Source: https://www.riigiteataja.ee/en/eli/513032017001/consolide
Timestamp: 2019-04-26 00:21:59+00:00

Document:
Entry into force 01.01.2002, partially 01.01.2003. a and 01.01.2005. a.
22.04.2010 RT I 2010, 22, 108 01.01.2011, enters into force on the date which has been determined in the Decision of the Council of the European Union regarding the abrogation of the derogation established in respect of the Republic of Estonia on the basis provided for in Article 140 (2) of the Treaty on the Functioning of the European Union, Council Decision 2010/416/EU of 13 July 2010 (OJ L 196, 28.07.2010, p. 24 - 26).
(1) This Act provides the organisation of and the requirements for the provision of health services, and the procedure for the management, financing and supervision of health care.
(2) This Act applies to the organisation of the provision of health services in the area of government of the Ministry of Defence with the specifications arising from the Defence Forces Service Act and Estonian Defence Forces Organisation Act.
(21) This Act applies to the organisation of the provision of health services in prisons with the specifications resulting from the Imprisonment Act.
(22) This Act applies to the organisation of the provision of health services in schools with the specifications resulting from the Basic Schools and Upper Secondary Schools Act.
(23) This Act applies to the professional activities of pharmacists and assistant pharmacists upon the provision of pharmacy services in the extent provided for in subsection 2 (11) and subsections 3 (4) and (5) of this Act.
(3) The provisions of the Administrative Procedure Act apply to administrative proceedings prescribed in this Act, taking account of the specifications provided for in this Act.
(1) Health services are the activities of health care professionals for the prevention, diagnosis or treatment of diseases, injuries or intoxication in order to reduce the malaise of persons, prevent the deterioration of their state of health or development of the diseases, and restore their health. The minister responsible for the area shall establish the list of health services.
(11) Pharmacists and assistant pharmacists provide health services in the framework of professional activity only in the case provided for in the law.
(2) In-patient health services are health services for the provision of which a person needs to stay at a hospital twenty-four hours a day.
(3) Out-patient health services are health services for the provision of which a person does not need to stay at a hospital twenty-four hours a day.
(1) For the purposes of this Act, health care professionals are doctors, dentists, nurses and midwives if they are registered with the Health Board.
(2) A health care professional may provide health services within the acquired profession or speciality with regard to which the Health Board has issued a certificate of registration of the person as a health care professional.
(3) A health care professional shall pay a state fee pursuant to the rate provided for in the State Fees Act for the issue of a certified transcript of a certificate of registration.
(4) Health care professionals for the purposes of the Medicinal Products Act are also pharmacists and assistant pharmacists providing pharmacy services in a general pharmacy or hospital pharmacy provided that they have been registered in the national register of pharmacists and assistant pharmacists maintained by the Health Board according to subsection 55 (1) of the Medicinal Products Act.
(5) Pharmacists and assistant pharmacists may provide pharmacy services within the acquired profession on which a certificate concerning registration as a pharmacist or assistant pharmacist has been issued thereto by the Health Board.
For the purposes of this Act, a patient means a physical person who has expressed his or her wish to receive health services or who receives health services.
Health care providers are health care professionals or legal persons providing health services.
(1) Health care providers, who have the obligation to maintain confidentiality arising from law, have the right to process personal data required for the provision of a health service, including sensitive personal data, without the permission of the data subject.
2) a body conducting an investigation has prohibited access to the data or transmission of the data in the interests of preventing a criminal offence, of apprehending a criminal offender or ascertaining the truth in a criminal proceeding.
(1) Use of the classifications, directories, address details of the State Information Systems and standards of the Health Information System is mandatory upon maintaining records of the provision of a health care service.
(11) Documents certifying the provision of health care services may be created and preserved in digital form and digital records may be created if preservation of the integrity and authenticity thereof is ensured during the prescribed retention period and these are arranged and described pursuant to the Archives Act.
(12) Health care providers may digitalise the paper documents which certify the provision of health care services if the integrity and authenticity thereof is ensured pursuant to the requirements provided for paper documents in the Archives Act and the Personal Data Protection Act. Paper documents which certify the provision of health care services and which have been digitalised may be destroyed prematurely on the basis of an assessment decision of the public archives.
(2) The conditions and procedure for maintaining records of the provision of health services and preservation of the documents thereof shall be established by a regulation of the minister responsible for the area.
8) clinical psychology trainees under supervision and at the responsibility of a clinical psychologist.
(11) A resident physician may participate in the provision of specialised medical care, general medical care and emergency care with the purpose of acquiring a profession, under supervision and at the responsibility of a medical specialist who has at least five years of work experience in the specialty of specialised medical care corresponding to the practical training passed by the resident physician.
(2) The activity of the persons specified in subsections (1) and (11) of this section shall be deemed to be the activity of the person under whose supervision and responsibility the persons practice.
2) a person who directly sells medical devices on the basis of a medical device card.
(4) The participation of the persons specified in subsection (3) of this section in the provision of health services has been regulated with the Medicinal Products Act and Medical Devices Act respectively.
For the purposes of this Act, emergency care means health services which are provided by health care professionals in situations where postponement of care or failure to provide care may cause the death or permanent damage to the health of the person requiring care.
(1) Every person in the territory of the Republic of Estonia has the right to receive emergency care.
(2) Health care professionals are required to provide emergency care within the limits of their competence and with the means available.
(3) Emergency care provided to persons insured by compulsory health insurance and persons equal thereto (hereinafter persons covered by health insurance) shall be paid for from the funds designated for health insurance in the state budget.
(4) Emergency care provided to a person not covered by health insurance shall be paid for out of the funds prescribed for such purpose in the state budget, on the basis of a contract entered into between the Ministry of Social Affairs and the Estonian Health Insurance Fund and pursuant to the Health Insurance Act.
(1) General medical care means out-patient health services which are provided by family physicians and health care professionals working together with them.
2) as a specialist without a practice list.
(3) The provisions of this Act regulating provision of specialised out-patient care apply to the activities of family physicians specified in clause (2) 2) of this section.
(4) A family nurse is a nurse or a midwife who works together with a family physician and provides health services to persons belonging to the practice list of the family physician to the extent and pursuant to the procedure provided for on the basis of subsection 8 (61) of this Act.
(1) The practice list of a family physician is a list of persons who are to be serviced by the family physician pursuant to this Act.
(2) Each family physician shall have one practice list.
(3) Every citizen of the Republic of Estonia and alien staying in Estonia on the basis of a residence permit has the right to register in the practice list of a family physician and change a family physician on the basis of a written application. A person shall be transferred to the practice list of a new family physician as of the first day of the following calendar month.
(31) A new-born child born in Estonia shall be automatically registered after birth in the practice list of his or her mother’s family physician.
(32) If the mother of a new-born child has not been registered in the practice list of any family physician, the child shall be registered, based on a written application of the child’s parent or guardian, in the practice list of the family physician specified in the application or the family physician shall be appointed to the child by the Health Board.
(4) The practice list of a family physician comprises persons registered with the family physician and persons determined by the Health Board on the basis of the Estonian population register address, taking into account the maximum number of persons on a practice list specified in subsection (41) of this section.
2) 2001–2400 persons if at least one health care professional qualified as a physician provides general medical care to persons entered in the list together with the family physician.
(42) The Health Board may, with the consent of the Estonian Health Insurance Fund, approve a list smaller than the minimum number of persons on a practice list if the number of persons permanently residing in the local government of the service area of a family physician is less than 1200.
(43) The Health Board shall appoint a person not registered in a practice list of a family physician to a list, compare the lists and approve the amended lists and shall notify the person, family physician and the Estonian Health Insurance Fund of the amendment as necessary but not less frequently than by the twentieth date of the calendar month following the last month of each quarter. In order to compare the lists, the Health Board shall have the right to receive data from the health insurance database established on the basis of subsection 15 (1) of the Health Insurance Act. The appointment of a person to a practice list of a family physician shall be calculated as of the first day of the calendar month following the appointment.
