There are too many hospitals in Estonia and too few rehabilitation and long treatment hospitals, reported Swedish consultants to the Estonian Ministry of Social Affairs at the end of April.
Two Swedish companies, Scandinavian Care Consultants and SWECO International, have since December 1999 examined relevant facts about health care in Estonia and visited 60 hospitals all over the country. There are at present 78 hospitals in Estonia, most of which are more than 20 years old.
The number of Estonian hospitals should be reduced to 13 in 15 years, while many can be transformed into rehabilitation and long treatment hospitals.
Roomelt Malviste, assistant to the chief doctor in Magdaleena hospital does not believe these reforms would better the condition of hospitals.
“The medical treatment in Estonia is not bad,” said Malviste. “I believe that reducing the number of hospitals to 13 does not improve the level of treatment.”
Peeter Mardna, member of the board of the Estonian Hospitals’ Association said that according to the new plan there will be 2.5 times less hospitals in Estonia than there are in Sweden or Norway. In Sweden there are 95 hospitals per 8.4 million people, in Norway there are 72 hospitals per 4.2 million people and in Estonia there should be 13 hospitals per 1.4 million people, Mardna said.
He also said that it is amazing that the most modern hospital in Estonia, built in Keila in 1989 has to be removed, and a hospital in the small town of Haapsalu will be turned into a regional hospital of Laanemaa province.
“This decision has been made by people, who are at the same time related to Laanemaa in their past or present,” said Mardna. Hannes Danilov, Secretary General at the Ministry of Social Affairs, who is leading the development plan, was a governor of Laanemaa province from 1994 to 1999, said Mardna.
Another member in the development team, chairman at the Social Affairs Committe in the Estonian Parliament Toomas Vilosius, has also tight links with Haapsalu, said Mardna. Vilosius has been working in a central hospital in Haapsalu for 16 years.
Most of the Estonian hospitals have been rebuilt during the last few years, but not according to a long- range plan, the consultants reported. In nearly all the hospitals there is an urgent need to make profound reconstructions and update the infrastructure with respect to area standards, hygiene facilities, ventilation, fire protection and lifts.
“The sanitary conditions in our hospital are the best in Tallinn and so is the medical equipment. Each ward has a separate toilet and a shower bath,” said Malviste. The Swedish consultants noted in their report that medical technology in Estonia is advancing at an increasing speed.
Although the secondary hospitals are very big and the rate of occupancy is often low, wardrooms are usually overcrowded, the consultants found. Compared to Swedish and Danish gross areas per bed, Estonian area standards are many times smaller. At the same time the average length of stay at the Estonian hospitals is much longer than in Scandinavia and should be reduced. The plan foresees sending patients to health care centers or to treat them at home.
“Patients do not stay long in our hospital. The average length of stay last year had dropped to 8.3 days. The treatment conditions in Estonia are not the same as in Sweden. Our patients do not have the same possibilities to cure at home and the number of nurses is many times smaller than in Western countries,” said Malviste.
Malviste said that the rate of occupancy in Magdaleena hospital is low because the hospital gets too few financial resources from the sick-fund. “Out of the 188 beds only 69.5 percent were filled last year. This year we predict a smaller occupancy, because the budget in the contract with the sick-fund was 8-10 percent smaller,” said Malviste.
Mardna said that Estonians have 30 times less money to spend on treatment. “The Estonian 2.4 billion kroon treatment budget allows us to spend 24,000 kroons on each patient, while Swedes can spend 30,000 Swedish kroons on a patient,” said Mardna.”It is superb to achieve such results with that amount of money.”
The development plan also foresees reducing the number of acute care beds from the present 8,200 to 3,100. This makes it possible to save one third of the operating costs on accute treatment and allows for better care of the growing number of aged people.
Patients, who need qualified treatment, should be concentrated in fewer hospitals in order to improve the quality of treatment. This will make it possible to concentrate a more professional staff and better medical equipment to fewer hospitals. Also the barriers between the different departments will fade away and the staff should start developing teamwork.
According to the new development plan, Estonia should be divided into four service regions so that each Estonian would live within 70 kilometers from an acute care hospital. This restructuring would enable patients to get medical treatment in 60 minutes.
The consultants also found that there are too many obstetrics departments in Estonia compared to the small number of deliveries last year.
Swedish specialists also noted that diseases and causes of death related to the socio-economic structure and to habits such as drinking, smoking and consumption of fat are significantly more common in Estonia than in Norway and Sweden. Malviste agreed with that statement saying that: “The average lifetime of Estonian men is short due to many different aspects such as socio-economic and nutrition traditions.”
The rebuilding and renovating of Estonian hospitals according to the above mentioned Hospital Master Plan for Estonia 2015 would cost about 5.5 billion kroons.
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