Despite the historically low number of births, the Ministry of Social Affairs certainly has no intention of closing the maternity wards of smaller hospitals, and none of the county hospitals should be closed completely, said Health Minister Riina Sikkut (Party social democratic) Vikerraadio’s morning show. Sikkut also said that the centrality of the hospital system to Tallinn must be reduced, but the state must ensure that the Tallinn hospital is built.
Jaanus Pikani, head of the expert group that conducted the study commissioned by the Ministry of Social Affairs, “Development plan of the Estonian hospital network until 2040”, told the ERR commenting on Sikkut’s point of view that his analysis did not says county hospitals should be closed O.
“It is rather a question of redesigning hospitals based on needs, so that the service provided satisfies needs. For this reason we also proposed the concept of community hospital. In the interview the minister also tried to say it through the flowers that each hospital should find its own profile, but it is clear that even profiled there must be sufficient demand for the business, which would ensure such a burden on the hospital, which in turn would ensure the quality of care provided,” said Pikani .
According to Pikan, the fact that doctors move from one hospital to another does not necessarily ensure the necessary load on the functioning of the hospital. “And nowadays it is not possible to provide specialized medical care with bare hands. Today’s specialized medical care requires equipment, mostly quite expensive, and the effective use of equipment means that there must be enough people who need this service,” Pikani said.
Pikani said that if we start from the demographic forecasts of the Statistics Office, it is still inevitable that the population will be concentrated in Tallinn and Tartu and that the population will decrease in other countries.
“But regarding the Tallinn hospital, the question is what are our priorities. What is the more urgent problem, the development of the primary level or once again investments in cement. The current state of the hospitals is such that it requires such a massive investment urgently?” ,” Pikani stated.
“It is obvious that there are limits to investments and the administrative capacity of the state: if investments are made somewhere, money is missing somewhere else. This is not a political decision in a situation where the budget is said to be lacking of the health fund? Already today 100-150 million euros”, he added.
Pikani also highlighted that it is a fact that the population in developed countries is aging and that the percentage of people suffering from chronic diseases is increasing.
“Many of them have multiple chronic diseases at the same time. Because of their illnesses, these people need help from a specialist doctor, perhaps several times a year. The focus is mainly on the primary, nursing and social levels. They rather need support in case of disease flare-up and short-term hospital treatment close to where they live, which means the idea of a community hospital is offered, efficient primary care and cooperation between different levels of medical care and social care “Pikani explained.
In the long run: Fewer births reduce hospital capacity
As for closing maternity wards in smaller hospitals, Pikani said it was a “very, very difficult political decision.”
“If you look at the opposition and the reaction to the closure of the maternity wards in Valga and Põlva, it is complex, isn’t it, because childbirth is part of the gynecological service, which means not only employees with a specific profile, but there an anesthetist, nurses and midwives are also needed. It is a complex question whether emergency medical care in surgery and gynecology is provided in small Estonian hospitals or not,” said Pikani.
Pikani noted that Haapsalu has not had a maternity ward for 20 years and it works very well, because Tallinn is 100 kilometers away.
“We know that below a certain threshold, even under 500 hospital births, the safety of childbirth can suffer. This has also been shown by the experience of other countries, for example in the Netherlands, the mortality rate of newborns is increased when there were many service providers, but the number of births in the hospital was very small. In Estonia the situation is very good in terms of reducing neonatal mortality, it is safe to give birth here, but it will last if the number of births in the wards motherhood is constantly decreasing?” said one health expert.
According to Pikan, the long-term plan must be looked at in the medical field, taking into account the age and location of the population, because today in Estonia one fifth of the population is over 65 years old, but by 2040, the Statistics Office predicts that the percentage of this age group will rise to 26%, which means a significant increase in demand for healthcare services.
“I doubt that without major changes in healthcare, which should mainly consist of a significant increase in the capacity of primary healthcare, the development of digital services and the integration of healthcare and social services, we will be able to ensure the availability of healthcare at today’s level, not to mention improvement,” Pikani added.
Palu: Hospital consolidation is common
Commenting on Sikkut’s views, Toomas Palu, consultant to the World Health Organization on health systems and financing in Ukraine, said that on the one hand there are clear technical arguments regarding the efficiency and quality of treatment when organizing a network hospital, but on the other hand there are political arguments Arguments play a role, for example, county hospitals are often important local employers.
“Between these two positions, politicians have to make decisions,” he said.
Regarding the idea of establishing Tallinn Hospital, looking at international trends, Palu can say that the consolidation of old depreciated buildings into new hospitals is a common process. “Often these hospitals are no longer located in the city center, but on the outskirts. The Pärnu hospital was also a good example in this direction,” he added.
Palu noted that some hospital buildings in Tallinn have definitely outlived their time.
“Once upon a time (at the beginning – ed.) the Swedish plan for the development of the Estonian hospital network recommended three hospitals in Tallinn. Then Tallinn had four public hospitals, and the children’s hospital remained separate. Now it’s up to “The city will have to decide how to unite the two hospitals. In my opinion, an important question is also what will happen to the old buildings and departments,” Palu said.
When it comes to health care funding priorities, Palu said money has two sides. “One is investments, which means investing money in new things, Tallinn hospital is a very big investment. And the other thing is covering the healthcare needs that exist every year, arising from the population, and investing in health of people. They need to be looked at separately,” he said.
According to Palu, the primary level of the medical network could still do much more to keep people healthy and address chronic diseases than it does now. However, this would also reduce the need for hospitalization.
Palu added that there should be an optimal hospital network in the country. “That takes into account the needs of the population and the economy of scale. Perhaps there are volumes large enough that it is worth running a hospital, because hospital services also require support services: laboratories and digital devices and high-tech operating rooms that it cannot be spread throughout Estonia with just a swipe of a finger,” one expert said.
2024-01-05 02:50:00
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