“Towards Integrated Healthcare” conference

EHIF and the World Bank are organizing a conference in Tallinn, Estonia on October 25th – 26th. The event is held at the Space X center. The two organizations are introducing their report “Payment Systems Review” for the first time. The report gives an overview of developing strategic purchasing in Estonia. Furthermore, this will be the first time that the results for the risk management pilot project will be introduced.

Registration is open and free. Sign up with this link.

Conference 2017

October 25th

9:00 – 10:00 AM Registration

10:00 – 10:15 AM Opening remarks by Rain Laane, Chairman of the board, Estonian Health Insurance Fund

10:15 – 10:30 AMOverview of care integration in Estonia, Tanel Ross

  • What are the current challenges in healthcare integration in Estonia?
  • Update of the World Bank study phase 1 indicators

10:30 – 11:15 AM Estonian care management program pilot, The World Bank

11:15 – 12:15 PM Estonian care management program pilot – experiences from Estonian participants

  • Developments of primary care in Estonia—where are we today? Diana Ingerainen.
  • Results and experiences from the Estonian primary care doctors’ point of view. How to implement this into practices to ensure sustainability for the program? Elle-Mall Keevallik
  • The importance of teamwork to support patient-centered outcomes. Evelyn Joost

12:30 – 1:30 PM Lunch

1:30 PM – 2:15 PM "Estonian Enhanced Care Management: What’s Next", The World Bank

2:15  PM – 3:00 PM European Union Instruments for Practical Support to Health System Reforms,  European Commission DG Sante, Dr Loukianos Gatzoulis

3:00 PM - 3:30 PM Coffee break

3:30 PM – 4:15 PM  Presentation by the Ministry of Social Affairs, Maris Jesse

4:15 PM – 4:45 PM Conclusions and overview of the next day, moderator Hannes Hermaküla

October 26th

9:00 – 10:00 AM Registration

10:00 – 10:15 AMIntroduction of the day by moderator Hannes Hermaküla

10:15 – 10:45 AM„Payment System Review for Estonia – what did we find?” The World Bank.

10:45 – 11:15 AM "Opportunities in Strategic Purchasing and Care Integration in Estonia", Maivi Parv, member of the board, Estonian Health Insurance Fund

11:15 – 12:00 PM Panel Discussion: Where is the world heading in terms of strategic purchasing and care integration?

Panelists include the Estonian Health Insurance Fund, The World Bank, OECD, The Dutch National Institute for Public Health

12:00 - 1:00 PM Lunch

1:00 PM – 1:45 PM Can People Afford to Pay for Health Care? Coverage, Access and Financial Protection in Estonia.  Dr. Tamas Evetovits, Head of WHO Barcelona Office, WHO Regional Office for Europe.

1:45 PM – 2:15 PM Conclusions and overview of the conference, moderator Hannes Hermaküla

2:15 PM – 3:00 PM Press meet-up


Collaborations between the Estonian Health Insurance Fund and the World Bank

“The State of Care Integration in Estonia” second phase is the second collaboration between the Estonian Health Insurance Fund (EHIF) and The World Bank. In 2015, the first phase of the project ended and the report, which assessed the state of health care integration in Estonia and its driving forces, was presented in Tallinn. All conference materials from the previous phase summary can be found here.

In 2015, EHIF signed a cooperation agreement with the World Bank to continue analysis for the purposes of disease prevention, and improving access to health services; and the development of the health care system.

The expert team at World Bank has been working with EHIF to develop policy advice for the Estonian health care services contracting and payment system. The results are presented at this conference for the first time.

Estonian Treatment Management - Pilot Project

One of the main goals of stage II of the study is to develop a model that would help Estonian family physicians identify in their lists the patients whom the implementation of preventive, advisory and monitoring activities would most benefit: the patient's health and quality of life; and at the same time support the optimal use of health insurance resources.

Today, The World Bank in cooperation with EHIF, and with the family physicians participating in the project, have developed an evidence-based model of risk patients and started piloting the model since 15 February 2017. In total, the project involved eleven family physicians from different regions of Estonia. The pilot project ended by September 2017.

