Doctor hotlines sold to Confido due to staff, funding shortages

Estonia's family doctor hotline.
Estonia's family doctor hotline. Source: ERR

The previous owner of Estonia's family doctor hotline sold the service to Confido after it failed to reach an agreement with the Estonian Health Insurance Fund (EHIF) over funding needs. The pediatrician hotline, meanwhile, likewise ended up in the private healthcare group's hands as the retirement-age pediatricians who had been staffing the hotline couldn't work anymore and the previous owner failed to find new doctors to replace them.

Two nationwide hotlines operate in Estonia aimed at helping address simpler health concerns: the family doctor hotline 1220, and the pediatrician hotline 1599. Both have been acquired and are now being operated by the business tycoon Margus Linnamäe-owned Confido Healthcare Group, which year after year has continued its expansion in the country's medical landscape.

Psychiatrist-sexologist Imre Rammul, the former owner of longtime family doctor hotline operator Arstlik Perenõuandla OÜ, told ERR that the decision to sell to Confido in 2019 has a broader context.

Around 1987, Rammul and a good friend and colleague teamed up to establish the medical services cooperative Ave, which operated a helpline in Tartu. The  psychiatric-based helpline service was initially offered via a nonprofit using project funds raised by the gambling tax; later, this expanded to include broader medical consultations funded by sponsor money.

Some time later, they acquired another company offering consultation services, and continued operations under the Raviminfo/Arstiliin brand. This was funded by contracts with medical institutions, pharmacies and pharmaceutical companies. At the same time, they applied for fixed funding from the City of Tallinn, EHIF and beyond.

"We struck out with our applications the first time around, but then we hit 2004, when the health fund seemingly came across our application at the bottom of a drawer somewhere and announced a procurement titled 'Family Doctor Hotline,'" Rammul recalled.

Arstlik Perenõuandla OÜ won the contract in spring 2005. The hotline didn't yet have the short code 1220, but once that was established, an agreement was reached with EHIF that Arstlik Perenõuandla would retain the intellectual property and expertise, but the number would belong to the health fund.

EHIF, which since updated its Estonian-language name from Haigekassa to Tervisekassa, financed the service based on a price coefficient. Under the previous procurement this coefficient stood at 0.9, but in the provider's opinion was reduced too far at one point, the dispute over which even ended up in court.

As Arstlik Perenõuandla lost to EHIF in court, they didn't have the financial capacity to compete at a coeficient of 0.85, or 15 percent cheaper.

"A discount product like that wouldn't have ensured a sufficient quality of service, and on the other hand, at a coefficient of 1.0, we evidently would have been outbid," Rammul explained, noting that it turned out later that their competition had won the procurement at a coefficient of 0.92.

"At the time, selling seemed to be the safest and most reasonable option," he added.

And so a transaction took place in 2019 in accordance with which the family doctor hotline was acquired by Confido Healthcare Group OÜ that October.

According to Rammul, Confido had already asked around on two previous occasions about buying the hotline, and a deal was reached the third time around. He himself, he clarified, had not actively sought suitors for the hotline.

The former owner maintained that the size of the deal's price tag is confidential information, but acknowledged that it was a totally reasonable price at the time.

"We didn't foresee the arrival of COVID," he added, referring to the global COVID-19 pandemic that reached Estonia in spring 2020.

Pediatrician hotline staff retired

Estonia's nationwide pediatrician hotline, meanwhile, was taken over by Confido last August. The hotline, Estonia's first such premium-rate doctor hotline, had been operated by the Tallinn Children's Hospital Foundation since 1995.

Inna Kramer, CEO of the foundation, said that they sold the pediatrician hotline to Confido due to a shortage of labor to staff the line.

"We had pension age doctors who had reached a very solid age, and they just didn't have the energy or desire to continue," Kramer admitted. "We unfortunately were unable to find new employees."

She added that they initially reduced the hotline's hours of operation, but that didn't seem to be a good solution from the patients' perspective, and so the foundation began seeking an opportunity to get the service into better hands.

Kramer confirmed that the foundation got in touch with Confido itself, based on the fact that they also ran the family doctor hotline.

The pediatrician hotline charges a premium rate of €1 per minute; Kramer noted that this has remained the price ever since Estonia adopted the euro — i.e. 2011.

"It certainly wasn't terribly profitable," the foundation chief said. "It paid for the salaries of the doctors on duty."

She added that the conditions of the contract prevent her from revealing the transaction price.


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Editor: Aili Vahtla

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