Regional Statistics of Estonia 2004Eesti keeles 7. Public health OverviewDefinitionsMethodologyPublicationsMain trendsTablesDiagrams Since the independence of Estonia, health care sector has changed thoroughly. The reform results reflect from the health care institutions, the number of personnel and providing and using medical care. During the years of independence, the number of doctors has decreased continuously. In transitional period 1992–2001, the number of doctors decreased more than 20%. Decreasing continued in the following years. As the population has decreased also, the insurance with doctors per capita has stayed more or less the same. In 1994–2003 the number of doctors per 10,000 people decreased remarkably in Põlva, Valga and Lääne-Viru county and increased in Tartu, Pärnu and Hiiu county (Diagram 7.1.). Nursing staff decreased also in 1992–2001, although in two last years (2002–2003) the number increased and outnumbered the rate in 2001. At the end of 2003, 4,277 doctors were working in Estonia, whereas almost half of them (49%) worked in hospitals of which 72% (1,500 doctors) in Harju and Tartu county. Nursing staff in hospitals occupied 58%. Compared to 2002, the number of doctors, dentists and nursing staff increased slightly in 2003. In 2003 there were 32 practising physicians and 65 persons employed in nursing care per 10,000 inhabitants. The biggest number of doctors per 10,000 inhabitants was in Tartu county (55) and the smallest in Rapla (15) and Lääne-Viru (16) county. The nursing staff per 10,000 inhabitants was the biggest in Tartu county (88) and the smallest in Jõgeva county (30). The relation between doctors and nursing staff has been quite stable since the beginning of 90ies. There are about 2 nurses per one doctor, which is considered to be not enough. In Tartu, Jõgeva and Hiiu county there were fewer than 2 nurses per doctor in 2003. Considerably higher was the relation in Lääne county (1:2.8) and Ida-Viru county (1:2.7). The number of dentists has slightly increased since 1992. In 2003 there were 8.3 dentists per 10,000 inhabitants. The most (12.8) per 10,000 inhabitants were in Tartu county, almost 3 times fewer in Ida-Viru county (4.3) and Lääne county (4.6). In connection with the physician reform, the number of physicians has increased continuously. In 2000–2003 the number of physicians per 10,000 inhabitants increased from 3.3 to 5.9. There were 803 physicians at the end of 2003. The number of physicians varied by counties — it was the biggest in Hiiu county (7.8), remarkably smaller in Lääne (5.0) and Valga county (5.1). During the last decade the number of hospitals has decreased above all. The main reasons are closing small hospitals and uniting hospitals. In 2000 nine hospitals of University Hospital of Tartu were reorganised to one (consisting of 17 clinics) hospital and in 2001–2002 on the basis of 13 hospitals in Tallinn, three hospitals were formed. Medical specialities, which need modern expensive technology and top qualified specialists, were assembled to two biggest regional centres — to Tallinn and Tartu. Due to that, the number of hospitals in 1991–2003 decreased about 60% (from 120 to 50). In 2003 the joining of hospitals continued in Ida-Viru county, where the Central Hospital of Kohtla-Järve and Hospital of Puru were united and after that the Hospital of Kohtla-Järve and Hospital of Puru were united to Ida Virumaa Central Hospital. In Tartu county the reorganisation of small hospitals continued. In the reorganisations of health care system the number of hospital beds has decreased continuously. In 1991–2003 the number of beds decreased more than two times (from 17,600 to 8,000). In Central Estonia and Ida Viru county the number of hospital beds decreased by 60%, notably lesser than in Pärnu and Järva county (38% and 28%, respectively). Compared to 2002, the number of hospital beds decreased by 3% in 2003. In Ida-Viru county 170 and in Harju county 168 hospital beds were closed (16% and 5%, respectively). In 2003, the biggest number of hospital beds per 10,000 inhabitants was in Viljandi and Lääne county (85.1 and 77.6, respectively), also in Tartu and Harju county (74.6 and 67.4, respectively). At the same time the number of patients getting medical care in hospitals is quite stable. As the population of Estonia has also decreased constantly, the number of hospitalized per 10,000 people increased in 1992–2000 by 15% (from 178 to 204), and decreased by 2003 to 192. In 2003 inpatient treatment was provided the most in Harju and Tartu county where the biggest hospitals of Estonia are — North Estonian Regional Hospital and University Hospital of Tartu. The number of hospitalized per 10,000 people was the biggest in Tartu county (296), but 4 times smaller in Jõgeva county (72). In Lääne county the indicator was more than Estonian average — 221. Despite of the decrease of hospital beds the number of hospitalized has not decreased, because the use of hospital beds has intensified. In 1992–2003 the average duration of inpatient treatment decreased by 49% (from 16.1 days to 8.2). At the same period the average duration decreased in Tartu, Viljandi and Harju county. In 2003 the average length of stay at hospitals did not change significantly. Compared to 2002 the decrease was 3% (from 8.5 days to 8.2). The change of the indicator was small also in most of the counties, although in Põlva county the average length of stay at hospitals increased from 6.7 days to 7.8 and in Jõgeva county from 9.9 to 11.6. There were 17 private hospitals in Estonia by the end of 2003, i.e. one third of the total number of hospitals. Most of them were small hospitals. In 2003, the number of beds in private hospitals covered 10% and the number of hospitalized under 7%. Private hospitals were only in five counties. Appointing to private sector in statistics is based on