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An incompetent tender has created a situation where two Harju County cities have lost access to critical medical services. The health insurance fund acknowledges the problem and is in crisis talks with major hospitals, while no quick solution is on the horizon yet.
Specialist medical care tenders took place on the county level last year and this time, the Kallavere Hospital in Maardu and Mediluks in Paldiski did not qualify for a contract, meaning that residents are forced to seek out specialist doctors in the capital Tallinn.
The winners are neither interested nor obligated to offer services in small cities as the tender concerned the whole of Harju County that includes Tallinn. This has led to a situation where Paldiski has lost all free specialist doctor appointments, while Maardu only retains some.
While the Kallavere Hospital won dermatology and venereal disease, as well as post-surgery recovery specialties, residents of the city have no access to gynecologists or orthopedists. Paldiski has lost all funded specialist doctor appointments as the contract of recent service provider Mediluks was not renewed.
The problem is illustrated by a recent incident that took place in a Tallinn hospital where a young man and a woman wearing a cast on her leg wanted an x-ray. The visit was supposed to be a regular checkup.
The patient was told that while the doctor was indisposed that day, it would be possible in two weeks’ time. One could have the x-ray taken in Paldiski, sent to the capital and hear back from the doctor in that time.
“We’re from Paldiski where there are no more doctors,” the man explained. It is also no longer possible to take x-ray images in the city.
Vivika Tamra, chief PR specialist for the Estonian Health Insurance Fund, admitted that availability of medical care close to home is not ensured in this situation. “We have discussed how to improve the next tender to retain the service in different areas. The tender could have been more successful, but we could not foresee the result,” she said.
Tamra added that future tenders will have to consider more flexible solutions to make sure services are retained everywhere. “It would be bad if specialist doctors could only be found at the two largest centers. That is not our interest,” she said.
For now, the fund is negotiating with the North Estonia Medical Center (PERH) and the East Tallinn Central Hospital (ITK) to have the major hospitals offer services in Maardu and Paldiski. Neither is obligated to operate in those areas. Negotiations are still underway.
Chairman of the board at PERH Agris Peedu said that planning specialist medical care is a time- consuming process that requires careful consideration. He added that the priority of PERH is to ensure the hospital is always fully staffed. ITK is similarly less than enthusiastic about offering services in small places. The hospital’s marketing chief Inge Suder said that ITK does not have enough specialists to offer appointments in Paldiski.
The West Tallinn Central Hospital (LTKH) has already turned the fund down because the premises and equipment were not found to be good enough. Spokesperson for the hospital Liisa Suba said LTKH is understaffed as it is, which is why it cannot send its doctor off to Paldiski.
Vivika Tamra said it is possible to turn to family doctors in both Maardu and Paldiski.
The Ministry of Social Affairs told Postimees that new first contact medical centers are being built all over Estonia that will bring new services for the family medical care level. In addition to family doctors and nurses, the medical centers will employ physiotherapists and midwives, offer nursing care servicesand other specialists as necessary.
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