Garder calls Estonia’s family doctor list system outdated

Edvard Garder, chief executive of the Confido private medical centre, has told ERR that Estonia’s family doctor list system is outdated and needs comprehensive reform because the country operates in a digital age.

Garder said Estonia could follow Finland’s example by requiring all medical faculty graduates to work as general physicians for a few years.

He also said he was pleased that a new hospital in Tallinn was not built, arguing that the hospital of the future would not be a huge concrete structure but rather a collection of smaller buildings.

Garder is a surgeon who has worked at the North Estonia Medical Centre, led Läänemaa Hospital and now heads Confido. He said moving from surgery into administrative work was emotionally difficult but practically smooth.

He took his first leadership position at Läänemaa Hospital during the first wave of the Covid-19 pandemic, when there was so much work that he had no time to think about the change.

Garder said he still sometimes works in an operating theatre. Surgery remains one of his passions, he said, and is not something he can easily set aside.

Although the work of a surgeon and the head of a medical institution are different, both involve making critical and difficult decisions quickly, he said. Garder also agreed that surgery is among the world’s most stressful professions, although the level of stress depends on the type of surgeon and the procedures performed.

He said he did not actively choose either his position in the state healthcare system or his later move to private medicine. In both cases, he was offered the job. At the time, accepting the private-sector position appealed to his ego and seemed like the right step, he said.

Garder identified two main reasons why people in Estonia who need medical help cannot always see a doctor: a shortage of healthcare workers and the way the healthcare system is organised.

He expressed doubt that the Health Insurance Fund’s deficit, estimated at about 100 million euros this year, could be eliminated by 2030, as Health Minister Karmen Joller hopes.

Garder said there were many ways to improve healthcare funding, but none was easy. The most positive scenario would be for the Estonian economy and companies to perform better, hire more people, raise wages and generate more social tax revenue for the Health Insurance Fund. He said that scenario did not currently seem credible.

Other options include raising taxes and increasing people’s out-of-pocket payments.