(44) The Health Board shall exclude a person from the practice list of a family physician if the person is not a subject of the Estonian population register or if the place of residence of a person not covered by health insurance is not in the Republic of Estonia according to the population register. The Health Board shall notify a person of appointment to and exclusion from a list in writing or by electronic means within seven working days as of making the decision. If a document needs to be delivered to more than a hundred persons of if the data on residence of a person are not known to the Health Board, the decision shall be published in the official publication Ametlikud Teadaanded.
(45) If the number of persons entered in a practice list of a family physician exceeds the maximum number of persons on a practice list, the Health Board shall, taking account of the maximum number, appoint the person to the practice list of another family physician based on the address according to the Estonian population register. On the basis of an application of a family physician, the Health Board shall be entitled to appoint a person not covered by health insurance to a practice list of another family physician if a practice list with the maximum number of persons provided for in clause (41) 1) of this section includes more than 800 persons not covered by health insurance.
(46) The minister responsible for the area shall establish, by a regulation, the bases of and procedure for the compilation, amendment and comparison of practice lists of family physicians and the maximum number of practice lists.
(47) Upon the establishment of the maximum number of practice lists, the minister responsible for the area shall proceed from the number of persons being the subjects of the Estonian population register and considering the better organisation and availability of general medical care.
8) the name of the sole proprietor or business name of the company through which the family physician provides general medical care.
4) the website address of the place of business, if applicable.
(6) A family physician shall ensure the accessibility and continuity of health services to persons entered in his or her practice list to the extent and pursuant to the procedure prescribed in the work instructions of family physicians and health care professionals working together with family physicians.
(61) The work instructions of family physicians and health care professionals working together with family physicians shall be established by a regulation of the minister responsible for the area.
(7) A family physician shall inform persons entered in his or her practice list where and who the persons can turn to in order to receive medical care outside the reception hours of the family physician. The Estonian Health Insurance Fund may enter into a contract with the family physician for the provision of general medical care during evening and night hours and on days off.
(1) Substitution for a family physician is a situation in which a family physician, due to his or her temporary absence from work, does not personally and directly provide general medical care to persons belonging to his or her practice list, above all, does not personally provide out-patient consultations to persons entered in the practice list.
(2) The family physician shall ensure the finding of a substitute for a family physician in case of his or her absence from work for up to three months (hereinafter short-term substitution).
(3) The family physician shall ensure the finding of a substitute for a family physician in case of his or her absence from work for more than three months (hereinafter long-term substitution) by submitting a notice in a format which can be reproduced in writing to the Health Board no later than ten calendar days before the substitution setting out the cause of temporary absence from work, duration of substitution, name and qualification of the substitute, place and organisation of provision of general medical care and his or her contact information during the substitution.
(4) A family physician shall notify the local government of his or her service area and the persons entered in the practice list of the family physician of short-term and long-term substitution setting out the duration of substitution, name and qualification of the substitute as well as the place and organisation of provision of general medical care during the substitution. Information regarding the organisation of substitution shall be disclosed by the family physician to the persons entered in the practice list at the place of business of the family physician.
(5) In case of short-term substitution, the family physician shall be substituted for by a health care professional with the qualification of a physician.
(6) In case of long-term substitution, the family physician shall be substituted for by a health care professional with the qualification of a family physician or a resident physician studying in family medicine residency.
(7) Long-term substitution may last for up to one year, in case of training related to professional development for up to two years, and in the case of parental leave, until the termination of parental leave.
(8) The substitute of a family physician shall notify the family physician and the Health Board immediately in a format which can be reproduced in writing of premature or extraordinary termination of substitution for a family physician.
(1) The service area of a family physician is an area of a local government or local governments determined by the Health Board in which the family physician and health care professionals working together with the family physician make house calls if necessary upon the provision of general medical care. A family physician shall provide emergency care to persons living or temporarily residing in the service area who are not included in the practice list of a family physician.
(2) If the service area of a family physician includes an area of local governments of several counties, the accessibility of general medical care shall be ensured to the persons living in the service area as required. Upon determination of a service area, the Health Board shall take into account the circumstances affecting the provision and accessibility of general medical care as required caused by the specific character of the area, including the number of residents and organisation of public transport in the area, if necessary.
(1) The place of business of a family physician is a place in which the facilities of the family physician are located and where the family physician provides general medical care.
(2) If the place of business of a family physician is not located in the service area of a family physician, the accessibility of general medical care shall be ensured to the persons entered in the practice list of a family physician as required. The distance between the place of business and the service area shall not be unreasonably long. There must be a reasonable public transport connection between the place of business and the service area.
The minister responsible for the area shall establish the requirements for the facilities, installations and equipment of places of business of family physicians.
(1) General medical care provided to persons covered by health insurance shall be paid for from the funds designated for health insurance in the state budget in the amounts in which the Estonian Health Insurance Fund has assumed the obligation to pay for it.
(2) Persons not covered by health insurance shall pay for general medical care themselves.
Family physicians may practise as sole proprietors or through companies providing general medical care.
(1) The partnership agreement of a company operating as a general partnership or limited partnership shall be entered into in writing and shall be appended to the application for entry of the company in the commercial register.
(2) Companies providing general medical care may merge only with other companies providing general medical care.
(3) Companies providing general medical care shall not be partners or shareholders of companies providing specialised medical care.
(1) A company providing general medical care may have no other area of activity besides the provision of general medical care, nursing services permitted to be provided independently, midwifery care services permitted to be provided independently, physiotherapy service and social services, and teaching and scientific research in health care, and granting the use of immovable property.
(2) A family physician entered in the commercial register as a sole proprietor may provide only general medical care, nursing services permitted to be provided independently, midwifery care services permitted to be provided independently, physiotherapy services and social services and engage in teaching and scientific research in health care and granting the use of immovable property under the business name entered in the commercial register.
2) local government or local governments if the place of business of a company providing general medical care is located in at least one of their administrative territories.
(2) If a partner or shareholder specified in clause (1) 1) of this section has been deprived of the right to practise as family physician, he or she shall transfer his or her share to a family physician who commences provision of health services through this company or to a local government within three months as of the deprivation of the right to practise as family physician. If the share is not transferred within three months, the company is required to cancel the share and compensate the value of the share to the family physician.
(3) If the partner or shareholder specified in subsection (2) of this section was the only partner or shareholder of the company, he or she shall transfer the share within three months to a local government or family physician who commences provision of health services through this company, or decide to dissolve the company. If the family physician does not exercise the specified right, the company shall be dissolved by a court judgment at the request of the person who grants the right to compile practice lists.
(4) In the case of the death of a partner or shareholder specified in clause (1) 1) of this section, the share of the company shall be transferred to his or her successor if the successor is a family physician who commences provision of health services through this company. In other cases, the successor of the family physician shall transfer the share to a family physician who commences provision of health services through this company or to the local government within three months as of acceptance of the succession. If the share is not transferred within the period, the company is required to cancel the share and compensate the value of the share to the successor.
(5) If the partner or shareholder specified in subsection (4) of this section was the only partner or shareholder of the company, the successor may transfer the share within six months as of acceptance of the succession to a local government or family physician who commences provision of health services through this company, or decide to dissolve the company. If the successor does not exercise the specified rights, the company shall be dissolved by a court judgment at the request of the person who grants the right to compile practice lists.
(1) Emergency medical care means out-patient health services for the initial diagnosis and treatment of life-threatening diseases, injuries and intoxication and, if necessary, for the transportation of the person requiring care to a hospital.
(2) Each person staying in the territory of the Republic of Estonia has the right to receive emergency medical care.
(1) An ambulance crew shall provide emergency medical care on the basis of a dispatch order received from the alarm centre or information received in any other manner.
(11) Owners of ambulance crews are the providers of vital service specified in clause 34 (2) 2) of the Emergency Act.
(2) The Government of the Republic shall establish the procedure for co-operation in emergency medical care between the emergency medical staff, hospitals, rescue service agencies and police authorities.
5) the co-operation of emergency medical staff and the procedure for mutual settlement with family physicians.
3) organise the temporary substitution of ambulance crews.
6) the number of ambulance crews established on the basis of clause (3) 1) of this section.
(42) The Health Board shall enter into a new contract with an owner of an ambulance crew who has provided service in compliance with the conditions provided for in subsection (41) of this section and the contract under public law. The owner of an ambulance crew and the Health Board may amend the contract only by taking account of the circumstances provided for in subsection (41) of this section.
