Tallinn City Government members are discussing the potential merger of several institutions and the subject of building a new hospital in Tallinn has been discussed for years.

"Nobody disputes the need to improve hospital infrastructure in Tallinn. But merging hospitals is something else. These are two different things," said Urmas Sule, head of Pärnu Hospital and the Estonian Hospitals Association, told Monday's "Terevision". "If you are going to build a hospital, you need to be very clear about who or what is going to be in it."

Sule said there are two options for merging hospitals in the Tallinn region under one management structure: "One option is to form a single legal entity, which will certainly have more than 10,000 employees. This would be the biggest company in Estonia. The other option is to merge the top management, the boards. And this should be a relatively simple operation."

Tiit Meren, a board member of the Tallinn Doctors Association, said the move is unlikely to reduce patient waiting times. A new hospital also raises more questions than it answers, he said. There is currently no "big picture" of what Estonia's healthcare system should look like.

Meren said a new hospital is "wishful thinking" although Tallinners have been hoping for a "new modern hospital" for a long time.

"We know what the state budget impasse is. We know what the possible intentions of a neighboring country are. Today, our decisions are influenced by many more factors than a few years ago," the doctor added.

Meren said the healthcare sector's problems are being solved from the wrong end. Those inside the system can see where the bottlenecks occur and how solutions introduced to fix them do not work.

"People come in and say they have not had a proper family doctor for a year," he said, adding the sector is "in crisis." The entire healthcare system is biased towards hospitals and specialists, the doctor said.

"In fact, a situation should be created where all those with health concerns go to the family doctor and the selection would take place from there," said Meren.

Sule said forming a new organization initially creates additional confusion and a long-term plan is needed. Additionally, "horizontal management" rather than top-down management is required in modern hospitals. He believes efforts need to be made to ensure mid-level managers cooperate.

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