Collective agreement in healthcare sector under pressure
Employers in the Estonian healthcare sector have stated that they cannot afford to pay the 2006 wage increases due under a two-year collective agreement signed in 2004. The employers argue that they face a shortfall of EEK 100 million, a position disputed by the Ministry of Social Affairs and the Health Insurance Fund. Trade unions insist that the agreement must be fulfilled.
In September 2004, after a long-lasting and complicated negotiations (EE0409102F, EE0410102N), in which the public conciliator was involved (EE0402102F), a two-year agreement was signed for workers in the healthcare sector. The agreement was signed for employers by the Estonian Hospitals Association (Eesti Haiglate Liit, EHL) and for employees by four trade union organisations - the Estonian Medical Association (Eesti Arstide Liit, EAL), the Trade Union Association of Health Officers of Estonia (Eesti Keskastme Tervishoiutöötajate Kutseliit, EKTK), the Federation of Estonian Healthcare Professionals Unions (Tervishoiutöötajate Ametiühingute Liit, ETTAL) and the Estonian Nurses Union (Eesti Õdede Liit, EÕL) and the Ministry of Social Affairs (Sotsiaalministeerium). It provided minimum wage increases for 2005 and 2006, in total of 50% for doctors, 56% for nurses and 43.7% for medical carers. According to the agreement, from 1 January 2006, hourly minimum wages should increase up to EEK 75 for doctors, EEK 39 for nurses and EEK 23 for medical carers. The agreement was fulfilled in 2005, but in the very end of the year, EHL declared that the hospitals would not be able to fulfil it in 2006 unless they do not get an extra EEK 100 million. EHL argues that fulfilling the agreement could lead some hospitals to serious economic difficulties.
This agreement was signed on the condition that the Health Insurance Fund (Haigekassa) will increase the reference prices for medical services: in 2005 by EEK 365 million and in 2006 by EEK 212 million. In addition, the reference prices should be adjusted by increase in consumer price index and costs related to changes in inflation level. According to EHL, in adjusting the reference prices, the Health Insurance Fund has not taken into account different essential price components, altogether approximately in the amount of EEK 100 million.
The Health Insurance Fund and the Ministry of Social Affairs do not agree with the statements of EHL and state that there is foreseen money for fulfilling the agreement in the budget. Though the Fund states that it is not able to cover the amount by 100%, but this has been known to all the parties already since the very beginning. The parties of the agreement gathered on 11 January 2006, but did not find any solution for the problem. Still a united position was reached that the lack of finances affects above all some small county hospitals and that the system of financing hospitals should be changed.
Trade unions are upset with the behaviour of EHL, claiming that this would spread uncertainty to not only the healthcare sector but to the whole system of industrial relations in Estonia. In addition, it could again boost the migration of Estonian healthcare workers. The Estonian Transport and Road Workers’ Trade Union (Eesti Transpordi ja Teetöötajate Ametiühing, ETTA), which is bound to EÕL through a joint strike pact (EE0408102F, EE0310101N), has declared solidarity with healthcare workers and is ready to go as far as to arrange a nationwide strike.
In the light of the scarcity of financial means of the Health Insurance Fund, the Ministry of Social Affairs is again trying to place apart of sickness benefits on employers’ shoulders (EE0509102F). The amount of money spent on sickness benefits is increasing year by year and the Ministry is convinced that a large part of claims for sickness benefits are unfounded. The idea is to make employers pay for the first days of sickness, but in the same time to give them a right to control whether an employee saw a doctor. In addition, the system should motivate employers to change the organisation of work so that employees would not have so many chronic diseases. The Estonian Employers’ Confederation (Eesti Tööandjate Keskliit, ETTK) (EE0310102F) opposes the idea strongly as it would only raise the costs for employers without getting any support from the state. It rather insists on decreasing the percentage of the wage that employees get while sick (at the moment 80%) or to prolong the period while employees are unpaid (at the moment only the first day of sickness).
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