Health centers being established or already operating are facing a situation where they cannot hire as many family physicians as they had initially hoped. In the worst case this may result in a recourse reaching hundreds of thousands of euros.
Health care facilities planned in county centers should theoretically be the most attractive. County centers are active places and most patients live there.
The reality, however, turns out to be different. As the 2.1 million euro health care facility in Põlva was completed late last year, some doctors’ offices remained empty on the opening day. They were unable to find as many physicians as they had promised the ministry.
“The Ministry of Social Affairs itself said that we should add at least two more places for practice above the preliminary agreements,” remembers Koit Jostov, the former board chairman of the Põlva hospital, who headed the establishment of the health care center. “They told us that if young doctors come here, they would want to have their practice in the county center rather than in some remote municipality.”
As already said, there were no free young family doctors available at least when the health care center was opened. The reasons why the doctors expected to join the center fail to show up are different. Many retire, but there are others fearing to lose their independence when signing up as family doctors. Too high rent and other lessees also play their role.
Another aspect in case of experienced family doctors is that they are used to their present location and satisfied with the situation.
“Relations between people also play a role quite frequently. The health centers cannot be made attractive enough for family doctors,” adds Agne Ojassaar, legal advisor of the Health Board health care services department.
But Jostov, the head of the Põlva hospital, decided not to take the risk, despite the ministry’s bold recommendation. Jostov decided to apply for one extra place, but failed to find a doctor for it. A family doctor retired at the same time, leaving another vacancy. The end result: minus two instead of nine doctors as promised in the application.
The Järva county hospital is facing the same difficulty. “We are so badly tangled up in the problems that we cannot go forward or turn back,” says Andres Müürsepp, the hospital’s board chairman. “It cannot be ruled out eventually that the Järva hospital, which developed real estate with the best of intentions, will have to pay a fine for failing its task and hiring eight doctors.”
The Järva hospital planned in its funding application submitted to the Ministry of Social Affairs that the Paide health center to be completed in 2020 will have places for eight family doctors. It has become clear by now that only five doctors will be available.
Since the hospital will lease space to the doctors, it may happen that the hospital will have to pay for maintaining the vacant space. And that is not the worst of it. If the hospital should fail to provide the services promised in the application, some EU support may be reclaimed.
Andres Müürsepp told the local paper Järva Teataja earlier that unless the vacancies will be filled, the state center of supportive services can reclaim 100,000 euros per every vacancy.
According to him, the crux of the problem is that while the hospital submitted the funding application, the services of the health center will be provided by the family doctors. The practices of the family doctors are independent legal entities and the hospital cannot influence or compel them in any way.
“We submitted the application, we are guilty. And now it may end up that we cheated the EU,” Müürsepp says.
Thus the hospital, together with the Paide town government, appealed to the Ministry of Social Affairs to motivate family doctors to join the center. But the ministry backs out and says that they cannot compel anyone. The Health Board gave the same answer.
“We would like very much the doctors concentrating in health centers, but we cannot force them,” Ojassaar says.
The actual plan of forming health care centers is ambitious: almost the whole Estonia should be covered with primary-level health centers by 2023. They will number 61 altogether.
Local governments, hospitals and family doctors involved in the health care network development plan and provides of special medical services received support for building the health care centers. Three quarters of the project’s funding comes from the European Regional Development Fund, the remaining quarter is the contribution of the participants. Total cost of the 61 projects is roughly 173 million euros with the structural support amounting to nearly half of it.
Both the Põlva and Järva hospitals applied for money for having a brand new primary-level health care center built in their territory, concentrating the region’s family doctors and nurses, physiotherapists and midwives.
Hospital managers, who talked to Postimees, are also critical about the suddenly amended regulation. The regulation of March 2018 stipulates that the recipient of the support must ensure the services planned in the project within three months after the issuing of the operating license.
The earlier regulation of 2015 did not contain the three-month requirement. It stipulated that the recipients should proceed from common sense.
“We are building these centers so that the young doctors still studying would have an opportunity and reason to go somewhere else but Tartu or Tallinn. But we have to realize the agreements with people who are currently working and will retire in the near future,” says Urmas Sule, head of the Estonian Association of Hospitals and board chairman of the Pärnu hospital. “This is the essential conflict. And, honestly, there is no solution fitting everybody.”
Heli Paluste, head of the Ministry of Social Affairs health care network, admits that other health care centers face the same problem. “There are difficulties with finding doctors, but also problems with providing other services,” she says.
Although the Estonian Association of Hospitals and the Association of Estonian Cities and Rural Municipalities, besides the Järva county hospital and the town of Paide, have asked the ministry to amend the three-month rule, the ministry sees no reason to do so.
Paluste says that the solution is much simpler. If a hospital, having applied for money, notices that it cannot meet the family doctors’ target, it can immediately inform the ministry. If there are no obstructing factors, the ministry will grant a reprieve.
“They have to say that they can find the family doctors within three years for example, and ask for approval for their absence. This is what the Põlva hospital did. They asked for an extension and received it,” Paluste says.
“A financial reclaim may happen if the three-month term – which indeed did not exist previously – should run out and an inspection would show that there are no promised doctors,” Paluste explains.