she said.

Patients should also play their part in ensuring the healthcare, system is not overburdened, Erlenheim said. "We all have to contribute, not just the state, not just the health service providers. Our patients need to become smarter and understand that not everything necessarily needs to end up with a visit to the doctor's office," Erlenheim said.

According to Erlenheim, it is also necessary to assess whether some of the work of doctors can be automated. She added, that there would also be benefits to merging Tallinn's two central hospitals.

Irja Lutsar agreed in relation to emergency support centers, adding that they could be more beneficial in Tallinn and Tartu than elsewhere. According to Lutsar, it is also important to ensure people are able to receive medical care at weekends.

Kert Kingo stressed, that many people do not have access to their own family doctor, and in the best case scenario, medical advice is often provided by e-mail. "Phone calls are not answered and it is impossible to get an appointment. We have to find a solution to the problem of why people can't see their GPs," said Kingo.

According to Helmen Kütt, one solution the Social Democratic Party envisions to extend health insurance to everyone. "Then people who do not currently have health insurance, would not go to the emergency room because that is practically their only way of getting help in the case of an emergency," she said, adding that the move would cost around €80 million to implement.

Doctor shortages

The debate moved on to a discussion of the current shortage of doctors in Estonia. Signe Riisalo said, that the state should provide more support for experienced doctors to encourage them to work as GPs. It should also look at the possibility of bringing in foreign practitioners. "We need to teach them the language and skills," Riisalo said.

Riisalo pointed to workload and working environment as important factors to consider in order to ensure doctors and nurses stay in Estonia.

Kingo said, that as medical training is funded for by Estonian taxpayers, doctors should be stay in Estonia to work after qualifying. "It's elementary, there are no free lunches," Kingo said.

In response to Kingo, Lutsar compared the situation in Estonia to that of Ireland, pointing out that both are required to train people abroad due to being small countries.

"In Ireland, you can't study to become a specialist in infectious diseases, which affect children, for example," Lutsar said.

Kütt raised the issue of regional inequalities when it comes to healthcare. She suggested that one potential option would be to start offering higher salaries to doctors who are prepared to work in rural areas.

To this end, Riisalo suggested the possibility of introducing grants, or of GPs working together in pairs.

According to Erlenheim, training courses for family doctors ought to be adapted to meet individuals' needs. Let's try not to just apply a one-size-fits-all approach," Erlenheim said.

According to Danilson-Järg, Estonia's demographic crisis is also a factor in the current shortage of doctors. "We need to focus on making sure that there are good working conditions in those areas, which are very important for the country," Danilson-Järg said.

Tanel Kiik stressed the importance of introducing digital solutions to reduce the burden on medical staff.

According to Kert Kingo, the shortage of medical staff was exacerbated by the dismissal of those who did not want to be vaccinated against coronavirus.

Irja Lutsar added, that compromises cannot be made when it comes to providing medical training. She argued, that if students are admitted onto training programs too easily, there is an increased chance that they will drop out. "I think, that the current (level of) admissions is the right one," she said.

In response to a question on how to make more money available for healthcare, Helmen Kütt said, that funds could be transferred from the Unemployment Insurance Fund (Töötukassa). "This would provide €200 million to the Health Insurance Fund," she said.

According to Erlenheim, Eesti 200 would generally agree with this idea. "However, the assumption is, that the state budget is in such good shape that social security funds are no longer needed to achieve a balance, provide liquidity or for some other purpose than originally intended. Then, in that case, they can also be used wisely," Erlenheim said.

Lea Danilson-Järg said, emphasized the importance of providing more funds for healthcare. "We also see this as an opportunity to create the possibility for people to take out private health insurance and use private services. The more money we put into health services, the better. We also need to think about taxation," Danilson-Järg said.

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