Feedback and suggestions
The most important function of the Estonian Health Insurance Fund (EHIF) is to organize health insurance in order to provide health insurance benefits to insured persons. EHIF is also responsible for contributing to the development of clinical standards and guidelines, motivating healthcare institutions to improve the quality of healthcare services, organizing the performance of international agreements involving health insurance and EHIF, participating in the planning of healthcare and providing an opinion concerning draft legislation and the drafts of international agreements related to EHIF and health insurance, as well as providing advise on issues related to health insurance.
Where to turn for advice or help in case of problems?
It is a very difficult task to achieve a state where all people are satisfied with healthcare. There can be several reasons for people’s dissatisfaction: fear that the doctor has made a wrong decision, people are not happy with doctors’ or other medical workers’ attitude or the conditions in the medical institutions, suspicion that medical institutions charge too much money, etc. Where can you turn for advice or help?
- You can contact EHIF when you are not satisfied with the availability of healthcare services (waiting lists / funding) or need information on treatment invoices. The main goal of the Estonian health insurance is to cover the healthcare costs of insured persons for the prevention and treatment of illnesses, to finance the purchase of pharmaceuticals and medical devices, and to pay temporary incapacity and other monetary benefits. EHIF is obliged under the law to check whether the services provided were reasoned and of required quality. To this end, we communicate with our contractual partners and check various documents prepared during the provision of a healthcare service (treatment invoices, reimbursable prescriptions, incapacity for work certificates), which must be medically reasoned and in accordance with the applicable legislation. To express your dissatisfaction, doubts or questions about a visit fee or treatment invoice you need to have a receipt or an invoice for the amount paid by the patient. You should also check the details of treatment services and treatment invoices on the patient portal. If you have reason to believe that the medical institution overcharged for your visit, you should contact EHIF. We take people's complaints very seriously and always check on service providers in those cases. Depending on the results of inspection, punitive measured set out in the contract will be applied.
- The Supervision Department of the Health Board inspects and assesses the adequacy and legality of the provision of healthcare services. The Health Board is responsible for carrying out compliance assessments for the registration and licensing of healthcare professionals, and for verifying the compliance of the service with the law - including whether the physician has duly complied with the documentation obligation, whether healthcare is available or the healthcare professional has complied with confidentiality and privacy requirements. The Health Board may initiate supervision proceedings based on a patient's complaint, depending on the circumstances of the complaint. The Health Board cannot assess the quality of healthcare services’ content.
- If you have doubts about the quality of a healthcare service you should consult the committee of experts on the quality of healthcare services. If the committee has detected a medical error, it will inform the physician responsible and the medical institution and, if necessary, propose to the professional association that the competence of the medical professional who made the mistake be verified. In its decision, the committee may give suggestions, advice or recommendations, but may not oblige a physician or medical institution to compensate the patient for the damage caused by a medical error. The patient has to turn to court to claim financial compensation.
- If a person doubts a physician's decision, he or she has the right to a secondary opinion. This means that he or she can ask another physician for an assessment for his or her health concerns. The physician who first diagnosed or treated the patient must provide the person who asked for a secondary opinion all information related to the patient's health concerns. Secondary opinion concerns the assessment of the accuracy of the diagnosis, the need for prescribed medicine or healthcare service, an assessment of explained alternatives and the expected effects and risks associated with the provision of healthcare service. The right to ask for a secondary opinion is also provided for in the Health Insurance Act.
- If you are dissatisfied with the conditions of a medical institution or the way healthcare professionals communicate, you should always first contact the management of the medical institution. Only then turn to either the social and health care department of the county government or the Ministry of Social Affairs. In the case of a family physician, you should also consider changing your family physician.