A publicly funded universal health care system, financed through income taxes, whereby every citizen receives the same level of care is a laudable ideal. However, as the Canadian example proves, it is difficult to implement equitably, equally, and impartially. This year’s influenza season challenges have underscored perceived inequalities with regard to access to basic care. Upset citizens have targeted various levels of government for perceived failures of rapid response. Medical professionals at the first level of contact with those desiring a flu shot have been hamstrung by bureaucratic red tape combined with an unusual system of supply of vaccine. At present, with the second wave of H1N1 deemed by some to have peaked, public concern has somewhat abated. However, experts remind all that the flu season is far from over.

Estonia’s medical professionals have also been concerned about governmental attitudes toward health care, most recently regarding reaction to the H1N1 or swine flu epidemic. The following is a summarized translation of a public statement by the Estonian Union of Physicians, Eesti Arstide Liit (EAL), released on Saturday, November 28th in Pärnu.

One of the biggest deficiencies of Estonia’s health care system is its over-politicized leadership. Regrettably, decisions concerning the health of the entire nation are made from positions based on the impressions and understandings of politicians, not from the needs of people or from the standpoint of physicians and health care specialists. Politicians sit on the boards of directors of hospitals, and hospital managing committees are too often composed according to political party membership. The most recent example of the incompetence of political leadership is the present lack of state preparedness with regard to the influenza epidemic, the lack of co-ordination of the health care system and the uncontrolled release of information to the public.

The Estonian Union of Physicians calls for the regulation of health care from the principle that everyone, regardless of place of residence or income level, be guaranteed equal opportunities of access to medical care. We must attain a social contract as to what level of health care we desire and require. Only then can the financing model be decided upon. At present choices are made in the exact opposite sequence: the functioning of the health care system and providing people with medical care is dependent on the sums allocated to social expenditures in the budget.

The World Health Organization’s data shows that the average percentage of GDP as allocated to social expenditures by European states is 26%. In Estonia that figure is 12% or more than two times smaller, placing us dead last in the European state rankings. The medical profession is baffled by the prime minister of Estonia’s declaration that addresses reducing social maintenance payments, as this will complicate the situation of those needing assistance and worsen the availability of medical care. The Estonian Union of Physicians does not consider it acceptable that the attitude of the Estonian state towards its people and their health is moving ever further from European values.

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