Health care specialist
The system of the therapy fund changed on 1 July 2024. The therapy fund, through which family physicians have been able to refer their patients to a clinical psychologist, speech therapist, and physiotherapist, is now managed by the Health Insurance Fund.
Family physicians used to be able to refer a patient to any clinical psychologist, speech therapist, or physiotherapist, and depending on the service provider, the Health Insurance Fund paid for the service either in part or in full. As of July, family physicians or doctors providing treatment can only refer people to a service provider who is a partner of the Health Insurance Fund.
The change will eliminate co-payments for patients and create a fixed list of providers who offer services funded by the Health Insurance Fund.
All treatments or therapies for which a patient has an appointment booked or where their treatment is in progress as at 1 July 2024 will be completed and covered through the previous funds until the end of September 2025.
If the patient is unable to go to their appointment before the end of September and the service provider does not have a valid contract with the Health Insurance Fund as of 1 July, they must pay for the service themselves or contact their doctor again, who will assess the medical need and, if necessary, issue a new referral to see a suitable service provider.
The main goal of the change is to create clarity about which institutions provide what services that are covered by the Health Insurance Fund.
The main advantage for patients is that the service becomes more affordable as the contractual partner may not ask the patient for a co-payment for a service reimbursed by the Health Insurance Fund. The service provider does, however, have the right to charge the patient a visit fee.
The therapy fund system will become clearer because there will be a list of service providers, or contractual partners of the Health Insurance Fund, so the family physician or patient will not have to search for the service provider with the help of Google, for example.It also provided an opportunity to significantly free up the schedules of family physicians,
who previously had to be responsible for invoices, documentation, and encrypted data exchange for patients referred to the service within the framework of the therapy fund.
The contacts, locations, and services offered by current partners can be found on the website of the Health Insurance Fund (in Estonian).
As at September 2024, the Health Insurance Fund has a total of 108 contractual partners for the provision of independent physiotherapy in 100 locations across Estonia, for the provision of speech therapy services in 46 locations, and for the provision of psychology services in 42 locations.
The number of partners is growing, as new service providers will be added to the list at the beginning of 2025, which should also ensure better availability of the service.