(43) The Health Board is not required to enter into a contract for provision of emergency medical care with all the owners of ambulance crews.
5) temporary substitution lasts for more than thirty days.
(45) A competition shall be announced within fifteen days as of the occurrence of a circumstance specified in subsection (44) of this section. If necessary, the Health Board shall organise the provision of the service through temporary substitution until entry into contract with the winner of the competition.
(5) An alarm centre has the right to send ambulance crews to other service areas in order to ensure the immediate accessibility of care.
(6) An ambulance crew of a state rescue service agency shall comply with the requirements established for ambulance crews by this Act and on the basis thereof.
(1) A company, sole proprietor, foundation or a state or local government agency which holds a corresponding activity licence may be the owner of an ambulance crew.
(2) A legal person which owns an ambulance crew may have no other area of activity besides the provision of emergency medical care, teaching and scientific research in health care, transport of patients relating to the provision of health services with a non-emergency vehicle or ambulance crew. A sole proprietor who owns an ambulance crew may provide only emergency medical care under the business name entered in the commercial register.
(3) The restriction on area of activity specified in subsection (2) of this section does not apply to providers of specialised medical care who own an ambulance crew.
(1) Emergency medical care shall be paid for from the state budget through the Ministry of Social Affairs.
(2) The minister responsible for the area shall establish the procedure for the financing of emergency medical care.
(1) Specialised medical care means out-patient or in-patient health services which are provided by medical specialists or dentists and health care professionals working together with them.
(11) Day care means out-patient health services the provision of which requires the short-term observation of a person’s condition and after which the person leaves from the health care provider on the same day.
(2) The list of specialties and additional competences of specialised medical care shall be established with a regulation of the minister responsible for the area.
(1) Companies, sole proprietors or foundations which hold corresponding activity licences may provide specialised out-patient care.
(2) The minister responsible for the area shall establish the requirements for the facilities, installations and equipment necessary for the provision of specialised out-patient care.
(1) A hospital is an economic unit formed in order to provide out-patient and in-patient health services.
(2) A company or foundation which holds a corresponding activity licence may own a hospital.
(3) A company or foundation which operates a hospital may have no other area of activity besides the provision of specialised medical care, emergency medical care, nursing services permitted to be provided independently, midwifery care services permitted to be provided independently and social services, teaching and scientific research in health care, maintaining a hospital pharmacy, manufacture of full blood and blood components and procurement and handling of cells, tissues and organs, and granting the use of immovable property.
(4) The types of hospital providing specialised medical care are: regional hospital, central hospital, general hospital, local hospital, special hospital and rehabilitation hospital. The minister responsible for the area shall establish the requirements for the types of hospital.
(41) Owners of regional hospitals and central hospitals are the providers of vital service specified in clause 34 (4) 1) of the Emergency Act.
(5) An owner of a hospital shall submit the functional development plan prepared on the basis of subsection 56 (1) 3) of this Act and the budget of the hospital to the Ministry of Social Affairs. The minister responsible for the area shall establish the conditions and procedure for the submission and disclosure of the functional development plans and budgets of hospitals.
(1) Specialised medical care provided to persons covered by health insurance shall be paid for from the funds designated for health insurance in the state budget in the amounts in which the Estonian Health Insurance Fund has assumed the obligation to pay for it.
(2) Persons not covered by health insurance shall pay for specialised medical care themselves.
(1) Nursing means out-patient or in-patient health services which are provided by nurses and midwives together with family physicians, medical specialists or dentists, or independently.
(2) The minister responsible for the area shall establish the list of nursing specialties.
(1) Companies, foundations or sole proprietors which hold corresponding activity licences may provide nursing independently.
(11) The restriction on the legal form of the provision of nursing specified in subsection (1) of this section does not apply to the providers of social services specified in § 100 of the Social Welfare Act and to the institutions providing 24-hour social services specified in § 20 of the Social Welfare Act in case of provision of home nursing service specified in the regulation established under subsection 25 (3) of this Act.
(2) The requirements for the facilities, installations, equipment, instruments and medicinal products necessary for the independent provision of out-patient nursing shall be established by a regulation of the minister responsible for the area.
(3) The list of out-patient nursing services which are permitted to be provided independently and the operations being part thereof as well as the conditions of provision of nursing services shall be established by a regulation of the minister responsible for the area.
(1) A nursing hospital is an economic unit formed in order to provide out-patient and in-patient nursing services which are permitted to be provided independently.
(2) A company or foundation which holds a corresponding activity licence may own a nursing hospital.
(3) A company or foundation which operates a nursing hospital, except for the owner of a hospital providing specialised medical care, may have no other area of activity besides the provision of nursing services permitted to be provided independently, out-patient specialised medical care, physiotherapy service and social services, maintaining a hospital pharmacy, teaching and scientific research in health care and granting the use of immovable property.
(4) The list of nursing services which are permitted to be provided independently at a nursing hospital and the operations being part thereof and the requirements for the staff, facilities, installations, equipment and instruments necessary for the independent provision of in-patient nursing shall be established by a regulation of the minister responsible for the area.
(1) Independent nursing provided to persons covered by health insurance shall be paid for from the funds designated for health insurance in the state budget in the amounts in which the Estonian Health Insurance Fund has assumed the obligation to pay for it.
(2) Persons not covered by health insurance shall pay for independent nursing themselves.
(3) Independent nursing provided in the course of the provision of 24-hour special care service shall be financed from the state budget through the Social Insurance Board independent of the fact whether the person is or is not covered by health insurance.
Midwifery care means out-patient or in-patient health services which are provided by midwives together with a family physician or medical specialist or independently.
(1) Companies, foundations or sole proprietors which hold the corresponding activity licences may provide midwifery care independently.
(2) Midwifery care may be provided independently only as out-patient service.
(3) The list of midwifery services which are permitted to be provided independently and the operations being part thereof as well as the conditions of and procedure for obstetrical home care shall be established by a regulation of the minister responsible for the area.
(4) The requirements for the facilities, installations, equipment, instruments and medicinal products necessary for the independent provision of midwifery care shall be established by a regulation of the minister responsible for the area.
(1) Independent midwifery care provided to persons covered by health insurance shall be paid for from the funds designated for health insurance in the state budget in the amounts in which the Estonian Health Insurance Fund has assumed the obligation to pay for it.
(2) Persons not covered by health insurance shall pay for independent midwifery care themselves.
(1) Registration grants a health care professional the right to provide health services within the limits of the profession or specialty specified in the document certifying the qualification and in the registration certificate issued upon registration.
(2) A health care professional may provide only the services as the provider of which he or she has been registered in the Health Board.
(1) In order to register health care professionals, the national register of health care professionals shall be established by a regulation of the Government of the Republic.
(2) The purpose of the national register of health care professionals is to register health care professionals in order to ensure national protection of the consumers of health services through provision of health services by persons who have the required qualifications and supervision over them and the required data for government agencies for the performance of the functions of the management and organisation of health care arising from Acts and other legislation and for the organisation of health statistics.
(3) Health care professionals are obliged to submit information to the authorised processor.
(4) The authorised processor has the right make inquiries by way of cross-usage in order to obtain information entered in the register and to obtain information from other registers.
(6) The Health Board is the chief and authorised processor of the national register of health care professionals.
(1) A person applying for registration shall submit to the Health Board a registration application and a copy of the document certifying his or her qualifications and the data on the European professional card upon the existence thereof.
(11) A person applying for registration shall pay a state fee for the review of an application pursuant to the rate provided for in the State Fees Act before submitting the application.
(2) The minister responsible for the area shall establish the list of information to be submitted in registration applications.
(3) The minister responsible for the area shall establish a list of the documents certifying qualifications which are the bases for the registration of health care professionals.
(4) The Health Board shall verify the correctness of information submitted in the documents certifying qualifications and shall make a registration decision within one month as of submission of the documents specified in subsection (1) of this section, except in the cases specified in subsections 29 (11) and 30 (2) of this Act.
2) he or she has been deprived of the right to work in the profession or speciality specified in the application for registration.
(6) If a person is not registered with the Health Board, he or she shall be notified thereof in writing within ten working days as of the date of making the decision.
