The Ministry of the Interior is seeking a solution to the fact that foreigners who have come to Estonia to work or study lack systemic access to primary healthcare. While individuals working in Estonia also pay taxes, they do not receive the healthcare to which they are entitled alongside all other students and employees studying and working in Estonia.

The Estonian-born Skype, which since 2011 has been under the ownership of Microsoft, employs some 100 foreigners in Estonia. Skype has opted to solve this issue by going the route of private medicine — which ensures faster access, no language barrier, and the desire to serve. All of Skype's employees in Estonia have health insurance as well. But not all employers solve the healthcare issue on behalf of their employees.

And so foreigners are faced with both a language barrier and a lack of information: many family doctors, or primary care physicians (PCP), refuse to accept patients who do not speak Estonian out of fear of ending up in a jam with English themselves; many older doctors, nurses and administrative personnel simply don't speak English at all; the Health Board's family doctor registry is likewise only available in Estonian. Which is why so many foreigners who have fallen ill and do not have a family doctor simply end up going to the emergency room to seek care.

Few doctors willing to take on foreign patients

"In order to serve patients in English, it isn't just the doctor who has to speak English, but also the receptionist, the nurse, and all other staff," explained Dr. Karmen Joller, a member of the board of the Estonian Society of Family Doctors. "Even if they do speak English, they may not have space on their patient rosters [to accept new patients]. We've asked among our own family doctors — there's maybe about a dozen family doctors in Tallinn who have space on their rosters and would be willing to accept foreigners as patients. There aren't very many of them."

She noted that while the language barrier may be present on the patient's side, it is still ultimately the doctor who is responsible if a patient receives the wrong treatment after relying on Google Translate, for example, to express themselves.

"No specific institution exists exclusively for treating foreigners," Joller added.

Health Board lacks overview of gaps in care

Just how many foreigners without a family doctor may currently be working or studying in Estonia, the Health Board doesn't know. Officials will, however, help foreigners who contact them find a primary care doctor.

"The Health Board does not have such an overview," admitted Agne Ojassaar, a legal adviser at the Health Board's Department of Health Services. "We do not gather information regarding family doctors' language skills, but with the new generation, we will no doubt be seeing more and more family doctors who speak English. There is no doubt that the number of such family doctors is increasing all the time."

Work in Estonia, an Enterprise Estonia project promoting Estonia's work environment to foreigners, has admitted that the majority of foreigners working in Estonia only start to think about primary care doctors once they are already sick. During peak season, dozens of foreigners per week contact the program in seek of help finding a doctor. First and foremost, however, it is recruitment firms, the same that help foreigners find apartments and kindergartens, that provide this service as well.

"Estonia's medical system is often unfamiliar to foreigners; they don't know exactly to whom they should turn — and this info we can give them," said Work in Estonia program director Triin Visnapuu-Sepp. "When the first ones showed up at the International House of Estonia here, we couldn't find the answers right away, but by now, in cooperation with the Health Building opening soon at the Ülemiste campus as well as the Health Board, we have managed to direct them to the right places after all."

Health Board: Solution is to learn Estonian

According to Visnapuu-Sepp, a lot of foreigners opt to see private doctors instead. "Which is kind of sad in that they actually pay taxes just like we all do, and they should be able to receive state healthcare in exactly the same way," she added.

"The Health Board still sees as the solution that people who come to live and work here permanently learn Estonian in the long term," Ojasaar offered on the Health Board's behalf.

The Ministry of the Interior, meanwhile, finds that a thorough overview of family doctors with foreign language skills should be compiled.

"We certainly do not have any such systemic plans in the works at the moment," Ojasaar commented.

While in all likelihood no one has opted not to come to Estonia due to poor accessibility to local healthcare, as many often don't consider this until something comes up, Visnapuu-Sepp admitted that some may have decided to leave due to this issue going unresolved. At the same time, she added that while there is still a long way to go, progress has nonetheless been made over the past three years.

Doctors and the Health Board alike, however, agree that a bigger issue than foreigners is locals who likewise cannot find a family doctor.

"I wouldn't say that this foreigners issue is more pressing than people's access to family doctors in general," Ojasaar noted.