1. Imaging in Estonia – incentives to integrate Peeter Ross, MD President Estonian Society of Radiology MIR 2009 Riga

2. Million inhabitants Estonia1,34 Latvia2,23 Lithuania3,56

3. Factors affecting development Compulsory health insurance since 1992 –Health insurance tax – 13% (paid by employer) Income tax – 21% (flat tax) –Fee for service or DRG –5,0% of GDP for healthcare in 2005 and 2006 Health care service providers are municipal, governmental or private –All public hospitals are incorporated into private law Wide range of e-services and high bandwidth connectivity –Internet 75% of population (15-74 years) use regularly internet (2009) Wide spectrum of mobile internet services

4. Radiology. Current figures Approximately 200 radiologists (+34 residents) –149 radiologist per one million inhabitants Country-wide PACS –Radiologists –Referring physicians Equipment –X-ray-143 (one unit per 9 400 inhabitants) –CT-19 (70 000) –MRI-10 (135 000) –Angiography-5 (270 000) –Mammography-6 (225 000) –Nuclear medicine-5 (270 000)

5. Last decade development Number of units

6. Last decade development Units per 1 million inhabitant Last decade development Units per 1 million inhabitant

7. IT solutions in radiology Country-wide PACS –39 radiology departments all over Estonia are connected –Accessible for radiologists and referring physicians –Radiology images Work in progress –Non-radiology images (endoscopy, eye fundus, dermatology etc.) –ECG Additionally 6 hospital PACS´es Estonian country-wide Health Information System –Referrals and Reports

9. Economic growth in Estonia

11. Incentives of different parites Interested parties –State Health care policy Guarantee radiology services for citizen –Health Insurance Fund Effectiveness (reduce costs) –Society of Radiology Professional working environment Quality International cooperation –Major health care providers Competitive services

12. Important events (1) 1991 – Establishment of Estonian Society of Radiology –Specification of radiology procedures –Accreditation of departments –Sertification of radiologists 1992 – Compulsory Health Insurance 1994 – Radiation Act (modified 2004) –1998 – Decree of Minister of Social Affairs regarding use of ionizing radiation in health care

13. Important events (2) 1997 – Primary care reform 2000 – Estonian Hospital Master Plan 2015 –Decreasing the total number of hospitals from 68 to 15 by 2015 2001 – Health Services Organization Act –Hospitals are either foundations or joint- stock companies 2001 – Estonian Radiology Master Plan 2015 2005-2009 – Acquiring resources to triple the number of CT, MR and angio units 2006 – Foundation of Estonian PACS

14. Estonian Radiology Master Plan 2001-2015 Conditions for the radiology department in central or regional hospital by 2005 –Availability of X-ray, ultrasound, CT, MRT, NM, interventional radiology –Electronic referral and report –Electronic archiving of radiology exams – country-wide PACS –Implementation of clinical-radiological meetings –Support from biomedical engineers –Implemented quality system of radiology service

15. Estonian Radiology Master Plan 2001-2015 Definition of radiologists workload –By examination units Structure of radiologists work time Planning of procedures5% Time for procedures15% Reporting of images20% Cooperation with other clinicians40% Continous medical education10% Teaching2% (up to 25%) Others (radiation protection etc.)8%

16. Important decisions in relation to economy

17. Consolidation of resources – increase in purchasing power

18. Important decisions in relation to economy Consolidation of resources – increase in purchasing power

19. Conclusions Economic recession fosters health care reforms Reform options –Policy change –New reimbursement schemes –Innovation It is important for radiology community to be involved in development of health care policy

20. Thank you! Peeter.Ross@itk.ee