(8) A person is required to submit the documents specified in subsection (1) of this section to the Health Board not later than within five years as of the issue of the document certifying qualifications.
(9) If a person fails to submit the documents within the term of registration specified in subsection (8) of this section, he or she may apply for the registration of himself or herself with the Health Board if he or she passes a theory examination and practice examination of health care professionals pursuant to the procedure established by the minister responsible for the area and submits a document certifying the results of the examination to the Health Board.
(10) In order to apply for the registration of himself or herself as health care professional, a person whose document certifying qualifications is not included in the list established pursuant to subsection (3) of this section shall pass a theory examination and practice examination of health care professionals pursuant to the procedure established by the minister responsible for the area.
(1) Subsections 28 (1)-(2) and (5)-(6) of this Act apply to the registration of persons who have acquired qualifications in the Member States of the European Union, Member States of the European Economic Area (hereinafter Member States of the European Economic Area) or in Switzerland.
(11) The Health Board shall submit an acknowledgement of receipt of an application for registration to the person applying for registration within one month as of submission of the documents specified in subsection 28 (1) of this Act and, if necessary, shall notify the person of the missing documents. The Health Board shall verify the correctness of the data submitted in documents certifying the qualifications and make a decision on registration within two months as of submission of all the requisite documents. If, in the course of registration proceedings, the need arises to assess the circumstances specified in subsection 29 (3) of this Act, the Health Board may extend the term for making the decision on registration to three months by notifying the person applying for registration immediately of the extension of the term and the reasons for extension.
(2) The qualifications acquired in a Member State of the European Economic Area or Switzerland shall be certified by a document which grants a health care professional the right to provide health services in the profession or speciality set out in the document in the corresponding Member State of the European Economic Area or in Switzerland.
(3) If a person has acquired a speciality of specialised medical care in a Member State of the European Economic Area or Switzerland and the speciality is not included in the list established pursuant to subsection 20 (2) of this Act or the speciality acquired by the person is not automatically recognised, the Health Board shall decide on the recognition of the person’s qualifications or obligation to take an aptitude test pursuant to the provisions of the Recognition of Foreign Professional Qualifications Act.
(4) The list of documents certifying the qualifications acquired in a Member State of the European Economic Area or in Switzerland and the procedure for the assessment of the correspondence of the qualifications shall be established by the minister responsible for the area.
(5) If an European professional card has been taken into use with the Commission Implementing Regulation in the profession of a health care professional based on Article 4a (7) of Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications (OJ L 255, 30.09.2005, p. 22–142) and the competent authority of a Member State of the European Economic Area or Switzerland has forwarded an application to the competent authority of Estonia for a person to work in Estonia, §§ 211, 214 and 215 of the Recognition of Foreign Professional Qualifications Act shall be applied to the application for and proceeding the applications for the European professional card.
(1) Subsections 28 (1)-(2) and (5)-(6) of this Act apply to the registration of persons who have acquired qualifications in foreign states not specified in § 29 of this Act.
(11) If a person who has acquired his or her qualifications in a foreign state not specified in § 29 of this Act and a Member State of the European Economic Area or Switzerland has recognised the qualifications beforehand and the person has obtained three years’ work experience in the corresponding profession or speciality in the Member State of the European Economic Area or Switzerland where his or her qualifications were recognised, the Health Board shall decide on the recognition of the person’s qualifications or obligation to take an aptitude test pursuant to the provisions of the Recognition of Foreign Professional Qualifications Act. Upon application for registration, the person shall submit a document certifying the required work experience and the right of the person to provide health services in a Member State of the European Economic Area or in Switzerland in addition to the documents required in subsection 28 (1) of this Act.
(2) The Health Care Board shall compare the qualifications of a person applying for registration with the qualifications required in Estonia, shall verify the correctness of information submitted in the documents certifying the qualifications and make a registration decision within three months as of submission of the documents specified in subsection 28 (1) of this Act. The procedure for comparing the qualifications acquired in a foreign state with the qualifications required in Estonia shall be established by the minister responsible for the area.
(3) In order to assess the compliance of qualifications, the Health Board may require that the persons who have acquired qualifications in foreign states not specified in § 29 of this Act take aptitude tests. The procedure for compilation, conduct and evaluation of aptitude tests shall be established by the minister responsible for the area.
(4) A person shall not be registered as health care professional if he or she has knowingly submitted false information or if the qualifications of the person do not comply with the qualifications required for working in this profession or speciality in Estonia.
(5) In the case specified in subsection (11) of this section if an European professional card has been taken into use with the Commission Implementing Regulation in the profession of a health care professional based on Article 4a (7) of Directive 2005/36/EC of the European Parliament and of the Council and the competent authority of a Member State of the European Economic Area or Switzerland has forwarded an application to the competent authority of Estonia for a person to work in Estonia, §§ 211, 214 and 215 of the Recognition of Foreign Professional Qualifications Act shall be applied to the application for and proceeding the applications for the European professional card.
(1) Certificates concerning registration shall be issued to health care professionals.
4) the date and place of issue of the certificate.
(3) The minister responsible for the area shall establish the standard format for certificates.
(1) If a person who has been registered as health care professional wishes to work outside of the Republic of Estonia, he or she shall apply for recognition of his or her professional qualifications pursuant to the procedure established in this section.
5) the profession or speciality in which recognition is applied for.
(3) A person applying for recognition of his or her professional qualifications shall, before submitting an application, pay a state fee for review of the application pursuant to the rate provided for in the State Fees Act.
(4) The Health Board shall issue a certificate of recognition of professional qualifications to a person within one month as of the submission of the application.
(5) A certificate of recognition of professional qualifications is valid for three months as of the issue of the certificate.
(6) In the case of loss, theft or destruction of a certificate of recognition of professional qualifications, a duplicate of the certificate shall be issued to the person on the basis of his or her application.
(7) If an European professional card has been taken into use with the Commission Implementing Regulation in the profession of a health care professional based on Article 4a (7) of Directive 2005/36/EC of the European Parliament and of the Council and the person applying for registration applies for the issue of the European professional card for working outside the Republic of Estonia, §§ 211, 214 and 215 of the Recognition of Foreign Professional Qualifications Act shall be applied to the application for and processing of the applications for the European professional card.
2) after the death of the person.
In the case of failure to comply with a precept, the Health Board may suspend the registration of a health care professional in the register established on the basis of subsection 271 (1) of this Act for up to one year.
The Health Board applies the alert mechanism pursuant to the procedure provided for in Chapter 32 of the Recognition of Foreign Professional Qualifications Act.
A person who has acquired his or her qualifications in a Member State of the European Economic Area or in Switzerland may temporarily provide health services in Estonia without the registration obligation required pursuant to § 27 of this Act and an activity licence required pursuant to § 40 of this Act, based on the provisions of Chapter 3 and 31 of the Recognition of Foreign Professional Qualifications Act. The competent authority for the purposes of Chapter 3 and 31 of the Recognition of Foreign Professional Qualifications Act is the Health Board.
(1) In order to grant the right to compile a practice list, the Health Board shall conduct a public competition pursuant to the procedure established by the minister responsible for the area.
(11) A competition shall be conducted for granting the right to compile a new practice list or organising the provision of general medical care for a practice list which has become available.
2) the names and personal identification codes of the health care professionals working together with the family physician.
(3) In the event there is a practice list not approved on the basis of a public competition, a family physician with a practice list shall have the right, within one year after the public competition, to apply from the Health Board, outside of competition, for the partial transfer of persons entered in the practice list of a family physician as a new list to a health care professional qualified as a family physician who has provided general medical care to persons entered in the practice list together with a family physician within the six months prior to submission of an application (hereinafter transfer of part of practice list).
5) the continuous provision of general medical care as required has been ensured to the persons entered in the practice list of a family physician applying for the transfer of part of a practice list and to the persons to be entered in the new practice list.
(5) In the event there is a practice list unfilled by way of public competition, a family physician with a practice list may apply for the transfer of part of a practice list in a reasoned manner from the Health Board also in a case unspecified in subsection (3) of this section if the principles provided for in clauses (4) 2)–5) of this section are complied with upon transfer of part of a practice list and the transfer of part of a practice list promotes the general accessibility and organisation of general medical care in the service area being applied for. Submitting of applications is not permitted if a public competition for granting the right to compile a practice list in the service area of the family physician specified in the application is being held at the time of submitting applications.
