Peremeditsiiin Eesti tervishoiukorralduses. Family Medicine in the Estonian Health Care System

Abstract

At the beginning of the 1990s, the situation was favourable for making changes in the Estonian health care system. Innovation was supported by physicians, patients, politicians, health care managers and the academic society. The most profound improvements were planned in the field of primary health care. Up to the 1990s, there was no specific training for and specialty of family doctor/general practitioner in the field of primary care. The primary health care system based on family physicians/general practitioners had existed for more
than twenty years in several Western Europe countries and its efficiency for providing health care for the population had been proven. Countries with strong primary care provide high-level, cost-effective and prevention-orientated services for patients. The implementation of the family medicine system in Estonia was the result of different stakeholders’ cooperation. Initially, international experts were invited to provide specific training, especially Finnish colleagues from the Universities of Tampere and Turku. Professor Mauri Isokoski was later elected Honorary Doctor of the University of Tartu for support and cooperation in the field of family medicine. Academic lecturers and
family doctors were sent to courses of family medicine in the Nordic countries, United Kingdom, Canada and elsewhere.
In 1991 a specialised course for family doctors was launched. Previous district doctors and paediatricians were the first trainees. They were interested in reorganising their work to provide comprehensive care to patients. Training was conducted by the Department of Family Medicine in cooperation with other specialties. Family doctors who had been retrained step-by-step started teaching and they were the first supervisors of residency training in family medicine. The Estonian Society of Family Doctors was established.
In 1992 the Department of Family Medicine in the Faculty of Medicine, University of Tartu was opened, including a professorship in family medicine. Family medicine was included in the basic programme of students in the medical faculty. Residency training in family medicine was organized according to European Union standards. Research in family medicine started; a PhD programme in family medicine was launched. During following decades, 15 PhD theses were prepared and defended. Family medicine in Estonia was recognized as an academic specialty.
In 1993 the specialty of family medicine was included into the list of specialties in Estonia. It means that family doctor is a specialty with specific training, evidence and research-based practice in Estonia, equal with other medical specialties.
The Estonian Health Project conducted by the Estonian Ministry
of Social Affairs supported the development of instruction in family medicine, the training of family medicine lecturers abroad, and replacement of office equipment and the creation of a legal environment suitable for family medicine.
In 1997 a regulation of the Estonian Ministry of Social Affairs was issued to control the implementation of patient lists, financing from the Health Insurance Fund, and specifying the job description of family doctors. In 2002 all those principles were included in the Health Services Organisation Act.
Follow-up surveys of patients’ satisfaction with the family doctors’ system showed that patients were mostly satisfied and usually got help for their problems at family doctors’ offices.
International cooperation within the World Health Organization,
EURACT, WONCA, World Bank and other working groups allows to share Estonian experiences of developing family medicine as well as to learn from other countries.
Implementing family medicine in the Estonian health care system was successful thanks to cooperation between physicians, the University of Tartu, Ministry of Social Affairs, local government institutions and patients.