The nationwide eBooking system allows individuals to view their digital referrals, appointments and search for available specialist appointments.

When a person logs into the website digiregistratuur.ee to book a doctor's appointment, they are presented with a view where both the patient and the Health Insurance Fund are checked by default under the payment section, meaning the system searches for both paid and free appointments.

However, if one accesses eBooking through the Health Portal at terviseportaal.ee, the default setting only has the patient box checked, meaning the system does not initially search for Health Insurance Fund-covered appointments.

If a user changes the setting to search only for appointments covered by the Health Insurance Fund, the system allows them to select the service category and county. However, after selecting a specific service, the system reverts back to also including the patient option, directing the user once again to view paid appointments.

This issue repeats when searching for appointments with a specialist in a different field. The website allows the user to select the service category, but after making the selection, the payment section automatically re-checks the patient box in addition to the Health Insurance Fund.

Since the Health Insurance Fund covers the cost of specialist care for insured individuals, ERR inquired TEHIK about why the system is structured in a way that directs patients to paid appointments.

Tõnis Jaagus, TEHIK's head of health services, explained that users had not previously flagged this issue, but it has been the case since the Health Portal was launched at the end of November last year.

"People likely overlook this because they use other filters when searching for appointments, which allows them to adjust the funding source to their preference," Jaagus added. "However, we emphasize that the need for specialist care is assessed by a family doctor, who will issue a referral to the appropriate specialist if necessary. Without a referral, it is possible to book appointments with an ophthalmologist, dermatologist, gynecologist or psychiatrist. When a referral is present, the Health Insurance Fund is automatically selected as the payer when accessing the eBooking system through the Health Portal."

Jaagus clarified that the system was not designed to steer users toward paid appointments.

"We are working with the Health Insurance Fund to ensure that more Health Insurance Fund-covered appointments are available in the system. It will become more user-friendly this autumn when it is fully integrated into the Health Portal. Although the business rules will remain the same, the new solution will better incorporate user feedback and be easier to use," he added.

Jaagus assured that the new system would not encounter the previously described issue, which was caused by navigating between two different environments. He stated that eBooking is regularly tested, and the filters selected by users are currently functioning as expected.

"It is not possible to select a service funded by the Health Insurance Fund if a referral is required to book an appointment or if the service must be paid for by the patient alone. Whether the service provider offers paid or free appointments depends on the provider," he said.

Jaagus noted that the business rules for the eBooking system have been the same since the beginning. The selection in the payment section is influenced by whether the service being sought requires a referral and whether only paid appointments are available.

He added that if the service requires a referral, the patient is always marked as the payer and a warning stating "a referral is required, or payment by the patient is necessary" is displayed. If the service does not require a referral, both the patient and the Health Insurance Fund are marked as payers, with a notification indicating that it is a service not requiring a referral.

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