On the assessment of the demand for health care services and on planning of the contracts of financing treatments

The health insurance funds collected in the form of a social tax is the common property of the people covered by health insurance, so that in the event of illness to all insured persons the financial support needed for use of modern treatment and for covering the suddenly emerged, and often quite substantial medical expenses would be guaranteed. With the help of this money, under the Health Insurance Act, the Health Insurance Fund has the obligation to make the diagnosis and treatment equally accessible to all the people covered by health insurance.

To meet this objective, the Health Insurance Fund annually assesses the need of the insured patients for treatment or demand for specialist health services. The demand assessment is carried out on a county level, on the basis of the place of residence of the insured, i.e., subject to assessment is how great is the expected need of the insured persons residing in the county for specialist health services for the next year. Since the possibilities are always limited, the demand assessed for the following year is adjusted according to the financial possibilities, i.e., with the budget of the specialist health services, the limit value is annually confirmed by the Supervisory Board of the Health Insurance Fund.

For preparation of the contract bids of medical institutions, an analysis is conducted on whether the demand for particular specialist health services in the contract specialties, is sufficiently large so that it would ensure doctors and other healthcare resources in the county have a sufficient workload. It provides an input for considering whether the Health Insurance Fund is justified to conclude an agreement for the purchase of specific professional services in the county from the local contract partner, which is the general hospital included in the development plan of the hospital network, or another contract partner. For provision of medical services of other specialties, the Health Insurance Fund concludes contracts with central and regional hospitals and, if necessary, with other service providers to ensure in general the provision of the relevant professional services in Estonia. In conclusion, the contracts take place where the purchase of one or the other specialty services is optimal, sustainable and ensures high-quality results, taking into account the health care policy framework

In addition to the assessed demand and the geographical accessibility principles, upon the planning of volumes of the treatment in financing contracts, the temporal availability of the services, i.e., the waiting list information (for details see here), capability of health care institutions to provide the service, which depends largely on the availability of the health care resources (e.g., medical personnel), and the information on new health care services added to the health insurance packages are taken into account (for the list of health care services and its updating, see here).