The SAO: training capacity is not able to ensure sustainability of Estonian health care system

Toomas Mattson | 5/16/2005 | 12:00 AM

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TALLINN, 16 May 2005 - The SAO audited the present situation of the labour force in the health field of Estonia and came to a conclusion that one cannot expect mitigation to the lack of health care professionals without making changes to the health care system. Continuing the training of health care professionals at the level of last year, by year 2025 there will be, according to the most optimistic prognosis and not taking into account the possible emigration, 500 doctors of working age less than today and the number of nurses will increase only 8 per cent as compared with the present situation.

As access to and quality of health services is based on a sufficient amount of existing health care professionals, the inability of the state to train a sufficient amount of persons jeopardizes the sustainability of Estonian health care system. As in addition to money deficit, capacity of schools (training facilities, training means, teachers) and shortage of possible candidates to student places hinder increase of state-commissioned education, it is absolutely necessary to review the present health care system.

According to the updated estimation of need, there is need for 4051 practicing medical specialists by the year 2015 in Estonia, but even pursuant to the prognosis of the Ministry we will have only 3769 practicing medical specialists by that time. Although, according to the set target, there could be 8-10 nurses per 1000 persons in Estonia by the year 2015, we could reach, even according to an ideal scenario, a level where there are only 7.5 nurses per 1000 persons. According to estimation of hospitals being attached to the development plan of hospitals’ network, there has to be completed 448 new vacancies of doctors during the next three years and already today there are less than 200 doctors.

By the end of 2004 there were entered 4972 doctors, 9414 nurses, 1297 dentists and 448 midwives in the register of health care professionals. The actual labour force in health care sector is substantially smaller than the registered amount of health care professionals. At the moment there are actually only 3976 practicing doctors of working age who have at least one job in health care sector or one thousand less than entered in the register. The total number of practicing dentists of working age is 1074, nurses 8059 and midwives 376.

Many of the health care professionals have reached retirement age, do not work in the area of specialisation or have several jobs. Ten per cent of the practicing doctors have reached retirement age. In the audit period (in 2004), approximately one tenth (1660 persons) of the registered health care professionals were not connected with any job offering health services.

The analysis, made in the course of audit, have revealed that 550 registered health care professionals of working age (including 256 doctors, 203 nurses, 62 dentists and 29 midwives) have not received any salary in Estonia nor have worked as self-employed persons during the year 2004.

Neither is the absence from labour market justified with maternity leave or parental leave. Many of them, most likely, work in foreign countries.

46 per cent of doctors, 37 per cent of dentists, 23 per cent of midwives and 12 per cent of nurses have several jobs. Even if all health care professionals had only one job, approximately 8000 jobs were still vacant (provided that all these jobs are needed and will be preserved after decrease of labour force).

The fact that the graduates who have acquired the profession of general doctor and care nurse leave health care sector, is also a problem. Health care professionals hold to their area of specialisation relatively firmly and therefore investment in their state-commissioned education is quite profitable to the state. 70-90 per cent of the graduates of different medical areas of specialisation set to work according to their specialty and almost the same amount will stay there. After graduation even 91 per cent of the doctors set to work in their specialty of whom 86 per cent will stay in health care sector. Except those who have graduated as general doctors and care nurses. After completing the main courses of medical faculty in the University approximately 71 per cent of graduates set to work as general doctors in their specialty, but after some years only 61 per cent of them remain in health care sector which, compared to the other specialties of doctors, is a very poor index. From graduates who have acquired care nurse profession only 43 per cent set to work in health care sector.

The SAO proposed the Ministry of Social Affairs to transform the registration of health care professionals and registration so that it could be possible to estimate the actual number of health care professionals who are able to offer in Estonia health care services of high quality. The target is to get a more precise overview of the existing labour force concerning health care professionals and to improve the planning activity. The SAO considers it also necessary to ensure internal conformity of development plans of different levels and to even out estimations concerning the needs of health care professionals. To settle the situation where the opinion of professional associations, the needs of hospitals and the actual labour force are not in conformity with each other, thereby jeopardizing sustainability of health care system.

The SAO is of the opinion that the Minister of Social Affairs in co-operation with the Minister of Education and Research has to ensure the graduates of main courses of the medical faculty a possibility to pursue studies in residency or to employ them more in the area of specialisation corresponding to their qualification. The target is to avoid the situation that has continued for years where a great part of labour force that has received an expensive training on the basis of state-commissioned education and are highly qualified, leave health care sector. One also has to review the curriculum of care nurse and to ascertain the reasons of the graduates of this specialty not hold to their area of specialisation. On this basis, to consider the possibilities of reorganisation of the specialty of care nurse in such a way that investment in state-commissioned education would be profitable for the state.

Pursuant to the SAO there has to be reviewed the existing hospitals’ net and to estimate possibilities for its provision with a needed number of health care professionals in a situation where even state-commissioned education in full capacity and returning of the specialists who left their area of specialisation in the sector will not be able to preserve the present number of doctors on and nor to increase the number of nurses to the level estimated as needed or meet the needs of the hospitals.

Toomas Mattson
Communication Manager of National Audit Office
Telephone: 6400 777
Mob: 51 34900
E-mail: toomas.mattson@riigikontroll.ee

  • Posted: 5/16/2005 12:00 AM
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