Quit drinking, keep smiling

27 January 2015

Forget the world view. In election programmes, the parties stand united in intent to make life miserable for tipplers and find funds to fill holes in Estonian teeth. At current level of financing, the healthcare system is in dire straits a few years from now, but why mention that?

With newcomers EKRE and Free Party ever so stingy to splash promises, the more is trumpeted by those currently in parliament. As one expert put it, never has there been such a string of health related vows. Up to now, the pre-elections health talk has mainly been about the waiting lines. This time, Reform Party, Centre Party, IRL and soc dems (SDE) have agreed to admit that just treating the sick won’t do the trick. We must prevent such state.

One almost intoxicated with prevention and propagating the healthy way is Reform Party. In their election platform, available at the website,  it twice promises (slightly altering the wording) that the current physical education classes at schools will be morphed into the more modern exercise education and at other lessons motion will come with the package. To get the pupils moving, SDE and IRL also intent to make an impact. The latter’s ambition is there to be no need for training sessions at all: the school load will be physical enough.

Though swimming sessions are just as mandatory at schools as multiplication table, Reform lets the voters know that swimming must go on. Dear me, the programme mentions not the multiplication thing …

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While reading the election promises by Reform Party, one in power for years, a reader will wonder how lots of the stuff flaunted is either already reality or just about to get started. Thus, we do have a cancer register, screenings thereof have already increased, e-consultation and e-emergency care card are in use, and since this year family doctors have the money to send patients to speech therapists and psychologists. Meanwhile, squirrels are promising more money for prevention of sicknesses while their own minister left said projects without state funding when the recession hit.

Also, the prime ministerial party is generous with money not theirs. Thus, their elections programme holds the millions of European Social Fund allotted to tackle/cure alcohol addiction, and the children’s mental health centres established out of Norwegian support programme. The programme is silent about what will happen when the EU money is over and the bills will be Estonia’s to pay.

The EU money coming to update hospitals network and family doctors’ system is also listed as Reform Party promise. Here, IRL has sinned likewise. The latter features another hollow vow yet: making treatment bill size visible for people. This is already happening.

By Centre Party, young doctors are promised initial support and accommodation. In reality, the support can already be tapped for year, but it remains to be seen that the exodus of young doctors be tamed. Neither are physicians attracted to smaller places by free dwelling places offered by local governments. The sole Tallinn ruler is also promising to ban drinking in public places though the law – again – sees to that already.

The dental harmony

All bigger party programmes include limits to drinking – substantial ones. In 15 years, Reform Party aims to outright halve that; to achieve this, excises will undergo a steady rise. IRL basically says the same; they would only allow alcohol sold on special areas while lifting age floor for buyers. The police would be awarded the right to use children for sham purchases, to unmask clerks who tend to transgress selling booze to minors.

Restricting alcohol ads is important to IRL, Centre Party and SDE. The latter writes about banning sales of alcohol to individuals visibly drunk. The latter does already exist and is working. Planning sober Sundays in Tallinn and having prohibited sales of alcohol near schools, the Centre Party would thus treat the whole land once in power.

While Reform Party hopes the seven years of EU money will cure ills of alcohol, Centre Party would allot 2 percent of alcohol excise to treat alcoholism. IRL, however, would re-establish the Soviet time forced treatment, creating a surveillance and support system to go with it.

The other topic of breathtaking party unity is in all things dental. An obviously self-fulfilling promise at that – the Health Insurance Fund having already decided that it can no longer be left on people alone to pay the dentist bills. Here, EKRE emerges as most generous. Dental care would be free. For all.

According to Praxis analyst Priit Kruus, such an open obligation would probably end up boosting dental care prices with Health Insurance Fund obligated to pay all bills. Here, the most modest is IRL: state support is promised to people who, due to lack of money, have not been able to see a dentist for the past 20 years. And that only if the state has the money.

All major parties are digital believers splashing promises on how the e-turn will save the health care system. Reform Party and IRL, both having been in power for years, are vowing to – at long last – to get the e-health solutions working. It is while the two were in power that the Estonian state spent €15m on e-solutions. A year ago, National Audit office passed a crushing assessment on how that money was used. Till this very day, the solutions sputter.

IRL is suggesting a personal health account system to where a healthy person might collect some money. At initial glance, the endeavour looks prudent as supposedly bringing extra money into health care. In reality, though, it would mean that those in deepest need i.e. the elderly would have less for treatment; and, as known to all who have collected money on bank accounts, the inflation will eat at it heartily. Also, knowing the Estonian salaries and fees charged for health services, only a few would be able to squirrel away a sum actually helpful.

The Free Party, meanwhile, wishes that folks would be free to use past of the money paid into health insurance on their own.

To cure the problem deemed worst by the public – the long waiting lines to see a doctor – Reform Party suggests a patient might personally opt for a medical institution and «by his way to the front», later presenting Health Insurance Fund the bill.

The clause makes merry the private clinic hearts while the ordinary hospitals worry. As assured us by heads of large hospitals last year, such a system would rather lengthen the lines as state money would be spent to pay the bills presented by the wealthy.

Wanted: a healthy male

While standing as one to fight for sobriety and for smiles filled with teeth, the view on hospitals network future is diverse as anything. Reform Party would let the two biggies – North Estonian Regional Hospital (PERH) and Tartu University Hospital – to divide the small ones between themselves («Rapla for you, Võru for me, and about Jõhvi we will see!»).

IRL would carry shaping of the network to its end, while standing against monopolies. The Centre Party would leave each county with its hospital – no to networking. Free Party, however, vows to make health care system work better – on account of the overly ballooned infrastructure.

He much talked-about promise to spare health-spending by employers from added levy is found in programmes of SDE, Centre Party, Free Party and EKRE. Now and again, the proposal has been argued against stating the state desires to maintain level tax policy and exceptions aren’t planned.

The other suggestion, many times discussed, is ensuring first contact medical care to those without health insurance as well. This time, we find it in Centre Party programme; SDE would ask them to pass screening.

A sign of the times, perhaps: several parties (Centre Party, SDE, Reform Party) have separately mentioned the need to start dealing with the health of the Estonian male. High time, sayeth the data…

According to analysis by Praxis, the future of Estonian health system looks gloomy, even if only considering the aging of the population. At the current funding model, the reserves accumulated in the good times will carry us for a couple of years more; then, the Health Insurance Fund budget will drop deeply into the red and the state will be forced to find extra money. Despite this darkness, the parties aren’t talking about the issue – though the keeping of their promises would cost dozens of millions of euros.

Centre Party desires to make financing of sickness benefits part of Health Insurance Fund. Essentially, this would mean moving money from one pocket to the other, with nothing added. Soc dems, however, think to tax those receiving dividends and parental benefits – to suck extra euros into health insurance.

Source: Quit drinking, keep smiling, PM