6) the written consent of the persons registered in the practice list of the family physician applying for the transfer of part of a practice list for their registration in the new practice list.
(7) Upon proceeding the application for transfer of part of a practice list the Health Board shall have the right to request the submission of additional information or explanations concerning the compliance of the transfer of part of a practice list with the principles provided for in this Act.
(1) Family physicians with a practice list may practice as sole proprietors holding an activity licence for the provision of general medical care or through companies holding an activity licence for the provision of general medical care.
(2) The practice list of a family physician shall be approved and the service area and maximum number of persons on a practice list of a family physician shall be determined or amended by the Health Board.
(3) The Health Board shall decide not to satisfy an application for transfer of part of a practice list if the requirements for transfer of part of a practice list specified in subsections 34 (3)–(6) of this Act have not been complied with.
6) in case of other significant public interest.
(5) On the grounds of better organisation and accessibility of general medical care the Health Board may determine an additional service area to a family physician upon his or her consent.
(6) The Health Board shall communicate the decision specified in subsections (2)–(5) of this section to the family physician, local government of the service area of the family physician and the Estonian Health Insurance Fund within five working days as of making the decision.
(7) The family physician shall commence the provision of general medical care within sixty days as of entry into force of the decision specified in subsection (2) of this section.
3) a digitally signed notice concerning the legal form of practicing as a family physician and providing general medical care or a change thereof.
4) the application specified in clause 37 (1) 1) of this Act upon first opportunity but at least six month before withdrawing from the employment of a family physician with a practice list.
11) the family physician or a health care professional working together with him or her materially violates personal data processing requirements.
(2) Before depriving a family physician of the right to practise as family physician on the basis provided for in clauses (1) 3)–5) or 11) of this section, the Health Board may issue a precept to the family physician.
(3) Upon failure to comply with a precept specified in subsection (2) of this section, the Health Board may impose penalty payment pursuant to the procedure provided for in the Substitutive Enforcement and Penalty Payment Act or issue an order to deprive the family physician of the right to practise as family physician.
(4) The maximum rate of penalty payment specified in subsection (3) of this section is 640 euros.
(5) In the cases specified in clauses (1) 1)-6) or 11) of this section, a family physician shall be notified of the decision to deprive the family physician of the right to practise as family physician within five working days as of issue of the decision. The decision to deprive the family physician of the right to practise as family physician shall be published in the official publication Ametlikud Teadaanded.
(1) Upon deprivation of a family physician of the right to practise as family physician, the Health Board shall organise the servicing of persons entered in the practice list of the family physician and the servicing of the service area until the right of a new family physician to practise is approved.
(11) Upon deprivation of a family physician of the right to practice as a family physician in the cases provided for in subsection § 37 (1) of this Act, the holder of an activity licence for the provision of general medical care through which the family physician operated, shall be required to preserve the documents concerning the practice list and to deliver them to the sole proprietor or company through which the provision of general medical care to the persons entered in the list is continued, or in case lack thereof, to the Health Board pursuant to the procedure provided for in subsection § 38 (2) of this Act.
(2) The procedure for delivery of documents concerning the family physician’s practice list shall be established by a regulation of the minister responsible for the area.
(3) If the family physician was the sole shareholder of the company providing general medical care or a sole proprietor and he or she is deprived of the right to practice as a family physician in the cases provided for in clauses 37 (1) 7) and 8) of this Act, the Health Board shall organise the preservation and delivery of documents concerning the practice list to the sole proprietor or company through which the provision of general medical to the persons entered in the list is continued.
(4) The sole proprietor or company through which the provision of general medical care to the persons entered in the list is continued shall be required to accept the documents concerning the practice list from the holder of an activity licence for the provision of general medical care or from the Health Board in the cases provided for in subsections (11) and (3) of this section.
Family physicians shall not be partners or shareholders of companies engaged in providing specialised medical care, or partners or shareholders of companies which are the partners or shareholders of such companies.
4) the independent provision of midwifery care.
(2) An activity licence for the provision of health services shall be issued to an owner of a hospital specified in the development plan of the hospital network only with respect to a type of hospital approved for the owner in the development plan of the hospital network.
(3) An activity licence grants the right to provide health services in the place of business specified in the activity licence.
(1) An application for an activity licence shall be adjudicated by the Health Board with the grant of or refusal to grant an activity licence within sixty days after the submission of an application.
10) information concerning compliance with the requirements set for data exchange with the Health Information System.
6) the information technology readiness of the applicant complies with the requirements set for data exchange with the Health Information System.
2) the type of organ allowed to be transplanted if the activity licence for the provision of specialised medical care has been issued for the transplantation of an organ.
An undertaking who has been issued an activity licence shall be required to prepare health care statistics and reports on economic activities concerning health care in accordance with the requirements established on the basis of clause 56 (1) 1) of this Act and submit these to an institution determined by the Ministry of Social Affairs or the minister responsible for the area.
The Defence Forces shall submit the data concerning the alteration or change of data belonging under the subject of review of an activity licence and the data specified in § 47 of this Act to the Ministry of Defence who shall forward it to the Health Board or an institution determined by the Ministry of Social Affairs or by the minister responsible for the area.
(1) In order to register activity licences for the provision of health services, the national register of activity licences for the provision of health services shall be established by a regulation of the Government of the Republic.
(2) The purpose of the establishment and use of the national register of activity licences for the provision of health services is to maintain records of sole proprietors and legal persons who have been granted the right to provide general medical care, emergency medical care, specialised medical care, independent nursing or midwifery care and to ensure the required data for the Ministries, the Estonian Health Insurance Fund and the institutions determined by the Ministry of Social Affairs or by the minister responsible for the area for the performance of the functions of the management and organisation of health care arising from Acts and other legislation and for the organisation of health statistics.
(6) The Health Board is the chief and authorised processor of the national register of activity licences for the provision of health services.
(7) The provisions of the General Part of the Economic Activities Code Act concerning registers shall be applied to the national register of activity licences for the provision of health services, taking account of the specifications provided for in this Act.
(1) The expert committee on the quality of health services (hereinafter in this section committee) is an advisory committee the purpose of which is to assess the quality of health services provided to patients and to make proposals arising from the assessment to the Health Board, the Estonian Health Insurance Fund and the health care providers.
7) make propositions to the Estonian Health Insurance Fund for review of contracts for financing medical treatment entered into with a health care provider.
3) judicial proceedings are being conducted concerning the same matter.
(4) A health care provider shall, at the request of the committee, submit to the committee the information and explanations necessary for assessing the quality of a health service provided to a patient. Members of the committee shall not disclose any data which become known to them in the performance of their duties.
(41) The Ministry of Social Affairs shall ensure the committee the organisational support necessary for assessment. If necessary, the committee may involve a psychologist or a social affairs specialist who shall organise the communication between the committee and the person having turned to the committee for an assessment.
(42) For the performance of duties specified in subsection (41) of this section, the representative of the Ministry of Social Affairs and the psychologist or social affairs specialist shall have access to the personal data of the patient as well as the right to participate in the committee’s meeting. The representative of the Ministry of Social Affairs and the psychologist or a social affairs specialist shall not disclose any data which become known to them in the performance of their duties.
(5) By 1 February of each calendar year, the committee shall submit to the minister responsible for the area a report of all the petitions submitted to the committee during the previous calendar year and the assessments of the committee.
(6) The committee is formed and its membership is approved by the minister responsible for the area.
(7) The rules of procedure of the committee and the procedure for assessment of the quality of health services shall be established by the minister responsible for the area.
(1) Cross-border health service means the health service prescribed for or provided in another Member State of the European Union to the insured person for the purposes of section 5 of the Health Insurance Act and the prescription and issue of medicinal products subject to medicinal prescription and medical devices in the framework thereof or the health service prescribed for or provided in Estonia to a person covered by health insurance in another Member State of the European Union, including the issue of medicinal products subject to medicinal prescription upon the provision of pharmacy services and the sale of medical devices on the basis of a medical device card.
