Patients’ Opinions on Family Doctor Accessibility in Estonia

Abstract

Питання організації охорони здоров'я One of the cornerstones of the Estonian health care reforms has been the reorganization of the pri mary level medical care. It was started in 1991 by commencing training for family doctors [1, 2]. Since 1993, the list of medical specialties in Estonia also contains family medicine, and by the present time more than 800 family doctors have been trained. In 1998 a new financing scheme for family doctors came into force, foreseeing the establishment of patient lists. It introduced a combined payment mechanism and a partial gatekeeping function for family doctors, and rendered the status of an independent contractor to family practitioners [3]. The aim of the reform in primary health care was to establish the primary health care system that is easily accessible and is based on trained and fully responsible family practitioners. Several studies have shown that the access to the doctors is one of the most important determinants of patient satisfaction with the care [4, 5].Al though priorities regarding different aspects of family practice vary significantly among different countries, the absolute requirements for good family practice as reported by patients are: the possibility of making appointments with in a short time, quick service in urgent situations, a family physician who really takes his/her time to listen and talk during the consultation. All these priorities refer particularly to accessible clinical care [6]. The common policy in the Estonian family medicine is that patients with urgent problems should be seen on the same day, while other patients should be granted an appointment in three days. These standard rules are fixed in the family doctor's job description. Since October 2002, when the Health Insurance Act came into force, all patients who have health insurance can visit their family doctors for free. According to the same act, family practitioners may ask up to EEK50 (€3.3, US$3.9) for a home visit. The aim of the study was to investigate the temporal accessibility and financial accessibility of family doctors in Estonia from the patients' point of view.

Primary health care in Estonia

“…Further studies demonstrated a rather high satisfaction as well. For example, in 2002 the satisfaction rate with the FDs was 87% [23] and most of the patients were admitted within two days [24]. Today, further evaluations of the Estonian PHC system have demonstrated rather high patient satisfaction and acceptability of the new system, however, the satisfaction with and acceptability of PHC services and FDs has been higher in patients living outside the capital, in older patients and in patients with multimorbidity [21,23,[25][26][27].…”

Primary care in Baltic countries: A comparison of progress and present systems

“…The progress of PC reform in Baltic countries has been examined in several studies. There are a number of studies about the Estonian PC system, explaining access to PC services [13], patient satisfaction and acceptability of the PC system [11,14] as well as economic aspects of PC reform [15,16]. The studies about PC reforms in Latvia and Lithuania primarily focus on patient satisfaction and acceptability of the PC system [17][18][19][20].…”