Budget cuts reach health insurance.

TALLINN -- The Estonian government's Cabinet of Ministers on August 6 authorized the Minister of Social Affairs to vote for a reduction in the budget for the Health Insurance Fund 'Haigekassa' of 500 million kroons (32 million euros).

According to Minister of Social Affairs Hanno Pevkur, the Health Insurance Fund's council will gather for discussions on the budget issue and for its modification on August 28.

Pevkur says "These changes will basically concern the budget for this year, which needs to be changed, taking into account results of budget reductions in February, as well as from later reductions taken in a second round of cuts."

The Minister also added that "the reductions will not strongly affect the Haigekassa operations or the work of the current doctors."

Ida-Viru Central Hospital neurologist Anaid Galojan, however, considers that the decision to cut the budget for health insurance is a very difficult and sensitive question. "Cutting any part of the state budget cannot have positive results. One of the problems is the longer waiting times that develop for the patient, as this damages the health of the population. It also takes much longer to come back to the current healthcare system after making the changes," said Galojan.

"Economic crises come and go, but one of the biggest values to society, which is health, cannot be recovered 100 percent when it is destroyed," Galojan added.

Everyone who is covered by the state health insurance is also a client of the Health Insurance Fund.

The partners of the Health Insurance Fund are the health care providers such as hospitals, medical specialists, family physicians, dentists, pharmacies, professional societies and associations of health care providers, health promoters and other state agencies. Revenues from employer-paid social taxes that are designated for health insurance go into the Health Insurance Fund's budget. The Ministry of Social Affairs is the steward of the Estonian health care system.

According to the head of the Department of Neurology at Tartu University, Professor Toomas Asser, there is still no final decision on how to finance the healthcare system, though there are some sources which have never been used yet. "The problem should be solved, whether by tax increase or by cutting the doctors salaries, but the most important thing is not to prolong the waiting list of patients. I hope that the government would not cut the benefits for HIV patients, and there is a huge need as well for tuberculosis care, and I also hope that they won't cut help for children," said the professor.

Chief of the Supervision Department of the Health Care Board Peeter Mardna says that the budget cuts are important to get spending under control and to save money. Visits to the dentist are to be reduced, for example, an expense Haigekassa currently covers. This should result in savings of about 100 million kroons.

Mardna, however, considers that cutting doctors' salaries would not be in the best interests, as there are other ways to cut spending. "I think it is quite [feasible] to get the budget of Haigekassa under control. There have been some changes in the law, which was adopted on July 1, 2009, on the work contract between employers and employees according to which the medical insurance would not cover some of the expenses for the sick."

"The Estonian healthcare system needs doctors, and I agree with Tartu University professor emeritus Ain-Elmar Kaasik, who recently told KUKU Radio that in five years we will face another problem concerning a shortage of doctors. At this rate in five years we will need about 500-600 doctors," said Mardna. "The officials who make the [funding] decisions cannot imagine what would happen if the state cuts the salaries of young qualified specialists, who would start to leave for better paying conditions," he cautions.