(2) In case of cross-border health services, the Member State of affiliation shall be a Member State of the European Union competent to grant a prior authorisation to the insured person for the receipt of the necessary health services outside the Member State of residence according to Regulation (EC) No 883/2004 of the European Parliament and of the Council on the coordination of social security systems (OJ L 166, 30.04.2004, p. 1–123); Regulation (EC) No 987/2009 of the European Parliament and of the Council laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems (OJ L 284, 30.10.2009, p. 1–42); Regulation (EC) No 1231/2010 of the European Parliament and of the Council extending Regulation (EC) No 883/2004 and Regulation (EC) No 987/2009 to nationals of third countries who are not already covered by these Regulations solely on the ground of their nationality (OJ L 344, 29.12.2010, p. 1–3), or Council Regulation (EC) No 859/2003 extending the provisions of Regulation (EEC) No 1408/71 and Regulation (EEC) No 574/72 to nationals of third countries who are not already covered by those provisions solely on the ground of their nationality (OJ L 124, 20.05.2003, p. 1–3), or where the person is insured or where he or she is entitled to health insurance benefit according to the legislation of the relevant Member State.
(3) In case of cross-border health services, the Member State providing treatment shall be the Member State of the European Union in whose territory health services are provided to a patient. In case of telemedicine it shall be deemed that health services are provided in the Member State in which the health care provider has been established.
(4) Costs accompanying the provision of cross-border health services shall be compensated to the persons insured in Estonia pursuant to the procedure provided for in the Health Insurance Act.
(1) On the proposal of the supervisory board of the Health Insurance Fund, the minister responsible for the area may establish by a regulation the restriction of access for patients covered by health insurance in another Member State of the European Union for the receipt of cross-border health services in Estonia.
2) the need to control expenditures and to avoid the misuse of financial, technical or human resources.
(3) Health services to which the restriction on access shall be established, the objective of establishing the restriction and the period of time for reassessment of the need to establish the restriction shall be provided for in the regulation specified in subsection (1) of this section.
(4) The restriction on access can only be established for health services which are provided by the health care provider on the basis of contracts for financing medical treatment entered into with the Health Insurance Fund.
(5) The established restriction on access shall be published on the website of the Ministry of Social Affairs, the Health Insurance Fund, the concerned health care providers and on the website of the national contact point in cross-border health services (hereinafter contact point).
(6) The procedure for the establishment of restriction on access for the receipt of cross-border health services in Estonia shall be established by a regulation of the minister responsible for the area.
(1) The health care provider shall submit to the patient all the relevant information specified in § 766 of the Law of Obligations Act, including information on the treatment possibilities, the availability, quality and safety of health services, information on the liability insurance cover of a health care provider or another individual or collective insurance cover relating to professional liability, and unambiguous invoices and information on the prices and, at the patient’s request, information on activity licences.
(2) Upon dispensing of medicinal products subject to medicinal prescription, the provider of pharmacy services shall notify the recipient of the medicinal product of the circumstances specified in subsection 33 (5) of the Medicinal Products Act and shall submit unambiguous invoices and information on prices to the recipient of the medicinal product and, upon the request of the recipient of medicinal product, information on activity licences.
(3) The seller of medical devices on the basis of a medical device card shall notify the buyer of the circumstances specified in § 321 of the Medical Devices Act and shall submit unambiguous invoices and information on prices to the buyer and, upon the request of the buyer, information on activity licences.
(4) In its territory, the health care provider shall apply the same price scale of health services to the patients originating from other Member States of the EU as to Estonian patients in a similar medical situation or prices calculated on the basis of objective and non-discriminatory criteria if there are no comparable prices available for Estonian patients.
(5) Patients who wish to receive or who receive cross-border health services shall have remote access to their treatment documents or have the possibility to receive copies thereof.
(1) A contact point shall be established for the notification of patients of the circumstances related to the provision of cross-border health services and to facilitate the communication between the authorities of the Member States of EU, health care providers and health care professionals.
(2) The functions of the contact point shall be performed by the Ministry of Social Affairs or the person with whom the Ministry of Social Affairs enters into a contract under public law for the performance of functions of a contact point.
(3) The activity of the contact point upon dissemination of data is based on cooperation with patient organisations, health insurance providers, health care providers and other interest groups. A contract shall be entered into between the participants in the cooperation network and the contact point, setting out the rights and obligations of the parties and other conditions.
(4) The Estonian Health Insurance Fund, the Health Board and the State Agency of Medicines provide their assistance to the contact point for the solution of issues that fall under their competence.
(5) The function of the contact point shall be the dissemination of data to Estonian patients, above all concerning the covering of costs of cross-border health services, existence and extent of the system of prior authorisations and the general rules for the provision of cross-border health services in Estonia to patients covered by health insurance in other Member States and the established restrictions on access.
(6) The specific functions of the national contact point of cross-border health services upon dissemination of data shall be established by a regulation of the minister responsible for the area.
(7) The data disseminated by the contact point shall be published in electronic format and in a format accessible to disabled persons.
(8) The activity of the contact point shall be financed by the Ministry of Social Affairs.
12) application of psychiatric coercive treatment ordered by court.
(11) Independent nursing provided in the course of the provision of 24-hour special care service specified in the Social Welfare Act shall be financed from the state budget through the Ministry of Social Affairs within the amount of the maximum cost of 24-hour special care service.
4) complex treatment of sexual offenders and addiction treatment of drug addicts with the duration of nine months applied instead of imprisonment.
5) the investments for building and renovation of the medical centres of the Defence Forces.
(22) The extent and procedure of the provision of medical rehabilitation specified in clause (21) 4) of this section shall be established by a regulation of the minister responsible for the area.
(3) Health care shall be financed from the funds designated for health insurance in the state budget pursuant to the procedure provided for in the Health Insurance Act.
(4) The depreciation of the buildings of health care providers shall be paid for from the funds designated therefor in the state budget on the basis of a contract entered into between the Ministry of Social Affairs and the Estonian Health Insurance Fund pursuant to the Health Insurance Act.
(5) If a convicted offender consents to complex treatment of sexual offenders or addiction treatment of drug addicts according to § 692 of the Penal Code, the state shall bear the costs of complex treatment and addiction treatment of the convicted offender with the duration of nine months according to clause (2) 4) of this section.
(6) Health services provided on the basis of national strategies and health care programmes to permanent residents of Estonia, persons residing in Estonia on the basis of a residence permit or right of residence and to persons legally staying and working in Estonia based on a temporary stay shall be financed from the state budget, including from the European Social Fund grants, through the National Institute for Health Development.
(7) The National Institute for Health Development may organise the processing of invoices for health services on the basis of a contract under public law entered into between the National Institute for Health Development and the Health Insurance Fund on the conditions and pursuant to the procedure provided for in the Administrative Co-operation Act.
Provision of health services and other expenses related to health care shall be financed from rural municipality or city budgets on the basis of the decisions of the rural municipality and city councils.
In the cases not provided for in §§ 52 and 53 of this Act, a patient shall pay for the provision of health services.
(1) Beginner’s allowance for medical specialists (hereinafter beginner’s allowance) is a lump-sum allowance paid to a physician who commences work as a medical specialist.
3) works as a medical specialist with the work load of at least thirty hours a week or works or practices as a family physician with a practice list.
4) in a position the place of work of which is outside Tallinn or Tartu City.
(4) A physician having acquired the speciality of family medicine may apply for beginner’s allowance if he or she commences practice as a family physician on the basis of a practice list and the practice list and service area of family physician are located outside of Tallinn, Tartu or the local governments immediately adjacent thereto.
(1) A physician entitled to receive beginner’s allowance shall submit to the Ministry of Social Affairs the application for beginner’s allowance no later than within five years after the completion of residency. The right of a physician who is on pregnancy and maternity leave or parental leave or a physician liable to service in the Defence Forces who has been called up to perform the conscript service duty after the acquisition of the speciality of specialised medical care to apply for the beginner’s allowance shall be extended by the period of time of the pregnancy and maternity leave and the parental leave or the period of time during which the person performed the duty to serve in the Defence Forces.
(2) The grant of beginner’s allowance shall be decided by the Ministry of Social Affairs within two months after the submission of an application. The beginner’s allowance shall be paid to the physician’s bank account within one month as of making the decision to grant beginner’s allowance.
