National Audit Office: Hospitals often use ambulances as taxis

According to a recent audit by the National Audit Office (NAO), ambulances are often called out to patients who should instead receive treatment from a family doctor or social worker. With hospitals often using ambulances in place of taxis, in the wrong circumstances, people could be left without access to the necessary life-saving medical attention.
According to a recent audit by the National Audit Office (NAO), ambulances in Estonia are often not used for their intended purpose, but instead for non-emergency journeys, which could be made using alternative forms of transport. The audit notes that around a quarter of call outs do not actually require an ambulance
Head of the audit Rauno Vinni, said that in many cases, it makes more sense for a patient to be treated by a family doctor or social worker instead of calling out an ambulance.
The audit also found that hospitals often use ambulances as if they are taxis, to transport patients who are in less critical condition. Overall, two thirds of patients taken from one hospital to another by ambulance were actually low priority. In Harju County, however, the proportion of journeys like that was as high as three quarters.
It was noted that hospitals would have to use other transport in place of an ambulance to make these trips, when ordering an ambulance is easy for hospitals and does not involve any additional costs for them.
"The problem is that if a series of bad circumstances coincide, such as a major incident occurring in an area where the ambulance needed is busy with another call, then a patient in critical condition may get that help late," said Vinni.
Due to a shortage of medically qualified emergency workers, the severity of calls is often overestimated. At the same time, however, no-one is monitoring the processing of ambulance calls by the emergency services.
Diligent use of the ambulance service would also save the state money, the auditing chief said.
"What we could do, based on indirect indicators, was look at how much these ambulance calls cost. On average, we can say that one call cost around €300, but the cost of a visit to a GP in 2023 was somewhere around €30. That difference is ten-fold. It shows just how much more expensive the ambulance service is," explained Vinni.
Ministry of Social Affairs has not solved problems
The National Audit Office concluded in its report that the Ministry of Social Affairs has, up to now, not provided the required leadership, nor has it taken the necessary steps to address these concerns. For a long time, the ministry has not had a clear view of what kind of ambulance service the Estonian state wants and is able to maintain.
The audit states that the sector has lacked a development strategy for years, the distribution of ambulance brigades in different service areas has not been specified in sufficient detail to assess their optimality, and the health authority 's ack of competence has prevented the organization of ambulance tenders.
As a result, the governance of Estonia's ambulance services sector is weak and a number of ambulance-related issues remain unregulated.
As a result, the governance of Estonia's ambulance services sector is weak and a number of ambulance-related issues remain unregulated.
The National Audit Office recommends that the Minister of Health take the lead when it comes to ambulance services and wants both the Health Board and the Health Insurance Fund to fulfil their responsibilities.
At the same time, the Minister of Health is also expected to improve the interconnection between various health services, including ambulances and family medicine, as well as the integration between the health and social sectors. To do so, the necessary legislative changes should be prepared and IT developments planned out.
However, the NAO also recommends that chair of the Health Insurance Fund's board could, for example, organize an open tender in order to select ambulance brigade operators.
Sikkut: Ministry drawing up action plan for development of ambulance services
Minister of Health Riina Sikkut (SDE) said that the audit's recommendations would be helpful for the organization of Estonia's ambulance system and confirmed that the ministry is in the process of drafting an action plan for its development.
The minister said that the draft being worked on also envision the creation of a dedicated steering group for ambulance services, which would enable the ministry to have a better overview of the performance of the Health Board and the Health Insurance Fund in relation to ambulance services.
"The development guidelines and the action plan will provide the parties with clear guidelines for the systematic development of the ambulance sector, including medical transport," Sikkut wrote in a letter to the NAO.
In order to better integrate the social and health sectors, the ministry plans to prepare an analysis including proposals for an integrated model for the organization of services by this May.
Rain Laane, board chair of the Health Insurance Fund, agreed with the main findings of the audit and confirmed that the Health Insurance Fund will continue to support the ambulance sector within the scope of its responsibilities. The Health Insurance Fund will launch an open tender process for ambulance services in the second half of the year, Laane told the National Audit Office.
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Editor: Michael Cole