Family Physicians Must Follow Their Job Description and Carry Out Their Contracts with the Health Insurance Fund

 

According to the evaluations of the Ministry of Social Affairs and the Estonian Health Insurance Fund family physicians are obligated to guarantee the availability of their services to patients on their practice lists according to the scope and manner prescribed in the Job Description for Family Physicians and Health Care Workers Employed in Their Practices. We are of the opinion that the strike of health care workers does not interfere with the family physicians carrying out their contracts because they can still receive and inform patients etc. during the strike.   The strike of the health care workers could only affect the daily work of a family physician as it interferes with purchasing diagnostic support services from the specialized medical care providers who have joined the strike. Family physicians can still refer patients to medical specialists, i.e. issue referrals to the patients.   The press statement made by the Society of Estonian Family Physicians on 1 October 2012 that the Health Insurance Fund only pays for 4 hours of appointments to family physicians and 3 hours to family nurses is misleading. Family medicine funding is largely based on capitation fees which are based on the presumption that the working time of a family physician is 7 hours and family nurse 8 hours a day in case of a minimum-sized practice list (1,200 people). As family physicians are also recompensed for tests and procedures, one hour of the doctors’ working time is compensated due to those.   Funding based on capitation fees means that the more a family physician has individuals on his/her practice list, the greater the amount of the capitation fees he/she receives, including the number of working hours compensated by the Health Insurance Fund. For example, if a family physician has 2,000 people on his/her practice list, then the physician can receive compensation for 11.7 working hours a day. This funding model is based on the presumption that as the practice list increases, the number of working hours and appointments of the family doctor and nurse also increase; consequently, it would be possible to hire extra employees if necessary.   We would also like to draw your attention to the fact that the emergency medical staff of the hospitals on strike still provides emergency medical care, thus ensuring that emergency patients receive all the necessary medical tests. Regular outpatient care, including diagnostic and laboratory tests, is provided to children up to 18 years of age and to oncology and haematology patients; gynaecologists continue to observe and treat pregnant women.   The Ministry of Social Affairs and the Estonian Health Insurance Fund are of the opinion that family physicians do not have any reason to change their organization of work during the strike of health care workers, and must therefore guarantee at least 20 hours a week for seeing patients, increasing the number of working hours in order to ensure the availability of medical care if necessary.   Therefore, family physicians are not entitled to mislead patients about the reception and working hours of family practices.