(3) The amount of beginner’s allowance shall be 15 000 euros.
(5) A physician who has received the beginner’s allowance is required to return the allowance paid to him or her if his or her continuous employment or practice on the conditions specified in subsections 541 (2)-(4) of this Act ends before five years have passed from the receipt of the allowance. Employment or practice is deemed to be suspended at the time of parental leave or performing the duty to serve in the Defence Forces of the physician having received the beginner’s allowance and the employment or practice obligation of the physician shall be extended by the given period of time. Employment or practice is deemed to be continuous at the time of the incapacity for work of the physician or if the length of employment as a medical specialist of the person who received the allowance pursuant to the conditions provided for in subsections 541 (2)-(4) of this Act is not interrupted for more than three months at a time during the five-year period. The beginner’s allowance shall be returned within three years as of the submission of the notice of repayment of the allowance in the annual amount of one-third of the amount of the allowance to be repaid.
(6) A physician who has received the beginner’s allowance is not obligated to repay the allowance paid to him or her if, due to a fundamental breach of an obligation by the employer, he or she has terminated the employment contract extraordinarily or if the employer has terminated the employment contract extraordinarily, because the continuance of the employment relationship on the agreed conditions becomes impossible due to a decrease of the volume of work or reorganisation of work or in another event of cessation of work (lay-off). A family physician practicing on the basis of a practice list who has received beginner’s allowance is not obligated to repay the allowance paid to him or her if his or her activity as a family physician ceases in circumstances beyond his or her control.
(7) The procedure for application for, payment and recovery of beginner’s allowance shall be established by a regulation of the minister responsible for the area.
2) the investments required for the construction, renovation and restructuring of hospitals specified in the list of hospitals.
(3) A development plan of the hospital network shall be developed for at least fifteen years and shall be amended by the Government of the Republic, if necessary. The Ministry of Social Affairs shall organise the preparation of the development plan of the hospital network and shall involve appropriate non-governmental organisations therein.
(4) The list of hospitals set out in the development plan of the hospital network may be amended on the proposal of the minister responsible for the area which has been approved by the Estonian Health Insurance Fund.
(5) The minister responsible for the area has the right to make a proposal, which has been approved by the Estonian Health Insurance Fund, to the Government of the Republic regarding amendment of the list of hospitals set out in the development plan of the hospital network if the owner of a hospital has acted in accordance with law and the activity licence issued to the owner, and has not violated the contract for payment for health services entered into with the Estonian Health Insurance Fund.
(6) The minister responsible for the area has the right to make a proposal, which has been approved by the Estonian Health Insurance Fund, to the Government of the Republic regarding exclusion of an owner of a hospital from the list of hospitals set out in the development plan of the hospital network if the owner of the hospital does not act in accordance with law or the activity licence issued to the owner, or violates the contract for payment for health services entered into with the Estonian Health Insurance Fund. If the activity licence of the owner of a hospital is revoked or the hospital has terminated its activities, the minister responsible for the area shall make a proposal to the Government of the Republic regarding immediate exclusion of the owner of the hospital from the list of hospitals set out in the development plan of the hospital network. This proposal need not be approved by the Estonian Health Insurance Fund.
(8) The conditions and procedure for investment from the state budget funds into hospitals specified in the list of hospitals shall be established by the Government of the Republic.
(9) The costs of preparation of a development plan of the hospital network shall be covered from the state budget.
7) the quality assurance requirements for health services.
(2) An institution determined by the Ministry of Social Affairs or by the minister responsible for the area shall publish statistical data on health of the previous calendar year within the third quarter of each year in the Internet.
(1) The Health Board shall perform the duties provided for in Chapter 2 and Chapter 3 of this Act.
(2) The Health Board shall maintain the registers of health care professionals and activity licences in accordance with the Personal Data Protection Act and the Public Information Act and is appointed as the chief processor of the specified state registers.
(3) If necessary, the Health Board shall organise the temporary substitution for family physicians practicing under practice lists, including the finding of a temporary substitute for a family physician in cases not specified in subsections 81 (2) and (3) of this Act or upon occurrence of an unforeseeable and inevitable necessity.
Correction – Added missing subsection (3) on the basis of an amending act. Basis: § 10 (4) of Riigi Teataja Act.
(1) Collection of health care statistics and reports on economic activities in the field of health care from the health care providers and publication of consolidated data shall be the duty of an institution determined by the Ministry of Social Affairs or by the minister responsible for the area.
(2) An institution determined by the Ministry of Social Affairs or by the minister responsible for the area shall have the right to delegate performance of the duties assigned thereto by this Act to the local government on the basis of a contract under public law.
(1) National stockpile of antidotes (hereinafter stockpile of antidotes) is an aggregate of antidotes used for the provision of health care services necessary for the treatment of life-threatening intoxications.
(2) The stockpile of antidotes is compiled by the Health Board who shall determine the list, quantities and division of the stockpile.
(3) The Health Board shall ensure the maintaining records of issue for use of the stockpile as well as the use and writing off of the stockpile.
(4) The antidotes are delivered to a health care provider free of charge. The health care provider having received the antidotes from the Health Board free of charge shall not receive compensation therefor from the person paying for health services.
(5) The Health Board shall ensure the health care providers access to information concerning the stockpile of antidotes.
(6) The health care provider shall ensure the proper maintenance, use for the intended purposes of antidotes delivered by the Health Board to be used by the health care provider and rendering harmless of aged antidotes and shall inform the Health Board of the use of antidotes.
(7) Compilation and renewal of the stockpile of antidotes according to the division established under subsection (2) of this section shall be financed from the state budget on the basis of clause 52 (1) 71) of this Act.
(1) The Ministry of Social Affairs shall coordinate the activity of the network for health technology assessment incorporating the agencies and persons engaged in the assessment of health technologies. The given network is based on the principle of good governance including transparency, objectivity, and independence of expert assessments, fair proceedings and relevant consultations with associated groups.
5) give opinions, if necessary, to the Ministry of Social Affairs, the Health Insurance Fund, Health Board and National Institute for Health Development on preparation of the list of compensated health services, medical devices and medicinal products, procurement of medicinal products and immunological preparations and preparation of public health programmes.
(1) The organisation of health care during increased defence readiness, a state of war, mobilisation and demobilisation shall be established in the national defence action plan based on the risk scenarios. The provisions concerning the organisation of health care in this Act shall be applied to the organisation of health care during increased defence readiness, a state of war, mobilisation and demobilisation, taking account of the specifications provided for in this section and in the national defence action plan.
(2) Upon preparation of health care for national defence, the minister responsible for the area shall have the right, based on the provisions of the national defence action plan, to decide on the organisation and the extent of performance of national defence tasks by the authorities and persons with national defence tasks during increased defence readiness, a state of war, mobilisation and demobilisation.
2) defence readiness levels and the content thereof for the performance of national defence tasks during increased defence readiness, a state of war, mobilisation and demobilisation.
5) depending on the changes in the security situation, prepare the changes concerning the area of health care to ensure the continuous operation of health services in cooperation with the Ministry of Defence and the Defence Forces.
(5) Upon preparation of health care for national defence and ensuring the continuous operation of health services, the health care providers shall be required to perform the tasks assigned thereto on the basis of the National Defence Act, this Act and the legislation established on the basis thereof.
3) another health care provider having received the task to prepare for national defence pursuant to subsection (3) of this section.
(7) The action plan specified in subsection (6) of this section may include the continuous operation plan of vital services and crisis management plan, taking account of the specifications of national defence.
2) organise the provision of health services.
4) decide on the use of the national health care stockpile.
5) notify their patients of the organisation of the provision of health services.
(11) The performance of the tasks specified in subsections (8)–(10) of this Act shall be based on the risk assessment.
3) the terms and amounts of and procedure for the establishment of the operation stockpile of medicinal products and medical supplies of health care providers.
(2) Health care providers are required to act upon preparing for emergencies and in emergencies and upon ensuring the continuous operation of a service pursuant to the regulation of the Government of the Republic established on the basis of subsection (1) of this section.
(1) The Health Information System is a database belonging to the State Information Systems where the data related to health care are processed for entry into and performance of contracts for the provision of health services, for guaranteeing the quality of health services and the rights of patients and for the protection of public health, including for maintaining registers concerning the state of health, for the organisation of health statistics and for the management of health care.
