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Financial results of the Health Insurance Fund for nine months of the year 2015

In the first nine months of 2015, the order for health services of the Health Insurance Fund amounted to 530 million euro, which is nearly 40 million euro more than in the same period last year.  Medications were compensated for 83 million euro and incapacity benefits were paid for 90 million euro.

This year, the funding for health care services has significantly increased. Compared to the same period of the previous year, the funding of health services grew by 8% or 39.6 million euro – funding of general medical care grew by 11%, specialized medical care by 7%, nursing care by 20% and funding of dental care by 13%.

During nine months of 2015, the family doctor service was funded at a total of 69 million euro, which is approximately 7 million euro more than the year before. The reasons for the growth are: reference prices of family doctor services have increased from the beginning of the year, additional remuneration for a second family nurse, key money, capitation fees and premiums for time worked outside normal hours. In addition, the use of the therapy fund for speech therapy and psychological services, which are now funded for family doctors as a new alternative. From 2015, the limit on the research fund also increased for all family doctors.

Within nine months, the Health Insurance Fund paid 418 million euro for specialized medical care to medical institutions for approximately 2.4 million treatment cases, which is 15.7 million euro more than in the same period last year. The number of people for whom the Health Insurance Fund provided funded services for nine months has grown by 1,600 people.

Based on the reports submitted to the Health Insurance Fund, as of October 1, 205 thousand appointments are registered for waiting times for specialized medical care.  The number of appointments registered for a waiting time has grown more than 15 thousand compared to the previous year. The number of patients in a waiting time over the maximum allowable time has decreased, and more people access the appointments within the waiting time allowed.

During the first nine months of 2015, 70% of first planned outpatient appointments for specialized medical care in hospitals, which were specified in the development plan of the hospital network, took place within the maximum allowed length (up to 42 calendar days).

In the first half of the year, the Health Insurance Fund paid 21.5 million euro for nursing care services, including increases in the financing of stationary nursing care by 20%, compared to the first nine months of the year 2014.  The number of in-home nursing visits increased by 18%. The result is to be expected since the aim of the Health Insurance Fund is to improve independent nursing care, in particular, the availability of home care services and stationary nursing care.

Within nine months of the year 2015, the Health Insurance Fund paid a total of 16 million euro for dental care services, including an increase in the number of children receiving dental care by 3,300.

Compensation for discount medicines amounted to 83.1 million euro, based on 5.9 million prescriptions. Compared to the same period of the previous year, the funding of medicines has increased approximately 3%.

The temporary incapacity to work was compensated for in a total of 90 million euro, which is almost 11 million euro more than in the same period last year. An increase in the benefits for temporary incapacity was caused by a higher average wage, growth in the number of employed insured people and more certificates for maternity leave.

Compared to the nine months of the year 2014, the volume of benefits for medical devices has increased by 1%, reaching 6.6 million euro. The number of users of medical devices has grown to over 8%.

Within nine months of 2015, the medical treatment of Estonian insured people in a foreign country amounted to 4.8 million euro of which the Health Insurance Fund paid 2.6 million euro to other Member States for the health services provided to seconded people, pensioners, and people staying temporarily in other Member States. Scheduled medical care abroad based on prior authorization by the Health Insurance Fund was funded for 2.1 million euro, and the Health Insurance Fund received medical bills from other countries for 232 people. Of these, 69 people needed treatment, 128 had medical examinations, and 35 insured people had expenses related to finding a bone marrow donor.

The full version of the report can also be read here.

Click here for a slide set summarizing the results of reports for nine months.