Dr Ralf Allikvee: Estonia needs three major hospitals

15. June 2018

In recent weeks, in connection with a joint declaration released by Tartu University Hospital, North Estonia Medical Centre and Tallinn Children’s Hospital, there has been much talk of what the Estonian hospital network should be like and how many major hospitals would be optimal for our country.

Dr Ralf Allikvee

As I see it, the optimum number for Estonia in the near future would be three major hospitals that would be responsible for the availability of quality healthcare service throughout Estonia. In addition, a few county hospitals – like Pärnu and Ida-Viru Hospital – would retain a key role. A merger between Tartu University Hospital, North Estonia Medical Centre and Tallinn Children’s Hospital, in the form proposed by these hospitals’ heads would certainly not benefit Estonian healthcare. For instance, the question is still unanswered: what role would the Health Insurance Fund play in future if over 50% of specialized medical care funding goes to one legal person who has to distribute the funding within the organization? This plan betrays a fear of the creation of a new Tallinn Hospital and the resulting increased competition in Tallinn and northern Estonia, not concern over the quality of healthcare service. 

”Networking of hospitals” continues to be a byword for two nationwide centres of excellence – the Tartu University Hospital and the North Estonia Medical Centre. If competence is primarily determined by experienced doctors and their teams, not by fancy instruments, it has long been a fallacy to say that Estonia has two centres of excellence for specialised medical care.  Currently Tartu University Hospital serves close to 450,000 people in southern Estonia and the North Estonia Medical Centre (NEMC) in northern Estonia close to 850,000. In terms of monetary operating volumes, NEMC is just as large as the clinic, but in terms of medical cases treated, it is one-third smaller than the university hospital. Thus, we have one competence centre in northern Estonia for 850,000 people, which serves close to one-third fewer patients than Tartu University Hospital. Something doesn’t quite add up… It’s simply that, combined, East Tallinn Central Hospital and West Tallinn Central Hospital have long surpassed the NEMC in terms of volumes. The city of Tallinn’s logical plan to merge East Tallinn Central Hospital and West Tallinn Central Hospital will finally bring about a situation where the state cannot just continue to ignore the prospect of a new Tallinn hospital as it has been doing for decades. The hospital that would be created would be Estonia’s largest and it would have strong potential for offering better medical service in Tallinn and other parts of northern Estonia. This is a concern for hospitals that have to this point enjoyed special status. It’s important to add that the networking of large hospitals that we have seen so far is more like corporate conglomeration – after all, the wait for treatment has not become shorter. And when we look at what is taking place right now in Valga and Põlva, there is also room for development when it comes to offering people suitable and comprehensible healthcare service. Before the formation of a super-hospital and going off to take the world by storm, one should clean one’s own house. 

I think that it would be good for Estonia if two major hospitals/competence centres were established in Tallinn. They would complement each other in many specific fields and keep each other from becoming too complacent. The main question for Estonia is the future of doctors and other healthcare specialists. If we have only one top-calibre team in various fields, what opportunities for advancement would Tallinn offer for young doctors? If the doctors don’t find suitable high-calibre work in their profession in a major Tallinn hospital, the only reasonable solution is to travel to Finland or Sweden. That risk is much lower if you have two major hospitals. 

It’s interesting that the hospital administrators proposed the year 2025 as the establishment date for the new mega-hospital – the same year that the Tallinn Hospital was supposed to be completed. If hospital administrators really do want a new super-hospital, it could definitely be done in 2-3 years; the process should not be dragged out to seven years. 

The Health Insurance Fund and the Ministry of Social Affairs should calmly analyse the hospital administrators’ plan and think about whether it would be better for Estonia to have one “super-hospital” essentially in a monopoly role, or three strong hospitals that would be able to ensure strong and consistent treatment quality throughout Estonia in cooperation with county hospitals.