Putting off decisions regarding hospital network harms state interests

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TALLINN, 10 February 2010 - Based on a newly completed audit the NAO finds that the active treatment hospital network set out in the hospital network development plan is too big and non-sustainable, because not all hospitals will have enough patients, qualified doctors or money for improvement of the hospitals in the future.

Trends in recent years show that the population of Estonia has constantly decreased, the decrease rate being the strongest in regions with smaller hospitals (7.9%). Upon planning the hospital network, the service areas of hospitals were planned larger than they have come to be by now.

In addition, the trends in recent years have shown that rural patients increasingly go to regional or central hospitals of cities, not to their county hospital, to get treatment. In 2008 every third visit was made outside their county. Six years ago such visits totalled merely 23%. Considering the decreasing number of people in regions and their desire to get services in larger hospitals, there are simply too few patients in county hospitals for provision of high-quality services.
When planning the hospital network it was planned that the active treatment investment need of hospitals is EEK 4.3 billion, but by now the need has risen to EEK 8.5 billion. The state has covered the modernisation of some hospitals using EU funds, but the NAO finds that the state is unable to cover the investment needs of all hospitals. Hospitals themselves cannot make the required investments using only the funds earned for provision of treatment services. Therefore the state should assess and decide whether it can afford such a hospital network and find money for investments.

According to the NAO, the functioning of a hospital depends of qualified staff. In the course of the audit it became evident that 16% of the doctors working in hospitals are of retirement age and in county hospitals the proportion of such persons exceeds a quarter. The situation will become really complicated within ten years, because the influx of new staff is not sufficient, considering that large age groups are about to reach retirement age. The situation appears to be really bleak in county hospitals where the proportion of staff of retirement age is the highest, but where only a few young doctors have gone to work full time in recent years.
Considering the aforementioned, the NAO finds that the development plan of the Estonian hospital network and the current hospital network exceeds Estonia's needs and, above all, what the state can afford. The Ministry of Social Affairs has failed to seize its opportunities of guiding the development of the hospital network. To the contrary, so far the ministers' decisions regarding the list of general hospitals and requirements for hospital types have led to a situation where the current hospital network is even larger than stipulated in the hospital network development plan.

On the basis of the audit the NAO advised that the Minister of Social Affairs draw up a new hospital network development plan in 2010 that is a compromise between regional provisions of specialised medical care and the available resources. This does not necessarily mean a new hospital reform. To begin with, the existing Hospital Master Plan 2015 and the Estonian hospital network development plan 2002 should be revised critically. When planning the new hospital network, the availability of first-contact care and medical rehabilitation must certainly be improved in order to compensate for the decreasing provision of active treatment services.
The NAO audited whether the existing network of active treatment hospitals is optimal, sustainable and structured in line with the Estonian Hospital Network Development Plan 2002. The NAO acted based on the presumption that the hospital network is optimal and sustainable if all hospitals have enough patients and qualified medical staff as well as funds for improving the hospitals and buying medical equipment now and in the future.

The auditors are prepared to share their additional comments.

Toomas Mattson
National Audit Office Communication Service
Phone: 6400777
Mobile phone: 5134900
E-mail: toomas.mattson@riigikontroll.ee

  • Posted: 2/10/2010 11:09 AM
  • Last Update: 11/10/2015 6:00 PM
  • Last Review: 11/10/2015 6:00 PM

The ‘arms race’ or the attempts of hospitals to acquire expensive equipment even though it will not have enough use is also eating into the finances of hospitals.

Corbis/Scanpix Baltics

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