Madis Veskimägi: Estonia's healthcare system needs a new legal framework

Doctor and health centre director Madis Veskimägi believes Estonia's healthcare system has several systemic flaws that prevent it from functioning properly. The health insurance fund's budget deficit is growing-100 million euros this year and up to 800 million within ten years-and solutions are often sought at the expense of the most vulnerable. Veskimägi proposes an alternative based on his nearly 30 years of experience running a rural health centre.

Estonia's healthcare system has reached a critical juncture. Although nearly 88 per cent of residents are satisfied with the work of doctors, nurses and care workers, satisfaction with healthcare administration has fallen to an all-time low of just 53 per cent. This is how Madis Veskimägi, a doctor whose work experience in rural health centres spans nearly 30 years, describes the situation.

Growing budget deficit

The health insurance fund's budget deficit is concerning: it reaches 100 million euros this year and within ten years is predicted to reach up to 800 million euros. In Veskimägi's assessment, the solutions proposed so far-raising co-payments and involving private capital-primarily affect the most vulnerable: children, the elderly, and people struggling with mental health and work capacity.

The main problems cited in the sector include underfunding, poor working conditions, toxic atmosphere in medical institutions and employee overload. Many healthcare workers work in multiple places at once to make ends meet.

Systemic errors and solutions

Veskimägi argues that healthcare administration contains a number of systemic errors that prevent it from functioning as an integrated and efficient system. However, he is convinced that even with current funding levels, it is possible to create a much better and more efficient healthcare system.

He believes such a system must be built on primary care: a network of locally accessible health centres and outpatient clinics that are well equipped and offer a wide range of procedures. Using his own rural health centre as an example, he describes how it is possible at local level to provide ultrasound, X-ray diagnostics, simpler procedures and dental services. It also arranges free transport to appointments for patients with mobility difficulties.

A new legal framework, not re-nationalisation

Veskimägi proposes a new legal framework for healthcare, emphasising that this is not re-nationalisation, although he has already been threatened with being "locked up" for this idea. In his view, healthcare system transformation must be undertaken systematically, not merely by increasing funding.

The doctor admits that his views may not please everyone, but stresses that they are based on decades of practical experience and a desire to find solutions that protect patients above all, not the interests of the system.