(2) The chief processor of the Health Information System is the Ministry of Social Affairs.
(3) The Health Information System shall be established and the statutes of the register shall be established by a regulation of the Government of the Republic.
3) concerning the health services provided to patients and for management of health care, including for maintaining registers concerning the state of health established on the basis of law, in compliance with the provisions based on subsection (2) of this section.
(11) A forensic expert of a state forensic institution shall have the obligation to forward to the Health Information System data on the cause of death if in the course of forensic examination it appears that death has arrived as the result of an illness or injury.
(12) Patients shall have the right to forward their declarations of health to health care providers through the Health Information System for the assessment of their state of health on the conditions and pursuant to the procedure established under subsection 42 (2) of this Act.
2) the conditions and procedure for the preservation of the documents to be forwarded to the Health Information System.
(3) The types of medical images, the requirements of information technology therefor and the conditions and procedure for making them available shall be established by a regulation of the minister responsible for the area.
(1) A patient has access to his or her personal data in the Health Information System. In order to protect a patient’s life or health, a health care provider may set a time limit upon forwarding data to the Information System in the course of which the patient can first examine his or her personal data only through a health care professional.
(2) A health care provider and a participant in the provision of health services specified in clause § 43 (1) 2) of this Act have access to the personal data in the Health Information System for entry into and performance of a contract for the provision of a health service.
(3) A patient has the right to prohibit the access of a health care provider to the personal data in the Health Information System.
(4) A health care provider shall, on the basis of a wish expressed by a patient, prohibit immediately access to the personal data of the patient in the Health Information System.
(5) A forensic expert of a state forensic institution has access to the personal data in the Health Information System for ascertaining the characteristics of injuries on the basis of clause 88 (1) 2) of the Code of Criminal Procedure and for conducting forensic autopsy of a deceased person.
8) data on performed operations, analyses, examinations and procedures.
(52) Decoding of the data specified in subsection (51) of this section and processing of additional data for identification of a patient is prohibited.
(6) Other persons have access to personal data in the Health Information System if such right arises from law.
(1) The ethics committee of the Health Information System shall assess whether the release of personal data from the Health Information System for the purposes of scientific research or statistics is necessary and justified and shall develop good practice guidelines. The assessment of the ethics committee is not legally binding.
(2) The ethics committee shall act pursuant to generally recognised principles of medical ethics and personal data protection and international and national legislation.
(3) An application for release of personal data for the purposes of scientific research or statistics shall be submitted to the chief processor of the Health Information System. The application shall comply with the good practice in scientific research.
(4) The rules of procedure, the number and the procedure for the appointment of the members of the committee shall be established by a regulation of the minister responsible for the area.
(1) State supervision over compliance with the requirements established for health care providers shall be exercised by the Health Board.
(1) For the execution of state supervision provided for in this Act, the Health Board may apply the special state supervision measures provided for in §§ 30, 31, 32, 49 and 50 of the Law Enforcement Act on the basis of and pursuant to the procedure provided for in the Law Enforcement Act.
(2) For the execution of state supervision provided for in this Act, the emergency medical staff may apply the special state supervision measures provided for in §§ 50 and 51 of the Law Enforcement Act on the basis of and pursuant to the procedure provided for in the Law Enforcement Act.
In the event of failure to comply with a precept, the upper limit of penalty payment imposed pursuant to the procedure provided for in the Substitutive Enforcement and Penalty Payment Act shall be 640 euros.
(1) A person whose area of activity upon the entry into force of this Act is the provision of health services and who, pursuant to this Act, requires an activity licence for the provision of health services shall apply for the activity licence within three years as of entry into force of this Act.
(2) Upon failure to submit an application within the term specified in subsection (1) of this section or if an activity licence is not issued to a person on the bases listed in clauses 45 (1) 1)-4) of this Act, the person loses the right to provide health services.
(1) General practitioners and paediatricians may practise as family physicians on the basis of practice lists until 1 January 2005 provided that they have received the right to practise as family physicians before entry into force of this Act and they currently undergo family practice residency training or participate in training courses to specialise in family medicine.
(2) The date of commencement of the time of absence from work specified in clause 37 (1) 10) of this Act shall be taken into account from 1 July 2007.
(3) A family physician regarding whose practice list a county governor has, with the approval of the Estonian Health Insurance Fund, before 1 January 2013 allowed for deviations from the maximum number of persons on a practice list shall bring his or her practice list into compliance with the requirements specified in subsections 8 (41) and (42) of this Act no later than by 1 January 2014.
(4) If the number of persons entered in the practice list specified in subsection (3) of this section exceeds the maximum rate provided for in clause 8 (41) 1) of this Act, the family physician shall no later than by 1 January 2015 ensure to the persons entered in the practice list the provision of general medical care in a manner that at least one health care professional qualified as a physician provides general medical care together with the family physician.
(1) Health care institutions administered by the state shall be reorganised into legal persons in private law pursuant to the procedure provided for in the Foundation of and Participation in Legal Persons in Private Law by the State Act.
(2) Health care institutions administered by local governments shall be reorganised into legal persons in private law pursuant to the procedure provided for in the Local Government Organisation Act.
(3) Upon reorganisation of health care institutions administered by the state or a local government into legal persons in private law, valid contracts of employment shall be transferred to the legal persons in private law being founded.
The contracts entered into with the owners of ambulance crews before 1 January 2007 shall be renewed under the conditions provided for in subsection 17 (42) of this Act and the Administrative Co-operation Act.
The national register of health care professionals and the national register of activity licences for provision of health services established before 1 January 2008 shall be brought into conformity with the provisions of §§ 271 and 501 of this Act by 1 April 2008.
(1) The schedule of transfer to the Health Information System by the data subject to entry in the Health Information System shall be established by the minister responsible for the area.
(2) The Health Information System as a whole shall be introduced not later than on 1 January 2013.
Beginner’s allowance in 2012 may be applied for by physicians who acquire the speciality of specialised medical care specified in clause § 541 (2) 1) of this Act and complete residency in 2012.
(1) Upon transfer of the organisation of general medical care into the competence of the Health Board, the county governors shall transfer to the Health Board the administration and documentation connected with the organisation of general medical care.
(2) All the rights and obligations connected with the organisation of general medical care which the persons had in front of county governors until 31 December 2012, they shall have in front of the Health Board as of 1 January 2013. All periods of time and terms specified in this Act shall not discontinue with the transfer of organisation of general medical care into the competence of the Health Board.
(3) Family physicians providing general medical care as sole proprietors and companies providing general medical care on 31 December 2012 shall apply for an activity licence for the provision of general medical care from the Health Board no later than by 30 June 2014. Application for an activity licence shall be exempt from state fees.
(4) Upon transfer of collection of health care statistics and reports on economic activities in the field of health care into the competence of an institution determined by the Ministry of Social Affairs or by the minister responsible for the area, the county governors shall transfer to the institution the reporting and documentation connected with the organisation of health statistics.
(5) Health care statistics and reports on economic activities in the field of health care shall be collected and the consolidated data shall be published by an institution determined by the Ministry of Social Affairs or by the minister responsible for the area as of 1 January 2013.
(6) All the rights and obligations connected with health care statistics and reports on economic activities in the field of health care which the health care providers had in front of the county governor until 31 December 2012, they shall have in front of an institution determined by the Ministry of Social Affairs or by the minister responsible for the area as of 1 January 2013. The periods of time and terms provided for in this Act shall not discontinue in connection with the transfer of health care statistics and reports on economic activities in the field of health care.
The activity licences for the provision of specialised medical care issued for the provision of nursing care before 1 January 2014 shall be valid until the expiry thereof.
(1) This Act enters into force on 1 January 2002.
(2) Subsection 22 (2) of this Act enters into force on 1 January 2003 and §§ 12–15 enter into force on 1 January 2005.
(3) Subsection 592 (11) of this Act enters into force on 1 January 2013.

References: § 100
 § 20
 § 29
 § 29
 § 29
 § 27
 § 40
 § 37
 § 38
 § 47
 § 766
 § 321
 § 692
 § 10
 § 43
 § 541