Organization of medical care for insured persons
How is Estonian medical and nursing care organized for an insured person?
The Estonian medical care consists of three levels: primary medical care, specialized medical care and nursing care.
In other words, the medical care system is like a three-step staircase: to resolve a health issue, you must first step on the first step of the stairs, i.e. go to your family physician. At the family physician, people are provided prompt counseling and necessary examinations and treatment. For example, a person with a chronic disease who needs medication or medical equipment to continue treatment should consult with his/her family physician. If necessary, the family physician will refer the person to the next steps, i.e. to a medical specialist or to a nurse.
If a health concern occurs unexpectedly and is very serious - such as an acute illness, trauma or poisoning - the person should contact the hospital's emergency department or call an ambulance on 112.
Estonia has a solidarity-based health insurance system. This means that health insurance money is collected from the 13% health insurance tax paid on the salaries of employed people. Health insurance contributions or access to the help do not depend on age, income or health risks. All insured persons in Estonia have the right to receive the same high-quality health care. The treatment costs of an insured person are paid by the Health Insurance Fund.
PEREARSTIABI
First contact in a healthcare system for a person with a health concern is his or her family physician or family nurse. The family physician, in cooperation with the family nurse, diagnoses and treats most diseases.
Each insured person has their own family physician. You can find the name of your family physician:
- at state portal eesti.ee under the service "Health insurance and family physician information"
- from the EHIF customer service line +372 669 6630
Every Estonian citizen and alien staying in Estonia on the basis of a residence permit has the right to register with the family physician and change a family physician based on an application.
Read more about registering with and changing a family physician: https://www.tervisekassa.ee/en/people/health-care-services/primary-health-care
N.B. If a person has a health concern but his/her family physician is not currently available, he/she can call the family physician advisory line 1220 or +372 634 6630. On this line, family physicians and nurses provide advice 24/7 in Estonian and Russian. Counseling in English is available daily from 3pm to 5pm.
SPECIALIZED MEDICAL CARE
In case of a health concern, you should first see your family physician, who, together with the family nurse, will diagnose and treat most diseases. The family physician will assess whether and how a medical specialist can help with the treatment. Family physicians can in many specialties also use the e-consultation service, which allows them to quickly consult a specialist and find out whether the patient needs to be referred to a specialist.
A patient is referred to a medical specialist if his/her health concerns require the intervention of a medical specialist in a narrower specialty. Persons in need of specialized medical care are registered on a waiting list depending on the severity of their healthcare problem. A person must receive the necessary medical care during a period when his/her state of health is not significantly deteriorating.
The insured has the right to choose a suitable medical specialist and book an appointment at any medical institution that has signed a contract with the Health Insurance Fund. The contract partners serve all the persons with the EHIF insurance cover, regardless of the place of residence of the insured person.
A referral is required to see a medical specialist. To get a referral, you must first consult a family physician. You can see an ophthalmologist, a specialist for skin and venereal diseases, a gynecologist and a psychiatrist without a referral.
Read more about specialized medical care here: https://www.tervisekassa.ee/en/people/health-care-services/specialised-medical-care
Find the service provider you need on the map https://www.tervisekassa.ee/inimesele/arsti-ja-oendusabi/haigekassa-lepingupartnerid
NURSING CARE
The purpose of nursing care is to maintain and, where possible, improve patients’ state of health and ability to cope, to provide treatment and support to patients in a stable condition and, if necessary, to alleviate their ailments. Nursing care also helps people prepare for going to a care institution or home. Nursing care is provided both in inpatient (hospital or care institution) and outpatient (home nursing, home supportive care for cancer patients) environment, depending on the patient’s needs.
Caregiving is a subject of both the healthcare and welfare systems.
Read more about nursing care: https://www.tervisekassa.ee/en/people/health-care-services/nursing-care
DENTAL CARE
insured persons are entitled to various dental benefits. Children, people in need of emergency care and people with special needs due to a medical condition are entitled to free dental care.
Free dental care, emergency medical care or dental benefits can only be used at dentists who have signed a contract with the EHIF. The reimbursable dental service must be listed in the health care services list of the Estonian Health Insurance Fund.
See the EHIF's contract partners here: https://www.tervisekassa.ee/hambaravi-partnerid
All adults with health insurance can receive a dental benefit of EUR 60 per year, with the patient paying at least 50% of the treatment invoice.
Payment for dental care is settled automatically between the dentist and the Health Insurance Fund. If the service provided by the dentist is reimbursed, the reimbursable amount will be deducted from the treatment invoice sum immediately upon payment.
In Estonia, dental care is free of charge for children under 19 years of age at the EHIF's contractual partner.
The EHIF also pays for children's orthodontics (including braces), but only for specific diagnoses.
Read more about dental care and benefits here: https://www.tervisekassa.ee/en/people/dental-care