Estonia has shifted from a hospital-centered system to strengthening primary healthcare (PHC) since the 1990s. Recent reforms emphasize multidisciplinary care, integrating home nurses, midwives, and physiotherapists, while promoting PHC centers over single-physician practices.
Estonia has undergone significant reforms in its primary health care (PHC) system over the past three decades, transitioning from a hospital-centric model to one that emphasizes multidisciplinary care. These reforms have been driven by financial incentives and substantial investments, particularly from European Union structural funds, to enhance PHC infrastructure.
Key Developments in Estonia’s PHC Reforms:
- In the late 1990s, Estonia restructured its PHC system to focus on family doctors, moving away from specialist-dominated outpatient polyclinics. This transition aimed to provide comprehensive first-contact care and establish family doctors as gatekeepers to specialized services.
- Recent reforms have expanded PHC teams to include home nurses, midwives, and physiotherapists. This multidisciplinary approach is designed to improve service quality and accessibility, moving beyond the traditional single-physician practice model.
- To facilitate these changes, Estonia implemented financial incentives encouraging group practices and multidisciplinary teams. EU structural funds have been instrumental, providing essential support for developing and modernizing PHC centers.
Challenges and Considerations:
Despite progress, several challenges persist:
- Resistance to Change: Some primary care providers are hesitant to transition from independent practices to collaborative group models, valuing their autonomy.
- Workforce Recruitment: Attracting specialists to work within PHC settings remains difficult, impacting the expansion of multidisciplinary teams.
- Sustainable Funding: Ensuring long-term financial support for the expanded scope of PHC services is crucial for the sustainability of these reforms.
As Estonia continues to refine its PHC system, addressing these challenges will be vital to achieving a fully integrated, multidisciplinary primary health care model.