This should be done as a precursor to discussing exactly what state support is needed, the prime minister went on.

A central hospital in Tallinn was first on the agenda during the last city administration made up of the Center Party and, latterly, the Social Democrats (SDE).

The conversation now has turned to transparency on the original plan – which reached design stage – and the interface between the capital and the state.

Tallinn is Estonia's wealthiest municipality, meaning the case would need to be made for significant state investment in the capital rather than elsewhere.

In a comment sent to ERR, Michal said: "Healthcare services in Tallinn must be integrated in the best interests of patients, and to provide optimal conditions to healthcare workers."

"The capital's healthcare reform and development needs to be carried out in collaboration with the North Estonia Medical Center (PERH), the Health Insurance Fund (Haigekassa) and the ministry, for a long-term perspective, as well as in cooperation with the private sector," the prime minister went on.

"This recommendation I gave freely to the previous city government, and I am extending it to the current one also."

"Renovating buildings, selling off unneeded ones, and then constructing new ones can only ensue once there is a concrete plan in place for the merger of various institutions. How this is being handled and its progress are not being communicated to the public," the prime minister went on.

Michal said that the current city government should not repeat the mistakes of its predecessor, which he characterized as starting with pouring the concrete as a "municipal catharsis," without first discussing why he concrete is being poured and for whose benefit.

"This means a short recommendation, while kindly and supportively offering a plan to provide better healthcare services in the capital, is that the city should clarify with stakeholders the bigger picture and patient benefits that can be achieved with the private sector. Then they can discuss exactly what level of state support is needed by Estonia's wealthiest city," Michal added.

"The state budget situation can be presented to city leaders by both finance and health ministers, albeit cast in different terms, but the situation itself will not change anytime soon," the prime minister added.

Tallinn announced a new international design tender for the planned hospital on Friday, even as the state has not pledged to finance the major project.

State money would be needed to complete the development, the city cannot go it alone. At the same time, the hospital as planned would have a far larger catchment area than simply within Tallinn city limits, and could even effectively serve the entire country.

The new medical campus, planned for the Lasnamäe district, would take on the responsibilities currently held by the Soviet-built East Tallinn Central Hospital (ITKH) on Ravi, and the West Tallinn Central Hospital (LTKH), on Paldiski mnt.

Finance Minister Jürgen Ligi (Reform) also last Friday had apparently dashed hopes that the state would support the hospital plan to the tune of €300 million. "I can immediately say no. The state does not have that kind of free money, and there are more serious issues in healthcare than concrete," he told ERR in characteristically acerbic style.

Despite this Tallinn Mayor Jevgeni Ossinovski (SDE) told ERR this Tuesday that the capital is moving forward with both the hospital design tender and the formulation of a financial plan.

Deputy Mayor Karl Sander Kase (Isamaa) also expressed hope that former Prime Minister Michal, a former Tallinn city councilor, would continue to support the establishment of the planned Tallinn Hospital.

The project's current estimated total cost is approximately €850 million, which as noted Tallinn cannot cover in full on its own.

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