The issue does not affect Tallinn alone, but is seen elsewhere in Estonia too.

Minister of Social Affairs Karmen Joller (Reform) said: "I have already asked to convene a round table, and we will start with ERs in Tallinn, because this issue is the most acute in Tallinn and Tartu, while it is significantly smaller in other municipalities. There are various options. The media has circulated the idea that referrals to ERs will definitely be introduced."

This option is used in Scandinavia. Another option, said Joller, a medical doctor by training, is directing people with minor ailments to on-call clinics instead of to ER. However, according to the minister, the experience of other countries demonstrates this does not reduce the burden on the healthcare system.

Elle-Mall Sadrak, head of the family doctors' association (X) said: "There is real hope that perhaps by autumn we could create something which would offer an alternative to ER on public holidays and weekends, for those patients who are not truly emergency department cases."

For instance, one easily accessible health center could start receiving patients on weekends and public holidays, though only with prior registration.

"In our opinion, this should not just be a walk-in system. If it was a walk-in, then people would pile up in the waiting room – you have many sick people there and diseases will start to spread," Sadrak added.

The rationale only works if access to ER is restricted, since people are unlikely to choose a clinic with limited treatment options when all tests can be done immediately at ER, it is argued.

Visit fees to a specialist at ER were raised to €20 last month, and public appeals have been made to avoid going to the ER with minor health concerns.

However neither of these actions has reduced the burden on emergency departments.

A study by the North Estonia Medical Center (PERH), in Tallinn, showed that the ER remains the first choice for many people.

Speaking about a survey, Marit Märk, head of ER at PERH, said: "66 percent of respondents had not contacted a family doctor beforehand and 77 percent had not used the free family doctor advisory line," before presenting at ER.

The issue is worsened by a shortage of doctors at PERH – from this month, the hospital has taken on five nurse practitioners to receive patients of this category, with two more to be added in June.

"This is a transition period. In the long run, we need to move towards a system where patients arriving in the green zone are pre-triaged – either through a family doctor's referral or via prior assessment through the advisory line," Märk added.

Cases where it is entirely appropriate to go to ER include chest pain, trauma, or bleeding, Märk said. Issues like joint or muscle pain, viral illnesses, or a common cold are cases which should be addressed by a family doctor and not ER, she went on.

Ultimately the decision on restrictions to ER access should be made at Ministry of Social Affairs level, the doctor added.

The hike to the specialist visit fee to €20 came into effect in April and was justified partly to reduce the burden on ER departments. The previous €5 fee had been in place for over a decade.

--

Follow ERR News on Facebook and Twitter and never miss an update!