equity (more than 50% majority in a company), property ownership (in case of self-employed person) and founders (in case of funds). In 2003, 6.0 outpatient visits per capita were registered on average in Estonia, incl. 2.9 physician visits. To every sixth person home visit was made. Every person visited dentist 1.2 times on average. The number of outpatient visits was similar to previous year. In Valga and Pärnu county the number of outpatient visits increased 20% and 14%, respectively. The number of home visits continuously decreased in comparison with 2002 — 24%, the most in Pärnu county 36% and Viljandi county 32% (Diagram 7.2.). As previously, decline tendency was in the number of visits to dentists per capita, which decreased by 2% in 2003. The development of health resorts continued in 2003: the number of persons accommodated in health resorts increased. Compared to 2002, the accommodated persons in purpose of medical treatment increased by 13.5% (from 93,430 to 125,980) and accommodated persons without the purpose of medical treatment by 14.1% (from 39,968 to 56,333). Such a rapid growth is characteristic to the last years. Need for the services of rehabilitation has increased remarkably in last years. Despite of that, the service is provided only in seven counties. The most important place is Pärnu county (35% of people using the services of rehabilitation). The latest reliable data on malignant neoplasms are available from 2000. The cancer incidence is increasing with age and the continuous growth of cancer incidence rate is largely related to the population ageing. In 2000 by counties, the incidence rate of men of malignant tumours per 100,000 inhabitants was the highest in Järva and Lääne-Viru county (607 and 554, respectively) and almost a half smaller in Hiiu county (318). The indicator of women was the highest in Hiiu county (516) and lowest in Põlva county (340). As population ageing has a great role in cancer incidences, then in comparing the counties age membership has to be taken into account. In 2003 the cases of mental and behavioural disorders (per 100,000 inhabitants) consulted by psychiatrists increased 10%, the incidence of new cases increased 6%. It is important to point out, that non-psychiatrists have registered almost one half of new mental and behavioural disorders according to Ministry of Social Affairs (mostly by family doctors). Those cases of incidence are not included to existing statistical data-tables. In comparing counties, one has to be careful in interpreting the data of mental and behavioural disorders reverberated in the table, because the data of psychiatrists are registered by the location of providing medical services and it is not known how big share of the people getting medical care was the inhabitants of this county. Compared to the previous year, in 2003 the number of injuries and poisonings per 1,000 inhabitants stayed almost the same — decreased by 2% (from 135 to 133), although increased in Põlva county by 80% (from 105 to 190). Remarkable increase was also in Jõgeva and Valga county. In incidence of appearance of infectious diseases in last years several positive changes have taken place. Very important public health indicators are the active tuberculosis incidence and prevalence rate. The increase of tuberculosis incidences, which characterises 90ies, stopped at the turn of the decade. In 2000–2003 new incidences of active tuberculosis decreased from 642 to 490 (from 47 to 36 per 100,000 inhabitants). The number of persons with active tuberculosis increased again by the end of 2003 — from 514 to 550 cases (from 38 to 41 per 100,000 inhabitants). In Estonia the frequency of tuberculosis incidences is 2-3 times higher among males than among women. In 2003 the incidence rate of tuberculosis among men was 54 and among women 21. Among men it was higher in Lääne-Viru and Ida-Viru county (100 and 71 per 100,000, respectively) and among women in Järva and Valga county (39 and 37, respectively). The most common of infectious diseases is the acute upper respiratory infections — almost every fifth person infects. In 2003, 18 cases of upper respiratory passages per 100 inhabitants were registered, the most in Järva county (22) and the least in Saare county (10). As typical, we can notice fluctuation of several infectious diseases incidence. Compared to the previous year in 2003 varicella decreased in most of the counties, although increased three times in Lääne county. In all of the counties scarlet fever incidences decreased — especially in Lääne and Järva county, where the incidences decreased 10 times. There was a significant increase of whooping cough and tick-borne viral encephalitis, although there were not any cases of tick-borne viral encephalitis registered in 2002–2003 in Järva county. There has been a double decrease of viral hepatitis (A, B and C) during last two years (2002–2003), although in 2003 in Ida-Viru county morbidity to viral hepatitis was three times higher than a year before. Half of all incidences in 2003 were registered in Ida-Viru county, at the same time there were not any viral hepatitis incidences in five counties. The first HIV infection was discovered in Estonia in 1988 and HIV disease (AIDS) in 1992. The explosive irruption of HIV infection was in 2001, when the number of new cases compared to the previous year increased from 390 to 1474. In the next years (2002–2003) morbidity to HIV infection decreased remarkably. In 2003, 840 new HIV-patients were registered in Estonia (62 per 100,000 inhabitants). The biggest number of infected people was in Ida-Viru and Harju county, where 428 and 362 cases were registered, respectively (244 and 69 per 100,000 inhabitants). In 2003 the number of several sexually transmitted diseases, as the incidence of syphilis and genococcal infections also decreased. Two thirds of these