National Audit Office: Healthcare needs more effective quality monitoring and systematic improvement of deficiencies

3/14/2024 | 11:00 AM

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TALLINN, 14 March 2024 – In order to ensure that the quality of healthcare services across Estonia is reliable, the state needs to create a more efficient system for monitoring quality and improvement of deficiencies, the National Audit Office finds in an audit published today. In addition, the quality assurance requirements remain general and are understood and followed differently by healthcare providers.

“The risks of patients are not always managed in the best possible manner, because there is no system for monitoring the quality of care in Estonia at the national level,” said Auditor General Janar Holm. “In addition, the Ministry of Social Affairs should take a more decisive lead in shaping the requirements and guidelines.” The quality assurance practices of healthcare providers are different, as their organisational capacity varies considerably. In addition, the shortage and excessive workload of healthcare professionals is exacerbating problems in the quality of health services.

The National Audit Office finds that to mitigate risks, the requirements for ensuring the quality of health services should be clear, up-to-date, and consider the different size of the institutions as well as the type of services they provide. At present, healthcare providers are subject to the same general requirements, which do not take into account whether they are, for example, a dentist, a general practitioner or a regional hospital.

National supervision would help to maintain a more consistent level of quality, but the supervision by the Health Board has so far been complaint-based and has only covered compliance with a few of the various quality assurance requirements. Healthcare providers themselves want national authorities to provide quality advice and guidance alongside supervision. However, this is not done at present.

At the same time, the licensing requirements for healthcare providers should be reformed to include new services and treatment methods. Licensing requirements should ensure that the premises, equipment, and staff of healthcare providers are suitable for the provision of the service. Currently, some of the licensing requirements are outdated.

The National Audit Office advises the Health Insurance Fund to continue updating the quality of care indicators in order to be able to draw meaningful conclusions on the quality of care and plan improvement activities. The Health Insurance Fund is the only national body that carries out activities assessing the clinical quality of health services, but these are limited due to lack of resources and the problems found are not always solved.

The introduction of automatically calculated indicators based on health data is also seen as an important direction for monitoring and improving the quality of care. The development of a system of quality of care indicators has started under the coordination of the Health Insurance Fund and indicators have been created in 10 out of 40 specialties. However, the functioning of the indicator system is hindered by data quality issues and administrative shortcomings. In addition, there is still no arrangement in place for making practical improvements regarding problems revealed by the indicators.

It would be recommended for the Ministry of Social Affairs and the Health Insurance Fund to clearly agree on the priority medical conditions for which to create treatment guidelines. In addition, the National Audit Office advises the Health Insurance Fund to consistently assess health care workers’ compliance with the treatment guidelines to identify shortcomings and ways to address them. The activities agreed in the implementation plans of treatment guidelines should be implemented and new monitoring indicators, including on previously approved guidelines, should be developed to provide regular information on compliance with the guidelines.

The National Audit Office finds that more should be done to collect and use the service experiences and health outcomes (treatment results) of patients in the design and financing of health services. Despite public authorities emphasising people-centred health care as a goal in rhetoric, little practical action has been taken. Measuring the health outcomes and service experience of patients would help identify faults in health services, but such measurement is currently done in a small number of projects. The shortcomings of health services are sometimes linked to communication with patients. In addition, communication with patient representative organisations has often remained limited and superficial.


The National Audit Office audited the functioning of the nationwide system for ensuring the quality of healthcare services and focused on the tasks and activities of the Ministry of Social Affairs and the agencies under its government – the Health Board and the Health Insurance Fund – in ensuring the quality of healthcare services. The audit did not assess the quality of services provided by healthcare providers because the underlying data is incomplete and the analysis would have required extensive expert analysis in many medical specialties and institutions.

In addition to public authorities, the audit gathered information from healthcare providers, medical specialty associations, patient representative organisations and the World Health Organisation. The development of treatment guidelines in other countries was also investigated with the help of supreme audit institutions in respective countries.

Priit Simson
Communication Manager of the National Audit Office
+372 640 0777
+372 5615 0280
[email protected]
[email protected]

  • Posted: 3/14/2024 11:00 AM
  • Last Update: 3/14/2024 10:22 AM
  • Last Review: 3/14/2024 10:22 AM

The National Audit Office finds that more should be done to use the service experiences and treatment results in the design and financing of health services.

Tiit Blaat, Ekspress Meedia

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