Longer treatment queues might be inevitable

Head of the Estonian Health Insurance Fund Rain Laane.

PHOTO: Tairo Lutter

Head of the Estonian Health Insurance Fund Rain Laane admits that there are plenty of unknown factors at play when it comes to the question of how quickly people will be able to see doctors again.

To what extent hospitals will be able to catch up after the emergency situation put scheduled treatment on hold depends, among other things, on how keen doctors and nurses are to go on holiday. Another concern is falling tax receipt that could cause the fund to change specialist care volumes.

Scheduled treatment was suspended in mid-March, while hospitals are now gradually returning to it. What will happen in terms of the fund’s planned treatment contracts?

We will not be making changes at first. We hope doctors and nurses will not go on holiday for four or five straight weeks in the summer.

The Ministry of Finance’s economic forecast suggests the Health Insurance Fund’s revenue from taxes will fall by €200 million this year. On the other hand, I think that catching up in terms of planned treatment is not so much a problem of money as staff. There are not enough people, while hospitals still need to maintain preparedness to see to coronavirus patients. While all hospitals will continue to see coronavirus patients, their treatment will take place in Tallinn, Tartu, Pärnu, Jõhvi and Kuressaare.

What will happen in terms of funding if a hospital fails to reach treatment volume specified in its contract by the end of June?

The money will be transferred to the second half-year. It is clear that patients might have to wait longer in some places.

The same amount of money will buy less treatment in the future – medical sector wages grew in April, overtime is now subject to a higher coefficient, to which we can add expenses on personal protective gear and disinfection of premises. Will queues to see doctors keep getting longer?

The fund pays for services based on a price list that already takes into account higher salaries.

We will also not be paying for protective gear indefinitely. We can compensate such expenses for up to 60 days after the emergency situation ends. On the other hand, the price of personal protective gear is forecast to come down as production volumes are growing.

We can raise the price of services next year if necessary.

We are also trying to promote cheaper treatment options, such as family doctors consulting with specialists to then treat patients on their own.

What type of risks does the fund need to keep in mind this year?

Money allocated in the supplementary budget is purpose-oriented and should something be left over, it will be added to the reserve controlled by the fund’s supervisory board and the government. We are keeping a close eye on receipt of tax.

Should the latter fall drastically, would you be forced to cut specialist care funding for hospitals, meaning less treatment and longer queues?

That is what it looks like, but we will see whether we can make use of reserves first because cuts would immediately affect patients. The important thing is to be flexible and make decisions quickly.

The year started out hopeful. Everything was upended by the March 12 emergency situation to contain the spread of the coronavirus. What were the fund’s income and expenses for the first three months?

A lot of companies have closed doors or suspended activities that is starting to affect the fund’s revenue.  Social tax receipt was down in March, while we are still a few million euros or a few percentage points in the black quarter-over-quarter.

On the other hand, we went on a cost-cutting regime as soon as the crisis began and have managed to save 15 percent. Treatment compensation for medical institutions fell by 5 percent.

It was clear by late March that healthcare needs additional funding. How much was the Health Insurance Fund given?

The Riigikogu allocated €213.2 million for covering costs associated with COVID-19, with the fund making monthly payments to its contractual partners. The crisis was shorter than we feared and we hope there might even be a little something left over.

When will you start compensating people for the first three sick days?

At the beginning of May when relevant legislation enters into force.

We made a number of sick leave payments longer than eight days recently. Around 500 payments did not go through because people had left wrong account numbers in the eesti.ee portal. It also turned out we couldn’t make payments to around 2,000 people for whom we had no data besides their name and personal identification code. Therefore, people who expect to be paid by the fund should visit the portal or email us their account number.

How should data move in an e-state?

Many have given their account number to the Tax Board and other state agencies, like the Health Insurance Fund, could have access to it, while data sharing is not permitted right now – there is no way for a person to even permit it.

I would also like to overturn a myth. People who owe money sometimes want their sick leave benefits to land on a different account in hopes of hiding income from bailiffs. Data moves electronically these days and debts are seized even before we make the payment.

Do sickness benefits confuse recipients?

People mainly ask us why they got so little in a situation where the state has promised to also pay for the first three sick days. We tell them that we pay 70 percent of daily wages. Secondly, the daily wage on which the benefit is calculated is based on the past year’s average. People who have gotten a raise this year might have forgotten they used to get paid less last year.

The rate of infection for COVID-19 started growing in March. How much money is the disease costing the fund?

The supplementary budget gave us €40.6 million, €33.6 million of which will be spent on longer sick leave certificates and €7 million on compensating the first three sick days if the sick leave certificate is for fewer than nine days. The employer will still have to pay for sick days four through eight.

Is the number of new certificates falling?

Yes, if for a time, we had 90,000 active certificates, the number came down to 34,000 by Tuesday. Comparing the first four months of the year, we issued 238,000 certificates this year and 171,000 in 2019 for an increase of 40 percent. Growth spiked in April.

The Health Insurance Fund opened its self-service portal where people can report having taken ill on March 16. How many have used it?

There were thousands of applications initially, while over 800 people asked us to revoke their certificates later – probably around the time it was communicated that going on sick leave without a valid reason is illegal. The symptoms of 550 patients were not deemed to be serious enough to warrant going on sick leave by family physicians. We are also planning on carrying out systematic checks on whether people have tried to defraud us.