cases were registered in Harju county (Tallinn). Average length of stay at hospital (ALOS) — average number of hospital bed-days of all discharged patients (including transferred to another hospital and dead) within a given period, not depending of the cause of hospital care. Bed occupancy — number of days a bed is in use per year. Bed occupancy rate — average number of days when hospital bed was occupied as percentage of available 365 days (utilized bed-days / available bed days during the calendar year). Bed turnover — number of hospital admissions per hospital bed per year. Day care department — department located by an inpatient or outpatient health care institution, where the patient has to stay for treatment or examination for more than 6 hours. Health care personnel — active health care professionals providing health care services. Hospital — residential establishment equipped with inpatient facilities for 24-hour care, staffed with professionally trained medical personnel. Hospital may also provide services on an outpatient basis. Incidence — occurrence of new cases of a specified disease during a specified period of time. Incidence rate — occurrence of new cases of a specified disease per population during a specified period of time. All infectious diseases are registered as incidence. Nursing staff — nurses, medical assistants and midwives. Outpatient care — outpatient medical care, when a patient’s visit to health care institution is confined only a few hours and accommodation and overnight in inpatient facility is not needed. Outpatient visit (in doctor’s office) — outpatient contact of a person who needs medical consultation in the doctor’s working time. Prevalence — a measure of the total number of existing cases of disease or condition at a specified point in time. To receive statistical data on health care institutions providing health care service and their subdivisions are enumerated. The Ministry of Social Affairs collects and processes the data. Several special data are collected and processed separately following their speciality by the Estonian Cancer Register, Tuberculosis Database, the Health Protection Inspectorate (infectious diseases), the North-Estonian Blood Centre, etc. As a result of reorganization of the data collection system of the Ministry of Social Affairs in 2004, the health statistics for 2003 are presented one year after the reference year — in 2005. The health personnel data for the previous years since 1998 have been revised by the Ministry of Social Affairs. According to the change of classification of graduates of physicians specialities in 2002 the physician-administrators and doctors of health protection are not considered practising physicians any more. The number of doctors includes the number of physician-interns and the number of dentists includes the number of dentist-interns. Surgeons of stomatology and oral surgeons are excluded from physicians and included in dentists. For compatibility of time-series of health care personnel the staff of the Health Protection Inspectorate for 1998–2001 is excluded. Since 2001 the staff of the Central Prison Hospital and since 2002 the staff of the health resorts and Bureau of the Forensic Medical Expertise are included. Data about malignant neoplasms come from the database of the Estonian Cancer Register. Due to amendments made in the Personal Data Protection Act, the processing of personal data was suspended. Therefore the data about malignant neoplasms since 2001 are not available. Since 1997 the International Statistical Classification of Diseases and Health Related Problems, 10-th Revision (ICD-10) is used in Estonia for reporting of morbidity data. The Statistical Office of Estonia provides only the basic data about health statistics. More detailed information can be found in publications and on the website of the Ministry of Social Affairs and in publications of special medical registers. In comparing the counties, what is to be kept in mind is that not only the proportions of health care but also the proportions of morbidity (for one, 1,000, 100,000 inhabitant) reflect the work of health care institutions in counties and volume of health services provided to the people of the area. Health care statistics is collected according to the provision of health services, not according to the residence of patient. As in-patient treatment is provided in every county, also to the inhabitants of other counties, and health care statistical data are collected aggregately on the basis of surveys of institutions, it is impossible to bring out the use of medical care of the inhabitants. The same goes to the morbidity, where the illness is registered to the statistical survey not according to the patient’s residence, but according to the medical institution. Present regulations of health care statistics do not enable to register illnesses on the level of an individual. Exception is the statistics presented on the corresponding sick registers (malignant tumours, tuberculosis, infectious diseases), where the data are individual-based and the residence of an inhabitant is considered the base. As the physician serves mainly the inhabitants of one county, the data of the physician reflect the provided medical care and morbidity of the people of the region. Receptions of specialist doctors and especially the use of hospital beds rather express the possibilities of getting medical care in the region, regardless of the residence of the patient. Eesti statistika aastaraamat. 2005. Statistical Yearbook of Estonia. CD-ROM. Tallinn, 2005. Maakonnad arvudes. 2000–2004. Counties in Figures. Tallinn, 2005. Eesti tervishoiustatistika. 2000–2002. Estonian Health Statistics. Sotsiaalministeerium, Tallinn, 2003. © Statistical Office of Estonia, 2005When using or quoting the data included in this issue, please indicate the source |