Agris Peedu, director of the North Estonia Medical Center (PERH), stated on the "Vikerhommik" radio program that the coming years will bring longer waiting times for planned outpatient appointments. "This is because, as has been reported in the media and stated by various government representatives, the Health Insurance Fund's financing is inadequate and reserves have already been used," Peedu said.

Reflecting on the new year, Peedu expressed significant concern over the Health Insurance Fund's treatment financing agreement. "Numerically, there is growth, but with certain caveats. When we look at the average cost per treatment case – a critical measure of how much funding we receive per patient – there is a downward trend," he explained.

Peedu noted that in 2024, PERH performed a significant amount of work beyond its financing agreement. "This shouldn't be confused with overtime. It's overwork – treating patients beyond what the financing agreement covers. When our treatment budget is exhausted, we're left with patients still in need of care, particularly emergency cases who arrive 24/7. Essentially, we're working at a discount. I sometimes call it a 'Black Friday' approach," he said.

When the hospital continues treating patients beyond the financing agreement, the Health Insurance Fund only partially reimburses these services, using a coefficient. However, the hospital must still pay its staff and ensure patients receive necessary medications, beds and other resources. "This ultimately comes at the expense of our future investments," Peedu acknowledged.

This primarily impacts the long-awaited psychiatry clinic project. The current Seewald complex, which requires investments, is not a viable option due to its status as a heritage-protected building. Another project awaiting funding is the second phase of the blood center, focused on blood production. "Our blood center handles over 70 percent of Estonia's blood supply. This is critical for the country's security and continuity," Peedu emphasized.

Given the financial constraints, Peedu encouraged people to rely more on their family doctors for health concerns. "Family doctors are the first point of contact in healthcare and will refer patients to specialists if necessary. Patients shouldn't feel disappointed if a referral isn't provided, as family doctors can often manage many health issues directly," he said. Peedu also reassured that while waiting times for specialist care may increase, emergency patients will always be treated immediately.

In addition to longer waiting lists, Peedu highlighted the growing number of patients visiting emergency departments as a major concern. He suggested stricter triaging could eventually become necessary. "We may need to tell some patients that their issue should first be addressed by a family doctor. Please schedule an appointment with a family nurse or doctor," he advised.

On a positive note, Peedu praised the Health Insurance Fund's decision at the end of last year to allocate additional funding for cancer treatments. He also assessed the hospital's staffing levels as very strong. "When our finance department analyzed the capacity of our clinicians, they found that, with current staffing levels, we could handle approximately €16 million worth of additional work compared to the Health Insurance Fund's 2025 budget allocation. This demonstrates the strength of our staff," Peedu said. However, he acknowledged staffing shortages in smaller hospitals in Hiiumaa, Rapla and Lääne County, where there is a clear lack of doctors and nurses.

Peedu also noted that healthcare workers have benefited from favorable collective agreements over the past seven to eight years.

"As a hospital director, I hope that a new collective agreement will be reached, ideally in 2025 or 2026, including a salary increase. But even if hospital profits look good, as you mentioned earlier, we cannot allocate those funds to additional salaries. This ultimately depends on whether the state can provide the necessary funding for wage increases," he concluded.

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