The Estonian Employers' Confederation has submitted several proposals to the government on how to reduce bureaucracy in occupational health — not only by streamlining processes, but also by expanding the authority of occupational health physicians.

"People who are flagged as possibly having a health issue are supposed to return to primary care, but for various reasons, many don't. In that light, employers' involvement could have a much greater impact on preventive health measures," said Marja-Liisa Alop, chair of the board at Meliva private clinics.

Employers are therefore calling for occupational health doctors to be allowed to order additional tests and conduct e-consultations at the expense of the Health Insurance Fund. While they currently have the right to do so, employers must pay for these services out of pocket.

"Access exists, but employers have to cover the costs, so it seems perfectly logical to tell people to see their family doctor instead," Alop said.

Employers also want to raise the tax-free cap on health-related benefits from €400 to €1,000.

"The current €400 limit was set in 2018, and since then, labor costs for healthcare professionals — which make up the bulk of healthcare service expenses — have risen by 96 to 99 percent," Alop added.

According to Ille Nakurt-Murumaa, head of the Estonian Association of Small and Medium-Sized Enterprises (EVEA), these proposals address minor issues instead of confronting the core problem. Nakurt-Murumaa, a lawyer with more than 30 years of experience in the field, argues that the current occupational health system doesn't work outside major cities and many employers are forced to shoulder unreasonable costs.

"The service is highly inconsistent in quality, which means it's high time we admit that the Republic of Estonia doesn't have the tax base to maintain two parallel systems of primary care — family medicine and occupational health," said Nakurt-Murumaa.

She also argued that there's no longer any need to routinely screen all employees working under employment contracts. Only those whose health has been affected by their work or who face risks due to the nature of their job should be referred to an occupational health specialist.

"It should definitely be needs-based, depending on a person's occupational risks. I also believe it shouldn't be mandatory the way it is now. Occupational health doctors themselves agree. We also need to rethink the exact frequency — how often someone should visit — and ensure that employees have the option to seek help if they feel, for instance, that repetitive strain from work has led to tendon issues," said Minister of Social Affairs Karmen Joller (Reform).

When drafting legislative changes, Joller said it is essential to consider the views of occupational health doctors and employers alike, since the latter bear the financial burden. Planning for a possible reform is only just beginning.

--

Follow ERR News on Facebook, Bluesky and X and never miss an update!