According to the Health Fund of Estonia (Tervisekassa), before the reform, only a family doctor could refer to the Therapy Fund service, but from July 1, other doctors can also make the referral. The Therapy Fund is a mechanism through which family doctors refer patients to clinical psychologists, speech therapists and physiotherapists, and its operation is fully managed by the single payer since July 2024.
“From the patient’s point of view, the changes in the therapy fund will simplify the patient’s journey in the healthcare system. A specialized doctor does not have to send a patient to a family doctor just to write a referral, but can also do it himself to refer to a specialist,” explained Dr. Elle-Mall Sadrak, head of the Society of Estonian General Practitioners. “The administrative burden on family doctors is reduced, as the specialist who issued the referral is responsible for the documentation.”
To use the services through the Therapy Fund, a patient must contact a doctor, who will decide if a more detailed examination or a referral to the necessary specialist is needed. Since July 1, 114 service providers who offer services provided by clinical psychologists, speech therapists or physiotherapists all over Estonia have signed contracts with the Health Insurance Fund (Tervisekassa). The network of partners is expanding, and new service providers will be added to the list at the beginning of the new year.
“The main goal of the reorganization of the therapy fund is to create clarity about which institutions, where and which services are provided for the money of the Health Fund. In addition, the new system helps to save time and save patients’ money, because with Tervisekassa’s contract partners, the insured person does not have to pay a visit fee or co-payment for the services of a clinical psychologist, speech therapist and physiotherapist,” stated Tervisekassa’s trusted doctor Katri Sersant.
In order to offer the services of a clinical psychologist, speech therapist and physiotherapist with the support of the national health insurance, the service provider must have a license issued by the Health Board and be a contractual partner of the Health Insurance Fund. Currently covered healthcare providers’ contacts, addresses and the services offered can be found on the Health Fund’s website.
As of July 1, the Health Fund has signed direct contracts for more than 8.8 million euros with service providers who offer mental health services from clinical psychologists, speech therapists and physiotherapists. For comparison, reimbursement for such services in 2023 was 4.2 million euros through the family doctor’s therapy fund. The Health Fund reviews the list of healthcare services, including the content of services and the price list of reimbursable services at least twice a year, so that it corresponds to the average market price and ensures services are priced fairly to ensure access to service.
