Availability of Health Services in Regional and Central hospitals in February 2012
Availability of Health Services in Regional and Central hospitals in February 2012
06.03.2012This year, the Estonian Health Insurance Fund continues the inspection of data pertaining to the waiting lists of specialties with a longer waiting period in regional and central hospitals. The aim of the inspection is to monitor the causes of long waiting lists in ambulatory specialised medical care and the terms and conditions of adding a person to a waiting list. According to the decision of the supervisory board of the Estonian Health Insurance Fund, the maximum length of a waiting list in case of ambulatory specialised medical care cannot exceed six weeks. A summary of the waiting list inspections organised on 1 August and 1 October 2011 can be read on the homepage of the Estonian Health Insurance Fund. In the beginning of February, the waiting lists of regional hospitals and Tallinn’s central hospitals were inspected; more specifically, the specialties in case of which, the availability of health services has been problematic according to the opinion of the regional departments of the Estonian Health Insurance Fund, were inspected. East Viru Central Hospital and Pärnu Hospital were excluded from this inspection, as individual specialties have longer waiting lists due to the shortage of staff, and no changes are going to occur in the foreseeable future in that respect, although the hospitals are trying to improve the situation. Similarly to other earlier inspections, this inspection also included a request for the first available free appointment (i.e. paid for by the Estonian Health Insurance Fund) offered to patients, as well as the free-charging appointment (paid for by the patient). The hospital’s adherence to the contract for financing medical treatment was also inspected. In addition, the inspection included appointments booked for return visits and for patients in need of emergency care (cito appointments). In North Estonia Medical Centre (PERH), the waiting lists for an ambulatory appointment with a medical specialist were inspected in the following specialties: urology, otorhinolaryngology, neurology, dermatovenerology, cardiology and endocrinology. Among these, the waiting list did not exceed the established maximum length in case of urology, otorhinolaryngology and cardiology. The insufficient number of doctors is the reason behind the long waiting lists in neurology, dermatovenerology and endocrinology. During the first quarter of the year, the medical institution plans to train nurses in the specialty of skin diseases and venereal diseases and to introduce appointments with nurses who could carry out simpler procedures. As a result, waiting lists to see medical specialists would become shorter. The medical institution believes that in case of endocrinology, the situation could be improved by introducing the family physician’s electronic consultation (i.e. appointment) system. At the moment, preparations are being made to join the pilot project. The system would help to decrease the number of times when patients are referred to a consultation with a medical specialist without grounds; thus, the workload of medical specialists would also become lighter. Emergency care is provided by the Department of Emergency Medicine and no separate cito appointments are booked for medical specialists’ consultations. Individual appointments are booked for return visits and depending on the specialty, they make up ca. 20–53% of all appointments. In Tartu University Hospital (TÜK), the waiting lists for an ambulatory appointment with a medical specialist were inspected in the following specialties: general surgery, urology, orthopaedics, otorhinolaryngology, rheumatology, gastroenterology, endocrinology and medical rehabilitation. The waiting list remained within the established maximum length only in the case of otorhinolaryngology. In order to improve availability of general surgery, orthopaedics and medical rehabilitation, the Estonian Health Insurance Fund has entered into negotiations on amending the volume of the contract on ambulatory services. The medical institution has reviewed the ambulatory work volumes of corresponding specialities and their appointment schedules and planned additional ambulatory appointments in endocrinology, rheumatology and medical rehabilitation. A new orthopaedic doctor has been hired to work in the specialty of orthopaedics. The specialties of neurosurgery and neurology were excluded from this TÜK inspection due to long waiting lists. The medical institution claims that there will not be any changes in the waiting lists of these specialties in the foreseeable future, as it is impossible to shorten the waiting lists – neither by employing doctors nor by solving the matter with an additional contract. The Estonian Health Insurance Fund is trying to improve the availability in the specialty of neurology by using contractual partners that do not belong among the hospitals included in the Hospital Network Development Plan. Depending on the specialty, emergency care appointments make up 6–12% and return visits ca. 20–53% of all the appointments. In West Tallinn Central Hospital (LTKH), the waiting lists for an ambulatory appointment with a medical specialist were inspected in the following specialties: urology, psychiatry, endocrinology and dermatovenerology. Among these, the waiting list remained within the established maximum length in urology and psychiatry. In the specialties of endocrinology and dermatovenerology, the medical institution cited the lack of capacity (doctors) as the reason for the long waiting list. In case of dermatovenerology, negotiations are underway to employ another doctor. One endocrinologist has left the medical institution; the workload of others has become heavier. No ambulatory appointments are planned for emergency care. All patients who need emergency care are served by doctors who see ambulatory patients out of turn, or sent to the Department of Emergency Medicine. Return visits make up ca. 30% of ambulatory appointments. In East Tallinn Central Hospital (ITK), the waiting lists for an ambulatory appointment with a medical specialist were inspected in the following specialties: vascular surgery, endocrinology, ophthalmology, otorhinolaryngology and dermatovenerology. At the time of the inspection, the waiting list remained within the prescribed length in the specialties of endocrinology, ophthalmology and otorhinolaryngology. According to the opinion of the medical institution, in the case of vascular surgery and dermatovenerology, money is the reason behind the length of the waiting lists exceeding 6 weeks. The Estonian Health Insurance Fund has entered into negotiations for the revision of contractual volumes. The percentage of emergency appointments varies, depending on both the specialty and the day of the week (1–20 appointments per day). In addition, patients in need of emergency care are served by the Department of Emergency Medicine. Return visits make up ca. 30% of ambulatory appointments. In Tallinn Children’s Hospital (TL), the availability of appointments with a medical specialist was inspected in ophthalmology, where, as of the beginning of February, the waiting list exceeded the allowed maximum length. According to the medical institution’s explanation, this was caused by the shortage of doctors. The hospital is actively seeking personnel. The management boards of all the inspected hospitals have received feedback on the results of the inspection. They have been asked to present a plan for measures to solve the problems related to the availability of health care services. All in all, it can be said that based on the results of the inspection conducted in February, the waiting lists exceeding 6 weeks were mainly caused by the shortage of personnel working in the corresponding specialties. In case of the inspected specialties, the number of hours allocated to fee-charging appointments was, similarly to earlier inspections, considerably smaller compared to the time allocated to appointments that were free of charge. Despite that fact, patients are more likely to get an appointment sooner if they are willing to pay for it. At the same time, there are hospitals and specialties where the fee-paying appointments remain unused. In order to improve the availability of health care services for insured persons within the established maximum length of the waiting list, the Estonian Health Insurance Fund will, if necessary, make a suggestion to review and amend contractual volumes with service providers. Such a solution is possible for specialties where the hospital’s capacity allows providing more ambulatory services and thus shorten the waiting lists. Medical institutions have tried to find opportunities to improve availability by reorganising their activities and increasing the number of appointments or cooperating more closely with family physicians. More information about the requirements for availability and waiting lists can be found on the homepage of the Estonian Health Insurance Fund.
Health Care Department