Map of Spas in Europe > The system of the SPA and rehabilitation in Estonia

The spas

Estonian spa tradition dates back to the 1820s when the first mud treatment facilities were built to use the local curative mud¹.

The spas are mostly situated on the coast (Haapsalu, Viimsi, Tallinn, Pärnu, Kuresaare, Narva-Joesuu, Toila) and only two of them inland (Värska and Pühajärve). Most of the spas were established in the Soviet times but several have been built in the period of independence. During Soviet times the spas were mostly funded by the trade unions. When Estonia regained its independence in 1991 the organization of trade unions fell apart and central funding was finished. As in the Ministry of Health and Welfare the priorities at that time were the maintenance of the hospital network and first aid, not rehabilitation nor prevention, the state sold the most of existing spas to the private owners.

In 1996 15 medical spas joined the Estonian Spas Association² to enhance spa and rehabilitation in Estonia. Members of ESA cooperate actively in the field of marketing and have recently implemented a Spa Dictionary to standardize the terms used in Estonia and Europe. The next bigger project will be creating the system of categorizing and rating the spa hotels.

All the spas have been completely renovated according to the European standards. Treatment possibilities are constantly being modernized and improved. In all medical spas work professional doctors and nurses. At the same time the wellness side has developed to offer the visitors more relaxation and beauty procedures. More and more new wellness spas are being built, especially in Tallinn. For all the spa services the customers have to pay themselves, getting support neither from the state nor the Health Insurance Fund.

In the 1990s when Estonia became independent the standard of living was low, the trade unions did not pay for the health packages any more and therefore wealthy customers had to come from abroad. In those years the Finns made up 90% of the visitors. From year to year the number of Estonian customers has risen, amounting to a little over 30%. The number of visitors from other countries besides Finland (mostly Sweden and Norway) has also risen, reaching 10%.

Rehabilitation

In Estonian medicine rehabilitation services have been divided into rehabilitation and physical rehabilitation. They are funded from different sources. 33% of the social tax paid by the employers is divided between 13% to the Health Insurance Fund which funds the physical rehabilitation and 20% to the Social Insurance Board which funds the pension insurance and different social benefits as well as the rehabilitation service.

Rehabilitation is a social service for the disabled people to improve their ability to cope and work independently. The service can be granted only to a person whose degree of severity of disability has been determined by the Social Insurance Board. In the course of the process a rehabilitation plan is drawn up. Preparing a rehabilitation plan is a teamwork where participate a doctor of physical and rehabilitation medicine, a physiotherapist, a psychologist, an occupational therapist, a speech therapist, a social worker and the patient himself. The Decree of the Estonian Government from 17.03.2005 No.52 has determined the amount of physiotherapeutic services during a calendar year. In general it is 10 hours a year for the grown-ups and 20 hours a year for the children. Rehabilitation service includes also accommodation (for a rather small sum) and compensating the travel expenses to the medical establishment. The Social Insurance Board has agreements with 61 establishments over Estonia which offer rehabilitation service³. Mainly these are bigger hospitals but also different patients associations and schools for children with special needs. There is only one spa in this list – Värska sanatorium. The patient has a right to choose where he would like to get the service and he himself appoints the time of the treatment. The queues are often long, up to several years for the pensioners. The children as a rule do not have to wait in the queue.

Physical rehabilitation is meant for restoring and maintaining the harmed functions of the patients (both for physically disabled and not disabled patients). This medical service is funded by the Health Insurance Fund⁴ according to the established price list. Only the doctor of physical and rehabilitation medicine has the right to prescribe physical rehabilitation and the procedures are carried out by the physiotherapist. Estonia is divided into four Health Insurance Fund regions and every regional Health Insurance Fund makes agreements for offering the service according to the resources of this region. Partly it coincides with the rehabilitation service, namely in the case of bigger hospitals where are physical rehabilitation units and which offer both rehabilitation and physical rehabilitation services for both out-and inpatients. Besides the hospitals the Health Insurance Fund has some agreements with the sanatorium-spas for offering the physical rehabilitation for the outpatients. In this case the Health Insurance Fund pays for the sanatorium treatment, not the patient himself. At the moment there are 4 such spas all over Estonia. What causes problem is the strict demands of the Health Insurance Fund to its agreement partners, constant paperwork, a yearly thorough control and relatively low payment for the service. For privately owned, profit- orientated spas an agreement with the Health Insurance Fund means obliging to the needs of the local inhabitants for sanatorium treatment.

At the same time the need for the physical rehabilitation is much bigger than the resources to offer it. In 2006 the National Audit Office stated that the availability of the physical rehabilitation differs regionally greatly. Patients living in the bigger cities get 70% more physical rehabilitation than people living in the rural areas and only 19% of all the people needing the physical rehabilitation got it and only half of them at the right time. So far the state has been interested only in developing the physical rehabilitation units in the hospitals. Here is the chance for the Estonian Spas Association to develop the co-operation with the Health Insurance Fund to make better use of the experience of the spas in offering physical rehabilitation services.

References
1 www.haapsalu.ee/index.php?lk=257&show=349
2 www.estonianspas.eu
3 www.sm.ee
4 www.haigekassa.ee

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