Healthcare in Estonia Liis Hinsberg Healthcare and Communications Department Estonian Health Insurance Fund 29.08.2016

Health insurance in Estonia Estonian health insurance is a social insurance and it relies on the principle of solidarity: the EHIF covers the cost of health services required by the person in case of illness regardless of the amount of social tax paid for the person concerned. Healthcare in Estonia January 30, 2017

Insured persons Insured persons are regulaar employees, self-employed persons, recipients of family benefits, students, children under the age of 19 etc. If a person visits a doctor then he/she has to present his/her ID card. Doctor then checks his/her insurance data online. Healthcare in Estonia January 30, 2017

Health Insurance Benefits NB! There is no reimbursement system for benefits in kind! Benefits in Kind Medical services Pharmaceuticals Medical devices Benefits in Cash Benefits in case of temporary incapacity for work Compensations for dental care of adult persons Supplementary compensation for pharmaceuticals Healthcare in Estonia January 30, 2017

Benefits in kind Medical services Primary care Specialist care (incl. rehabilitation) Nursing care Dental care (for children under the age of 19 and necessary dental care for adults). NB! This will change in July 2017 Cross-border treatment Benefits for medical - devices for everyone whose need to use a medical device has been established by a physician on the basis of the terms and conditions of the List of Medical Devices issued by the EHIF The person can buy medicinal products (pharmaceuticals) with fixed discount rates. Only medicinal products included in the EHIF’s list of medicinal products and registered in Estonia. Healthcare in Estonia January 30, 2017

Family physicians (GPs, primary care doctors) refer the patient to medical analyses and to a specialist, give advice concerning the prevention of diseases, take preventive measures and issues health certificates and prescriptions. treat most health issues. In case of acute illness the family physician must see the patient on the same day, otherwise within 5 working days. You can always call family physicians help line 1220 regarding health matters. The application form and list of family physicians  www.haigekassa.ee To find a family physician, please contact the Health Board at kesk@terviseamet.ee Healthcare in Estonia January 30, 2017

Referrals Referral is needed from the family practitioner to visit a specialized care doctor. No referral is needed for: psychiatrist, gynaecologist, dermatovenerologist, ophthalmologist, dentist, pulmonologist (for tuberculosis treatment), infection specialist (for HIV/AIDS treatment), surgeon or orthopaedist (for traumatology). Healthcare in Estonia January 30, 2017

Patients own contribution: co-payments Primary care is without co-payment (home visit up to 5 EUR) Specialist visit fee up to 5 EUR In-patient fee is up to 2.50 EUR per day and up to 25 EUR per hospitalisation There is no co-payment: For children below the age of 2, In cases related to pregnancy or childbirth, In cases of intensive care. Healthcare in Estonia January 30, 2017

Pharmaceuticals Medicinal products are reimbursed Via health services list (hospital care) Prescription pharmacy drugs reimbursed according to specified list validated by ministry Different discount rates apply to different diseases and pharmaceuticals EHIF compensates directly to hospitals and pharmacies Healthcare in Estonia January 30, 2017

Dental treatment Free for children under the age of 19 years Emergency dental care is free of charge – the necessity is decided by the doctor Not compensated to adults - pay for the whole service This will change in July 2017 Higher compensation rates for pregnant women, mothers of children up to 1 year of age and those having greater need for dental treatment because of sickness. Healthcare in Estonia January 30, 2017

In case of emergency Go to the emergency reception or call an ambulance (dial 112). Take your ID document and EHIC card/ insurance policy with you. Patient’s fee is 5 EUR or when not insured up to 50 EUR. ! However, we advise you not to turn to the emergency room if the treatment you require is not urgent and can be offered by family practitioner. The attending physician decides whether the patient needs in-patient treatment or not. Please see patient’s rights at The Estonian Patient Advocacy Association – www.epey.ee Healthcare in Estonia January 30, 2017

European Health Insurance Card (EHIC) EHIC grants the right to receive necessary medical care during your stay in the European Union and in the European Economic Area under the same conditions and at the same cost (free in some countries) as people insured in that country. Important! EHIC is not and alternatiive to travel insurance EHIC does not cover patients cost when travelling with the purpose of medical treatment EHIC does not guarantee free services Healthcare in Estonia January 30, 2017

European Health Insurance Card (EHIC) The European Health Insurance Card or its replacement certificate gives you the right for necessary health care during a temporary stay. Doctor decides whether necessary or not Does not apply for planned treatment – for planned treatment form E112 or S2 from the competent institution (or patients’ rights directive -> see next slide) Same rules and rights as for Estonian insured persons Health Insurance Fund’s partners www.haigekassa.ee Always show your card together with your ID Healthcare in Estonia January 30, 2017

You forgot your EHIC – now what? Turn to your insurance institution and request for a temporary replacement certificate Pay the bill at the health care provider’s. Then contact your insurance institution back home and send them the invoice together with the proof of payment (and application). After the procedure of payment authorisation, the costs will be reimbursed to you. <- Time-consuming! Healthcare in Estonia January 30, 2017

Important contacts Family physicians help line at 1220 or +372 6346 630 from abroad Advice in Estonian and Russian In case of an emergency (for police, ambulance or fire) call 112 When hesitating whether to call 1220 or 112, choose 1220 → in case your problem requires immediate assistance or ambulance, they will refer you to the emergency help line. Healthcare in Estonia January 30, 2017

Major hospitals North Estonia Medical Centre – www.regionaalhaigla.ee, +372 617 1995 East Tallinn Central Hospital – www.itk.ee, +372 622 7070 West Tallinn Central Hospital – www.keskhaigla.ee, 1314 or +372 667 0679 Emergency receptions: Ravi tn 18, J. Sütiste tee 19, Punane tn 18, Paldiski mnt 68. Healthcare in Estonia January 30, 2017

About insurance – turn to EHIF Insurance information and how to obtain the required medical benefits in Estonia is provided by EHIF. Call +372 669 6630 Write: info@haigekassa.ee Contact address: Lastekodu 48, Tallinn Website: www.haigekassa.ee benefits legislation digital prescriptions contacts of hospitals Healthcare in Estonia January 30, 2017

Keep in mind! Have your EHIC or insurance policy with you! Choose a family physician (GP)! Always call and book an appointment. Do not appear at the doctor’s unexpected. If you cannot go - call and cancel the appointment. Get a referral from your GP if you need to see a specialist. Healthcare in Estonia January 30, 2017

Thank you for your attention and have a safe stay! Contact me at Liis.Hinsberg@haigekassa.ee Healthcare in Estonia January 30, 2017