New reimbursement models
New service models also require new ways of reimbursing. Financing for Estonian healthcare services is largely based on the fee-for-service model. This approach does not support integrated patient care.
Integrated payment models were tested within the framework of pilot projects. The reimbursement model tied together the technological component and the healthcare worker's time. In addition, the call also experimented with outcome-based performance pay related to patient health and experience indicators. This meant that payment was based on the final outcome and impact on the patient, rather than the number of procedures performed.
These are important experiments because when using such payment models, healthcare service providers engage in closer collaboration and are motivated to make organizational changes, including in quality systems for e-services and training, to ensure that patients receive assistance in the best possible way.
Funding clinical assistants and treatment planning through the List of Health Care Services
The payment models tested in pilots included compensation for new roles and activities of healthcare workers. Some of which have been partially included in the permanent Health Care Services List, meaning they are funded for all healthcare service providers.
An important part of the Pre-visit project was the clinical assistant/health analyst, who supported the work of primary care centers in managing and resolving patient concerns. Since July 1, 2023, compensation for primary care clinical assistants has been included in the List of Health Care Services, allowing additional workforce to be brought to primary care to provide medical care under increasing workload. This allows the family doctor to focus on medical work while the team around them supports them in administrative activities.
One part of the service in the proactive health journey digital designer project (OTT) was the creating a treatment plan for the patient. The health center, in collaboration with the patient, created a personalized health or treatment plan using motivational interviewing, which included the patient's goals and activities. The role of the family doctor and their team was to empower patients to take care of their health. Funding for treatment planning is also provided through the healthcare services list as of July 1, 2023.