AHTI KALLIKORM ⟩ A giant hospital would be too much

Ahti Kallikorm, editor of the "Society and Health" section of Fookus. Photo: Kadri Purje

• Tallinn needs a hospital in the Mustamäe city district that would measure up.
• Tallinn Children's Hospital, maternity hospitals should be merged with North Estonia Medical Center.
• Merging Tallinn's central hospitals would take away doctors' ability to choose their employer.

Just as one should not keep all their eggs in one basket, not all hospitals operating in the capital city should be lumped together. While merging the East Tallinn and West Tallinn central hospitals and the Tallinn Children's Hospital might seem like a good idea, the North Estonia Medical Center should maintain its independence. On the one hand, this would preserve competition; on the other, pouring a billion into concrete instead of investing in human resources feels like throwing a party during a plague, editor and doctor Ahti Kallikorm writes.

Estonia's healthcare system faces complex challenges, as an aging population leads to rising medical costs, which in turn drive up overall healthcare spending. It is likely this increase in costs is the very iceberg that Minister of Social Affairs Karmen Joller (Reform Party) hopes to avoid crashing into – after all, the Health Insurance Fund's projected deficit from 2025 to 2028 exceeds 800 million euros.

As always, there are no solutions available that are 100 percent perfect. The same rule applies to the (major) hospital being planned in Tallinn, which is supposed to consolidate all hospitals currently operating in the city according to the 2040 hospital network development plan. But are the proportions really appropriate? The services of the East Tallinn Central Hospital and West Tallinn Central Hospital would move to a modern medical campus in Lasnamäe, while the North Estonia Medical Center would remain in Mustamäe. According to the current plan, the state would be the majority shareholder of the unified hospital, with the City of Tallinn as the minority shareholder.

Who remembers the original cost estimate for Rail Baltic and where it stands now, even though it is not even halfway finished?

Let us not delve into the details of this giant complex – suffice it to say that this is by far the largest construction project in Estonian healthcare, with a projected construction cost on the same scale as the Health Insurance Fund's four-year deficit (around 850 million euros). I do not want to jinx it, but who remembers the original cost estimate for Rail Baltic and where it stands now, even though it is not even halfway finished?

The plot allocated for the Tallinn hospital complex in Lasnamäe. Photo: Sander Ilvest

If we wish to consolidate healthcare services in Tallinn, we should keep in mind that Estonia's hospital network is divided into three tiers: county-level hospitals, such as those in Põlva, Võru, and Viljandi; central hospitals, such as the East-Viru Central Hospital, and the East Tallinn and West Tallinn central hospitals. On the third and highest tier are the Tartu University Hospital, which handles the most complex work in South Estonia, and the North Estonia Medical Center, which serves Tallinn and other regions.

The North Estonia Medical Center does not yet match the level of Tartu University Hospital because of missing specialties. Therefore, it would make sense to strengthen the North Estonia Medical Center by merging it with the children's and maternity hospitals. This would create a treatment facility in Tallinn that truly matches the Tartu University Hospital and the results of their work would be easy to compare and evaluate. The East Tallinn and West Tallinn central hospitals should of course be merged, but they should remain legally separate, so that the division of labor between a central hospital and a higher level remains clear. Then there would be no need to build such a large hospital building in Lasnamäe.

Although the merger might indeed lead to some cost savings, consolidating all of Tallinn's hospitals would eliminate all regional competition.​

Although the merger might indeed lead to some cost savings, consolidating all of Tallinn's hospitals would eliminate all regional competition. Where does a talented doctor go after submitting a resignation in frustration over a conflict with their boss? Right now, a valued physician can rather quickly find a new position at another hospital in the capital city. But what if the only option is a single large complex? Then the next stop might well be Finland.​

We do not want that. And who knows – maybe the Tallinn Hospital, in its currently planned form, is a giant iceberg that could tear a deep gash into our healthcare system?