Optimization
It’s crucial, especially in light of the current austerity measures, to focus on internal optimization within the healthcare system. This also includes putting a stop to the arms race among hospitals. Optimization is possible in all areas, but here are some specific proposals:
In Tallinn, we currently maintain four neonatal intensive care units (NICUs) operating 24/7. This requires covering shifts in situations where all units are struggling with staff shortages (in some units, more than 50% of doctor positions are unfilled, with similar issues for nurses and caregivers), leading to overtime work, duplication of equipment, increased administrative costs, etc. Additionally, the only hospital offering the highest level of intensive care does not have a maternity ward, which requires transporting critically ill newborns and separating them from their parents. This entire setup has long-term impacts on children’s treatment outcomes, which could also mean lower future income for the state.
Cancer patient treatment – do we need all procedures in all hospitals? Radiation therapy in both East Tallinn Central Hospital (ITK) and North Estonia Medical Centre (PERH)? The HIPEC procedure in both ITK and PERH? (It would be worthwhile to scrutinize the acquisition of equipment for this procedure, as there was an incident where a machine for one hospital was “accidentally” held up at customs, allowing another hospital to claim the credit for performing the first HIPEC procedure in Estonia.)
Supervision of services by the Health Insurance Fund – who codes the services, and how? This oversight is lacking, and hospitals are aware that they can essentially document whatever they wish. An example of this is home services—if a patient is admitted to the hospital, no one stops their outpatient services, and these continue in parallel.
As long as we manage hospitals like profit-driven businesses, everyone will want to perform expensive procedures and tests, but this is at odds with patients’ actual needs and the sustainability of healthcare funding.
Furthermore, it is odd to discuss salary cuts or tax increases when we are unable to internally optimize the system or effectively control the actual use of resources.
Recently added ideas
- Supported 1
- Don't believe in the idea 0
7 thoughts about the healthcare sector’s main problems
- Health concerns are not solved by the healthcare sector alone in the big picture, but rather by the economic success of society and the understanding at all levels of society that investing in health is worthwhile.
- Considering the current state of healthcare in Estonia, the idea of a mega-hospital …
- Supported 13
- Don't believe in the idea 10
Emergency services for a fee
- Supported 12
- Don't believe in the idea 7
Additional suggestions
The acquisition or construction of new or “unprecedentedly innovative” and expensive equipment (potentially costing millions of euros) in an institution should be evaluated from a national strategic perspective. The assessment should include:
a) Whether there is sufficient demand for the procedure or intervention in Estonia or the region, i.e., enough patients to justify the investment’s payback period.
b) Whether there is competent and sufficient personnel available to operate and maintain the equipment (payback period).
c) Whether the procedure or intervention is evidence-based and effective, i.e., what is the benefit to the patient?
The decision to invest should align with healthcare policy strategy and be based on the prudent use of taxpayer-funded health insurance money. It should not be left solely to the discretion of the institution’s management or financiers. The current national “indecision” allows institutions to engage in an arms race and make inefficient investments in machinery or infrastructure. In Sweden, local governments, who are also the local healthcare insurers, authorize the purchase of major equipment or investments. They determine whether such an investment is necessary and feasible in the region. Estonia could establish a strategic decision-making commission for major healthcare investments and the acquisition of expensive equipment. This commission would assess whether the specific investment of taxpayer money is justified.