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Partner Elo Tamm: Patient Insurance Reform Has Been Initiated in Estonia


With the June 7, 2019 initiation of the draft Patient Insurance Act, the Estonian Ministry of Social Affairs has achieved an important milestone in the development of the Estonian health care system. This draft act marks a principal change towards the creation of a patient-centric health care system, which will have a major effect on patients, health care service providers, health care professionals, insurance companies, and society at large.

It has long been discussed that there has been no system of assessment of the quality of the health care services in Estonia. Notably, the National State Audit Office of Estonia decided in 2015 not to conduct an audit of the quality of health care services in the country because, it noted, no basic quality criteria and monitoring system for the assessment of health care services had been set down in Estonian legislation. Also, it has been widely acknowledged that the system of adverse event reporting has not been efficient – a problem exacerbated by the laws establishing personal liability for health care professionals committing errors in treatment.

Patient insurance reform has now been initiated, however, resting on two major pillars: mandatory liability insurance for health care service providers and the creation of an adverse effect reporting system. In addition, the personal liability of healthcare service professionals has been eased.

The obligation to possess liability insurance is expected to be imposed on all health service providers who are licensed to act in Estonia. The liability insurance must cover all health services that are rendered by the health service providers, and the existence of liability insurance will be set as a condition precedent for both issuing and possessing a license to operate as a health service provider in Estonia.

The patients themselves, as well as their heirs, dependants, legal representatives, and certain third persons would be the beneficiaries of the insurance, and these persons would have the right to claim damages for bodily injury, damage to health, or death as a result of the health care service. Patients will have the right to submit their claims to the Patient Insurance Fund, and would have a right of recourse towards the insurer of the health service provider (in case damages are paid to the patient). The Patient Insurance Fund would pay out patient claims even where the health service provider has violated its obligation to obtain liability insurance.

The Expert Committee of Health Care Service Quality has also been reorganized. Previously, the Committee was in charge of assessing the errors of treatment, but the decisions of the Committee were not binding on the health care service providers, and the Committee did not have any role in ordering compensation for damages. The Committee will now, however, have new competences; it will resolve patient complaints against the Patient Insurance Fund and it will be a mandatory pre-trial institution for the settlement of patient claims against the Patient Insurance Fund.

In relation to adverse effect reporting, the draft Act proposes amendments to the criminal liability of health service professionals. Specifically, if the health service professional reports an adverse effect, criminal proceedings against the professional could be terminated. The amendment is designed to create a non-punitive system focusing on reporting adverse effects rather than penalizing errors by health care professionals.

This reform has not been greeted with overwhelming enthusiasm. The insurance coverage has been set at EUR 100,000 per insured person, EUR 300,000 per insurance case, and EUR 3 million per insurance period. Representatives of the health care service providers have been critical of the levels of protection to be granted to patients, noting that these amounts far exceed the levels of protection previously afforded to Estonian patients and that providing such levels of protection would significantly increase insurance costs, leading to potential shortcomings in the availability of health care services.

The current draft act is expected to enter into force on July 1, 2021, but there is a long governmental and parliamentary process that it must go through first, so interested parties will have an opportunity to voice their opinions on the reform.

This Article was originally published in Issue 6.6 of the CEE Legal Matters Magazine