A high-level delegation from the Republic of Moldova representing members of Parliament, the Government, hospitals and the state medical university visited Estonia on 20–23 July 2015 to learn about the Estonian experience in strengthening the hospital sector.
The delegation conducted meetings with representatives of the Ministry of Social Affairs, the Estonian Health Insurance Fund and the executive boards of several hospitals from Tallinn and Tartu, such as the East Tallinn Central Hospital, Tartu University Hospital and the North Estonia Medical Centre.
The purpose of the meetings and visits to various institutions was to understand the experience and approach taken by the Ministry of Social Affairs and the Estonian Health Insurance Fund in the regionalization of the hospital sector in the country. The providers' perspective was also an important part of the study visit, and their experience before and after regionalization was presented and discussed between the representatives of the Moldovan delegation and the above-mentioned hospitals.
Estonia's experience in reforming its health care sector has shown that the way to improve access and quality of hospital care is by tackling the inefficiency of the hospital infrastructure, which was quite similar to the current hospital infrastructure in the Republic of Moldova. The pathway to regionalizing hospital providers taken by the Estonian Government in 2001–2002 has improved access to good quality hospital care, as well as generated significant savings in the hospital sector, which were reinvested in the infrastructure, medical personnel and other hospital resources.
Pre-requisites for Moldovan hospital reform
During the visit, a policy dialogue among members of the Moldovan delegation took place to clarify expectations, opportunities and next steps. The Moldovan stakeholders agreed that certain key elements are a pre-requisite for an effective hospital reform to improve the efficiency and quality of care in the Republic of Moldova.
- All stakeholders have a common vision and follow a defined strategy of strengthening the hospital sector.
- Key parties in the process (Parliament, Government, National Health Insurance Company, service providers and local authorities) should act in a coordinated manner to reinforce each other's actions in improving hospital care based on the agreed strategy and vision.
- Continuity of reforms should be maintained regardless of changes in government.
- The roles and capacities of individuals should always be emphasized in the process.
- The type of governance and management of hospitals is important in the process of improving the efficiency of hospitals and should act as an enabler of change.
The study visit also allowed the Minister of Health of the Republic of Moldova, Mircea Buga, and the Minister of Health and Labour of Estonia, Rannar Vassiljev, to discuss partnerships between their countries, and to sign an action plan for further collaboration in the health sector until 2016.
The study visit was organized as part of the biennial collaborative agreement (BCA) 2014–2015 between the Ministry of Health of the Republic of Moldova and WHO/Europe. It is related to the European Union/WHO joint initiative to support policy dialogue and universal health coverage.