Participants on the Estonian side were:

Kersti Veidrik - Eraarst Kersti Veidrik

Ruth Kalda- Ülikooli Perearstikeskus

Helve Kansi - Helve Kansi

Katrin Martinson - Linnamõisa Perearstikeskus

Marje Oona - Ülikooli Perearstikeskus

Kerli Jaagosild - Kuressaare Perearstikeskus

Anne Kaldoja - Perearst Anne Kaldoja

Katrin Kurg - Järveotsa Perearstikeskus

Anneli Rätsep - Ülikooli Perearstikeskus

Anne Ager - Eraarst Kersti Veidrik

Sandra Soosaar - Ülikooli Perearstikeskus

Tiina Tamberg - Helve Kansi 

Ave Aberman -  Linnamõisa Perearstikeskus

Natalja Ivanova - Järveotsa Perearstikeskus

Laura Keidong - Kuressaare Perearstikeskus

Natalja Vabarna - Perearst Anne Kaldoja

Evelyn Joost - Laagri Perearst


Developing the evidence-based model of risk patients is targeted especially for Estonian family physicians using international studies and international experience. The aim of the model is to create a tool for primary health care workers (family physicians and family nurses) to identify better and manage the treatment process of chronically ill patients, integrating them with specialist medical care and social systems.

In the first stage of the preparation of the pilot project (January - February 2017), a patient monitoring web environment was developed for family physicians. This means that important data for family physicians (consisting of the health indicators and the medical history of the risk patients, as well as of the reference to the patient's socio-economic background) was located in the online environment, where the family physician and the family nurse had an overview of the health indicators of the so-called risk patients, and of the set treatment goals, based on planned activities, and can then monitor the implementation of the treatment plan.

What is Treatment Management?

Treatment Management is a means of improving the coordination of the treatment of the patients with complex and increased medical needs, both between the various levels of the health care, the social system, and between various providers of health care and social services. Treatment Management includes directional and preventive actions to a small portion of patients who are at high risk of health deterioration, or the risk of the increased use of health care services. Such actions may include, for example, patient monitoring after hospitalization, monitoring of referral to a medical specialist, and the results of the examinations; monitoring of the performance of the goals described in the family physicians’ quality system; ensuring the drug compatibility control and the usage; and monitoring of patients between scheduled appointments. Treatment Management is designed to address the needs of complicated patients in order to improve their health outcomes and reduce their need for more extensive health care services.  

Why is Treatment Management necessary?

All over the world, those who have a difficult socio-economic background make up only a small part of primary care patients, whereas the disease burden and health care costs of the people with lower socio-economic backgrounds account for a disproportionately large percentage. Many of these patients have multiple chronic diseases at one time, and they are confronted with major socio-economic problems, and/or simultaneously, they also have behavioral health comorbidities. They are likely to consume many different medications, visit several different medical specialists, and/or have significant functional restrictions.  Such characteristics may make coordination of the patient’s care difficult for primary health care providers, but failure to do so could lead to serious problems including unnecessary deterioration of health, duplication of examinations, mutual conflicts of the medication prescribed for treatment, and treatment errors. Treatment Management programs have a great potential for the improvement of  treatment coordination and patient’s treatment outcomes, and these programs are increasingly used by many different national health care systems.

Results of the pilot project are presented during the first day of the conference, October 25th.

Strategic Purchasing in Estonia „Payment Systems Review“

The review provides an assessment of the current health care payment system in Estonia, including potential options and recommendations for improvement in the short, medium and long-terms. Particular areas of focus include streamlining and strengthening incentives for the provision of high quality primary care, reducing unnecessary outpatient specialist and acute inpatient care, and highlighting potential models for promoting better integration across care settings.

The report draws on key informant interviews conducted in May 2016 with several members of the Estonian Health Insurance Fund’s (EHIF) staff and management board, as well as with primary care providers.

The report gives an overview of the health sector context and organization of care, the health care payment system’s legal framework and current payment mechanisms. The report presents a framework for evaluating the so-called ‘building blocks’ of the payment system, along with some recommendations for strengthening. This is followed with a summary of options and recommendations to improve the payment system for primary, outpatient specialist and acute inpatient care in the short, medium and long-terms. The report concludes with a discussion of some potential impacts and considerations that should be taken into account with respect to the implementation of recommended models for the longer-term.

The report will be presented during the second day of the conference, October 26th.