Joller told ERR that Tallinn's plan to merge its three hospitals, ambulance service and dental clinic into a single healthcare group is a welcome move.

"Both the North Estonia Medical Center and Tartu University Hospital implemented this kind of accounting-based consolidation long ago," the minister added.

"As for Tallinn's plan — as far as I've been able to follow through media coverage — it does not yet amount to the creation of a joint hospital in a substantive sense, meaning a unified system for service delivery and quality management that would actually streamline the healthcare network. But as a first step, it's good and necessary. It will in turn make it easier to move forward with establishing a joint hospital based on Tallinn's hospitals and the state-owned North Estonia Medical Center," Joller said.

Joller said the government would be discussing the joint hospital issue this week and likely next week as well.

"The state and the City of Tallinn agree that meaningful changes to the way healthcare services are organized in the capital are essential. We're talking about a very significant part of Estonia's healthcare system. Hospitals in Tallinn provide about 46 percent of all specialized medical care in Estonia, hold over half of the country's hospital bed capacity and employ nearly one-third of Estonia's healthcare workers," the minister explained.

According to Joller, merging the hospitals and structuring the management of the resulting large hospital will be a long and complex process that requires careful consideration.

"Fortunately, we don't have to reinvent the wheel — we have past experience from Southern Estonia, where several hospitals were merged to form Tartu University Hospital. It took several years to organize services, staff and logistics. It's crucial to involve hospital leadership and staff in this process — because the joint hospital will become the largest employer in Estonia," Joller said.

The minister also noted that she has heard that hospital staff have many questions and feel uncertain about the merger. "We also need to consider the joint hospital's impact on Estonia's entire healthcare system. Doctors have said that there hasn't been enough public discussion. I agree, and we will improve on that," she added.

According to Joller, the first step from the state's perspective is to create a legal entity — a joint-stock company jointly owned by the city and the state, with 40 percent owned by Tallinn and 60 percent by the state. After that, work can proceed on developing a unified management system, organizing joint procurements, merging support functions and so on.

Joller: New building not a magic wand

The Tallinn city government has made the state's commitment to participating in the construction of a new hospital building a precondition for merging PERH with the city's other hospitals.

"Given the current situation, it should be clear to everyone — even without explanation — that we cannot make a financial promise in the hundreds of millions or up to a billion euros," the minister said.

Joller also reiterated a point previously made by her fellow party members, Prime Minister Kristen Michal and Tallinn Deputy Mayor Pärtel-Peeter Pere (Reform): that concrete and shovels won't solve the real issues in Tallinn's and the region's healthcare network and that solutions must start elsewhere.

"The building project planned for the Tallinn Hospital has drawn a lot of criticism, and it hasn't adequately taken into account the long-term needs — what services will be provided there and at what scale. It's no secret that hospital buildings in Tallinn are outdated and healthcare workers and patients genuinely need new facilities. But before moving forward, we need to carefully consider how much space is needed, for what purpose and how we account for changes in the profile of people who require hospital care," Joller explained.

At the same time, the minister believes this does not prevent progress on creating a joint hospital.

On Tuesday, the Tallinn city government decided to merge all of the city's hospitals: East Tallinn Central Hospital, West Tallinn Central Hospital, Tallinn Ambulance Service, Tallinn Dental Clinic and Tallinn Children's Hospital. The merger will bring the hospitals under a single healthcare group, although no immediate changes are planned in how medical services are provided.

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