Hospital transfers can reset Estonia’s 10-day inpatient fee limit

Patients transferred between hospitals for continued treatment may be charged an inpatient fee again, even when they are being treated for the same health problem, ERR reports. The Health Insurance Fund says the practice undermines patients’ sense of fairness, while the Ministry of Social Affairs also acknowledges the issue.

Under Estonia’s Health Insurance Act, hospitals may charge an insured patient an inpatient fee for up to 10 calendar days per illness episode.

In practice, however, the 10-day count may restart when a patient is transferred from one hospital to another, such as a hospital closer to home. The second hospital can then charge the inpatient fee for another 10 days, even though the patient’s health problem has not changed.

Health Insurance Fund board chair Siiri Lahe raised the issue with Social Affairs Minister Karmen Joller. Lahe said the term “one illness episode” has different meanings for hospitals and patients, and hospitals do not currently share information about whether a patient has already paid the fee elsewhere or for how many days.

“Each hospital uses its own information system, and information about inpatient fees does not move into the nationwide digital health record,” Lahe said.

She compared the situation with specialist consultation fees. Under the law, patients cannot be charged again for a repeat consultation concerning the same service. In Lahe’s view, charging the inpatient fee again after a hospital transfer similarly undermines fairness and creates confusion.

Lahe asked the Ministry of Social Affairs whether “one illness episode” means only the time spent in a single hospital. She also noted that, according to the Health Insurance Fund, Estonian legislation does not separately define the term.

Heli Paluste, a health care network expert at the Ministry of Social Affairs, told ERR that from the patient’s perspective the treatment is indeed one care journey, and paying the inpatient fee again after moving between hospitals may raise questions.

“Unlike consultation fees, for which the law sets specific exceptions on when a repeat fee may not be charged when a patient moves between institutions, no similar cross-hospital exception has been established for inpatient fees,” Paluste said.

She said hospitals are independent institutions and that, from the receiving hospital’s perspective, a new episode begins when a transferred patient is admitted. The Health Insurance Fund also counts and finances treatment episodes separately by hospital in its contracts with hospitals.

Paluste said the Health Insurance Fund’s concern was understandable from the patient’s perspective. Because the current law does not explicitly define an illness episode across hospitals, she said the ministry may need to discuss with hospitals and the fund whether the rules and fee-charging practices should be clarified to ensure a clear and fair system of patient co-payments.