Download Ida-Tallinna Keskhaigla IV konverents

Imaging in Estonia –
incentives to integrate
Peeter Ross, MD
President
Estonian Society of Radiology
MIR 2009
Riga
Million
inhabitants
Estonia
1,34
Latvia
2,23
Lithuania
3,56
Factors affecting development
• Compulsory health insurance since 1992
– Health insurance tax – 13% (paid by employer)
• Income tax – 21% (flat tax)
– Fee for service or DRG
– 5,0% of GDP for healthcare in 2005 and 2006
• Health care service providers are municipal,
governmental or private
– All public hospitals are incorporated into private law
• Wide range of e-services and high bandwidth
connectivity
– Internet
• 75% of population (15-74 years) use regularly internet (2009)
• Wide spectrum of mobile internet services
Radiology. Current figures
• Approximately 200 radiologists (+34 residents)
– 149 radiologist per one million inhabitants
• Country-wide PACS
– Radiologists
– Referring physicians
• Equipment
–
–
–
–
–
–
X-ray
CT
MRI
Angiography
Mammography
Nuclear medicine
-
143 (one unit per 9 400 inhabitants)
19 (70 000)
10 (135 000)
5 (270 000)
6 (225 000)
5 (270 000)
Last decade development
Number of units
143
**
125
94
78
*
48
27
19
10
3
11
6
1999
2009
* There was about 120 acute care hospitals in 1990
* * Approximate figure
7
2
5
2
5
Last decade development
Units per 1 million inhabitant
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
1999
2009
MRI
2.1
7.4
CT
4.2
14.1
Mammography
7.8
5.2
Angiography
1.4
3.7
NM
1.4
3.7
IT solutions in radiology
• Country-wide PACS
– 39 radiology departments all over Estonia are
connected
– Accessible for radiologists and referring physicians
– Radiology images
• Work in progress
– Non-radiology images (endoscopy, eye fundus, dermatology etc.)
– ECG
• Additionally 6 hospital PACS´es
• Estonian country-wide Health Information System
– Referrals and Reports
Economic growth in Estonia
14
12
Real economic growth (%)
10
8
6
4
2
0
1994
1996
1998
2000
2002
-2
-4
-6
Real growth (%)
2004
2006
2008
Economic growth in Estonia
14
600,000
12
500,000
8
400,000
6
4
300,000
2
200,000
0
1994
1996
1998
2000
2002
2004
2006
2008
-2
100,000
-4
-6
0
Real growth (%)
Health insurance tax (Euro)
Health
insurance tax
revenue
(Euro 10³)
Real economic growth (%)
10
Incentives of different parites
• Interested parties
– State
• Health care policy
• Guarantee radiology services for citizen
– Health Insurance Fund
• Effectiveness (reduce costs)
– Society of Radiology
• Professional working environment
• Quality
• International cooperation
– Major health care providers
• Competitive services
Important events (1)
• 1991 – Establishment of Estonian Society of
Radiology
– Specification of radiology procedures
– Accreditation of departments
– Sertification of radiologists
• 1992 – Compulsory Health Insurance
• 1994 – Radiation Act (modified 2004)
– 1998 – Decree of Minister of Social Affairs
regarding use of ionizing radiation in health
care
Important events (2)
• 1997 – Primary care reform
• 2000 – Estonian Hospital Master Plan 2015
– Decreasing the total number of hospitals
from 68 to 15 by 2015
• 2001 – Health Services Organization Act
– Hospitals are either foundations or jointstock companies
• 2001 – Estonian Radiology Master Plan 2015
• 2005-2009 – Acquiring resources to triple the
number of CT, MR and angio units
• 2006 – Foundation of Estonian PACS
Estonian Radiology Master
Plan 2001-2015
• Conditions for the radiology department in central
or regional hospital by 2005
– Availability of X-ray, ultrasound, CT, MRT, NM,
interventional radiology
– Electronic referral and report
– Electronic archiving of radiology exams –
country-wide PACS
– Implementation of clinical-radiological meetings
– Support from biomedical engineers
– Implemented quality system of radiology
service
Estonian Radiology Master
Plan 2001-2015
Structure of radiologists work time
Planning of procedures
5%
Time for procedures
15%
Reporting of images
20%
Cooperation with other clinicians
40%
Continous medical education
10%
Teaching
2% (up to 25%)
Others (radiation protection etc.)
8%
• Definition of radiologists workload
– By examination units
Important decisions in
relation to economy
14
600,000
Health Services
Organization
Act
12
500,000
8
400,000
6
Radiation act
4
300,000
2
200,000
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
-2
100,000
-4
-6
Compulsory
Health
Insurance
Radiology
Master Plan
Real growth (%)
Health insurance tax (Euro)
0
Health
insurance tax
revenue
(Euro 10³)
Real economic growth (%)
10
Important decisions in
relation to economy
14
600,000
Consolidation
of resources –
increase in
purchasing
power
12
500,000
8
400,000
6
Quality criteria
for radiology
4
300,000
2
200,000
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
-2
100,000
-4
-6
Transparent
reimbursement
Vision and
mission of
radiology
Real growth (%)
Health insurance tax (Euro)
0
Health
insurance tax
revenue
(Euro 10³)
Real economic growth (%)
10
Important decisions in
relation to economy
14
600,000
Consolidation
of resources –
increase in
purchasing
power
Real economic growth (%)
10
500,000
?
8
6
Quality criteria
for radiology
4
400,000
300,000
2
200,000
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
-2
100,000
-4
-6
Transparent
reimbursement
Vision and
mission of
radiology
Real growth (%)
Health insurance tax (Euro)
0
Health
insurance tax
revenue
(Euro 10³)
12
Conclusions
• Economic recession fosters health care
reforms
• Reform options
– Policy change
– New reimbursement schemes
– Innovation
• It is important for radiology community to be
involved in development of health care policy
Thank you!
[email protected]