Riigikogu discussed situation of health care in Estonia

 

The Act on Amendments to the Code of Criminal Procedure and Other Associated Acts (599 SE), initiated by the Government, which enhances the efficiency of criminal proceedings and increases conformity of the proceedings with the fundamental rights of the persons concerned, was passed with 71 votes in favour (1 abstention). As the main measures to achieve this, the provisions concerning charge proceedings have been disambiguated and made more conforming to the interests of victims. The Act enables to hold video conferences for conducting proceedings, preliminary hearings and simplified proceedings at the preliminary investigation judge and the sessions of a judge in charge of the execution of court judgments and in order to ensure the prosecutor’s participation in a circuit court session. Also, to create the possibility to deposit testimonies and to consider pre-trial testimony given by a person of less than 14 years of age in a matter relating to a sexual or family violence offence to be evidence in court proceedings if it has been video recorded and if the counsel has had an opportunity to pose questions or if hearing at court may be harmful for a witness of less than 10 years of age in case of another criminal offence. The Act enables also his or her pre-trial testimony to be used as evidence under the same conditions, etc.

 

The Code of Administrative Court Procedure (902 SE), initiated by the Legal Affairs Committee, which improves legal protection in administrative procedure and increases the fluency of the activities of the administrative court, was passed with 83 votes in favour. The Bill (755 SE) was submitted again because it failed to gain the necessary support of 51 votes at the final voting on 15 December 2010 and was dropped from the legislative proceeding of the Riigikogu. The Code specifies the implementation of the authority of the administrative court, in particular, the transition from one type of action to another in a situation where filing a correct claim may provide too complicated for a person who files the action (e.g. applying for establishment of nullity of an administrative act instead of annulment). The Code restricts to a certain extent the filing of an action of establishment as compared to the past practice, precluding it in a case when more effective means can be used for achieving the objective of the action. According to the Code, public and oral proceedings with the organisation of a court session remain the principal type of proceeding in the court of first instance and the court of appeal. The Code extends the possibilities to carry out an extended session in the case when participants in the proceeding fail to appear and it is possible to hear an action by way of written proceedings regardless of the consent of the participants in the proceeding, taking into account the weight of the matter and the issues being discussed. The simplified proceeding and conciliation procedure are provided in the Code as new simplified types of proceedings, besides the written proceedings. The Code also eliminates the general reference to the Code of Civil Procedure which remains applicable only to the extent and in the cases specifically referred to.

 

The Act on Amendments to the Penal Code, the Code of Criminal Procedure, the Mental Health Act, the Punishment Register Act, the Probation Supervision Act and the Health Care Services Organisation Act (717 SE), initiated by the Government, which enables to apply addiction treatment partly financed from the state budget funds to persons who have committed criminal offences and who have not been punished before and who at the same time are addicted to narcotic drugs, was passed with 76 votes in favour. The addiction treatment of a drug addict is applied in the cases when real imprisonment of six months to two years has been imposed on a person as punishment and the convicted offender agrees with replacement of the imprisonment. Imprisonment is replaced by addiction treatment the duration of which may exceed the duration of a real imprisonment. At the same time, however, a less restricted freedom and application of treatment at the expense of the state is guaranteed to the person in such case.

 

The Act on Amendments to the Emergency Act and Other Associated Acts (871 SE), initiated by the Government, which adds uninterrupted telecommunications services as a vital service to the Emergency Act, was passed with 84 votes in favour. According to the Act, uninterrupted telecommunications services is the electronic communications service for the Riigikogu, the President of the Republic, the State Chancellery, the Ministry of Justice, the Ministry of Defence, the Ministry of Internal Affairs, the Ministry of Foreign Affairs, police authorities, rescue service agencies, prisons and agencies and persons designated by the Government of the Republic, for uninterrupted and reliable transmission of the messages necessary for ensuring the consistent functioning of vital services (radio communication, data communication, SMS, voice call, etc.). The aim of uninterrupted telecommunications services is to ensure communications also in a situation where the usual channels fail to function. Uninterrupted telecommunications services are organised mainly on the basis of the existing commercial operators and networks. In limited cases, use of the transmission connections belonging to the state is provided.

