Last year, a laborer from Saaremaa traveling to Tallinn for surgery could have both of his inguinal hernias repaired in a single procedure. Now, however, only one would be operated on at a time, as the EHIF will no longer cover the second simultaneous operation. This means the patient would have to return soon for a second surgery.

The same situation applies to anyone needing multiple skin lesions removed at once when it's unclear whether they are melanoma — a highly malignant skin cancer — or not.

"The reason given by EHIF is that most of the necessary supplies are used up in the first surgery, and the second procedure is not as costly," said Peep Talving, chief of the Acute Care Surgery Division at North Estonia Medical Center (PERH). "Previously, we were reimbursed 40 percent of the cost of the second operation; now, it's zero."

According to Talving, a double procedure nonetheless does incur additional costs. He also acknowledged that this change puts patients in a difficult position, as they may have to wait months for another procedure, and in some cases this may also require extended or repeat sick leave.

"A simultaneous operation means that a second procedure is carried out during a single operation," said Liis Salumäe, chief medical officer (CMO) at Tartu University Hospital (TÜK). "In that case, the payer has already determined what [procedures] we should be doing."

At TÜK, she added, the clinics, or departments, most affected by these changes are the Ear Clinic and the Eye Clinic.

According to Salumäe, medical professional associations have already reached out to EHIF to seek a solution to this new issue.

The Health Insurance Fund itself believes that the reimbursement for the primary operation should be sufficient to cover a secondary procedure as well.

"We're entering a period where EHIF's expenses will exceed its revenues by €170 million as early as in 2025," acknowledged EHIF partnerships manager Ergo Pallo. In this situation, he added, EHIF needs to find ways to cut costs.

"In outpatient surgery, where simultaneous operations account for around 7 percent of all procedures, we've changed this rule because we believe using two billing codes simultaneously isn't justified based on the complexity of the procedure," he explained.

EHIF has not analyzed the potential indirect costs of discontinuing coverage for simultaneous surgeries, such as prolonged sick leaves.

On top of this, PERH will be able to perform even fewer scheduled surgeries this year, as its treatment capacity has been slashed by €600,000.

"For example, a kidney stone requiring inpatient surgery may now have a wait time of six months instead of three," Talving admitted. "An orthopedic operation — other than a joint replacement — that previously had a three-month wait could now take four or five months."

TÜK estimates that its wait times for treatment should not increase significantly due to the change.

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