Health Insurance Fund to Pay More than One Million Euros in Premiums to Family Physicians within the Framework of the Quality System
In 2011, family physicians achieved the all-time best result in meeting quality indicators; consequently, the Health Insurance Fund will pay premiums on quality to a record number of family physicians (i.e. 389) totalling to 1,192,055 euros. Throughout the years, family physicians from the Pärnu region have achieved the highest results. From 109 family physicians in Hiiu, Lääne, Pärnu, Rapla and Saare counties, 102 participated in the quality system in 2011 and 71% of the participants achieved a good result. “The results of the last six years demonstrate that an increasing number of family physicians is motivated to participate in the quality indicator monitoring system and is becoming more and more active in the prevention of diseases and observing patients with chronic diseases,” said member of the Management Board of the Estonian Health Insurance Fund Mari Mathiesen when commenting on the results. This year, 53% of the participants receive premiums for meeting the quality indicators in 2011; this number is significantly higher compared to 2010 when only 39% fulfilled the goals. Moreover, the number of family physicians who achieved the highest possible result has increased – from 182 in 2012 to 311 last year. 106 family physicians will be receiving premiums for additional competence (assessing the professional certification of family physicians and family nurses, observing normal pregnancies, conducting minor surgical operations). An increasing number of medical professionals have participating in the quality system over the years: 718 individuals participated in 2010; last year, the number was 756; this year, 777 out of the 801 family physicians with an approved practice list in Estonia announced joining the family physicians’ quality premium system. This means that 97% of all family physicians have joined the system. Quality premiums are paid by the Health Insurance Fund as lump-sum benefits and a family physician that fulfils the indicators stands to receive up to 3,834.70 euros. In addition, this year the funds for medical tests and procedures increase by 3% for family physicians who have achieved good and excellent results; this means an additional 1,716 euros for medical tests for an average-sized practice list. The quality indicator system for family physicians is being developed by the Estonian Health Insurance Fund in cooperation with the Society of Estonian Family Physicians and was first implemented in 2006. Quality indicators are activities which are directed at preventing the exacerbation and complications of diseases. The selected groups of diseases have the greatest effect on the heath and mortality rate of the population and the chosen indicators have an internationally recognized evidence base for their effect on the health of individuals (e.g. hypertension, diabetes). Further information about the quality system of family physicians and its results are available on the Health Insurance Fund website at: http://www.haigekassa.ee/raviasutusele/perearst/kvaliteedisusteem.