 

The Act on Amendments to the Act on Narcotic Drugs and Psychotropic Substances and Precursors thereof (886 SE), initiated by the Government, which amends the Act on Narcotic Drugs and Psychotropic Substances and Precursors thereof in order to enable handling of narcotic drugs and psychotropic substances for training service dogs at the Estonian Public Service Academy, was passed with 81 votes in favour.

 

Chairman of the Social Affairs Committee Urmas Reinsalu, Member of the Executive Board and Health Policy programme director of PRAXIS Centre for Policy Studies Ain Aaviksoo, Head of the Department of Public Health and Professor of Health Care Management of the University of Tartu Raul-Allan Kiivet and the Minister of Social Affairs Hanno Pevkur made reports at the deliberation of the matter of significant national importance “The situation of health care in Estonia”.

 

Reinsalu gave an overview of the situation of health care in Estonia and the related problems that had been discussed in the Social Affairs Committee. Chairman of the Social Affairs Committee pointed out the important aspects in the relevant World Health Organisation report concerning the opportunities to ensure the financial sustainability of Estonian health care system. Estonian health care system is financed mainly through the social tax for the specific purpose paid on salary. Recently, insurance cover was also extended to long-term registered unemployed people. Services such as for example emergency medical care, emergency care of persons not covered by health insurance and the public health and immunisation programme are financed from other state budget revenues. As one of the strengths of the Estonian system, the study points out the fact that health insurance is separated from other social insurance. The report highlights several problematic spheres. The public sector expenditure on health care is relatively small which brings about the increase of the share of patient cost-sharing in the financing of health care. The health care base can be extended by increasing allocations from the state budget. The principles according to which revenues are allocated from the state budget to the health insurance budget must be stable and transparent. According to the study, the rules of cost-sharing should be simplified and made more purposeful in order to ensure that people who are in a more difficult economic situation and use a large number of services are better protected from financial risks.

 

Aaviksoo stressed that, in the 21th century, health care services should function integrally in the conjunction of different parties and not by creating administrative oppositions which often emerge due to lack of resources. Complex activities move to big centres while simpler services can move out of there to counties and, finally, to people’s homes, that is, much closer to them. Aaviksoo underlined that this cannot happen without the relevant strategic relocation of health care resources. In his opinion, as the state of health and employment relationship are closely connected, it is expedient to increase involvement of employers as an active party of health care, whether as bearers of additional responsibility and the financing burden, or for example also as supporters to the health of employees together with an effective occupational health service. Indeed, in order to go on, priorities need to be formulated through quality and efficiency indicators which would be measurable at the level of individual, noted Aaviksoo.

 

In Kiivet’s opinion, in order to solve the main problems, particular attention should be paid to sustainability of the financing of the health care system, development of nursing care and follow-up treatment, and a long-term health care development plan which would satisfy patients’ needs.

 

Pevkur discussed the topical problems relating to health care and the possibilities to solve them. When analysing the proportion of health care costs in GDP, Pevkur stated that Estonia has often been criticised for the small proportion of health care costs in GDP. He explained that when GDP had fallen in 2009, then the proportion to the financing of health care had clearly risen. “This shows that, thanks to reserves, health care has after all been maintained at a reasonable level when compared to other spheres of life where other fields suffered significantly more as the result of the fall of GDP,” explained the Minister. He added that, when we look at the forecast of revenue, then despite the difficult years, the revenue of 2011 as regards health insurance will be greater than it was in 2010, by 17 million euro. In the future, the rise will be significantly greater, that is, almost double: 747 million euro, and later, by 2013, even two times greater.

 

Marika Tuus, Maret Maripuu, Maret, Merisaar, Liisa-Ly Pakosta, Eiki Nestor, Nikolai Põdramägi, Toomas Trapido, Jaak Aab, Mai Treial and Erki Nool took the floor during the debate.

 

The Riigikogu Press Service