Healthcare workers protest against cuts in spending

In October 2009, two trade unions representing healthcare workers held a small demonstration in protest against government plans to cut healthcare spending. The cuts will prolong hospital waiting lists and reduce the salaries of doctors and healthcare workers. The trade unions argue that this will cause another wave of migration of healthcare workers to other countries; however, the employers have approved of the proposal.


Due to the Estonian government’s plan to adopt the euro as the national currency from 1 January 2011, an aim has been set to fulfil the Maastricht criteria. Cuts in healthcare spending are among the measures proposed to improve the country’s budgetary position so that it can adhere to these criteria. The transition to the eurozone is expected to pull Estonia through the crisis and to restore its economic stability. Although the Estonian Health Insurance Fund (Eesti Haigekassa, EHIF) has over EEK 1 billion (about €64 million as at 27 November 2009) in reserve and over EEK 1.3 billion (€83 million) in retained profits that would cover the missing finances for the period 2010–2013, the government insisted on cutting its expenditure to save an estimated EEK 0.5 billion (€32 million). However, doctors, nurses and hospital executives insisted on using reserves and retained profits, since the budget cuts from the beginning of 2009 have already reduced the salaries of doctors and nurses. It is feared that the latest cuts will diminish the availability and quality of healthcare, as hospitals are afraid that they will be forced to implement redundancies as well as pay cuts.

Discussion over budget cuts

Discussions over the cuts in healthcare spending have been one of the most heated compared with those concerning cuts in other parts of the public sector. Healthcare workers argue that further reductions will prolong waiting lists and that the overall availability of treatment to patients will worsen.

Meanwhile, the supervisory board of EHIF proposed that the government could cut healthcare spending by lowering healthcare service prices by 6% starting from 15 November 2009 until 31 December 2010. According to EHIF, patient services should not deteriorate as services become cheaper. However, healthcare workers disagreed with this proposal, since in order to provide cheaper services, hospitals would have to cut their own expenses, including salaries. According to the Estonian Medical Association (Eesti Arstide Liit, EAL), hospitals cannot afford any more cuts. Personnel costs already form half of all expenditure, and the salaries of most healthcare workers have already been reduced by 8%–10%. Further budgetary cuts are thus expected to lead to redundancies, which would result in a lack of medical workers and thereby constrain the availability of medical care in the near future. The Estonian Nurses’ Union (Eesti Õdede Liit, EÕL) warns that a new wave of migration among healthcare workers could take place if any redundancies are implemented.

Instead of the proposed budgetary cuts, EAL has proposed changing the Health Insurance Act to allow for more extensive use of reserves to keep healthcare expenses at the same level.

Protest action

On 29 October 2009, EÕL and the Federation of Estonian Healthcare Professionals’ Unions (Eesti Tervishoiutöötajate Ametiühingute Liit, ETTAL) organised a demonstration to protest against the proposed spending cuts. Although an estimated 50 healthcare workers participated in the demonstration, they addressed the government with a petition that was also signed by EAL, the Estonian Family Physicians’ Association (Eesti Perearstide Selts, EPS) and the Union of Estonian Healthcare Professionals (Eesti Tervishoiutöötajate Kutseliit, ETK).

The demonstrators supported the proposal of the Estonian Hospital Association (Eesti Haiglate Liit, EHL) to use the undivided profits to cover the missing part of the budget for the period 2010–2013. They called on the government not to reduce the budget as it would damage the healthcare system irreversibly and lead to a significant deterioration of medical treatment availability. Despite the protest, however, the government decided to maintain its plan to cut healthcare spending.

Reactions to government proposal

The Estonian Trade Union Confederation (Eesti Ametiühingute Keskliit, EAKL) condemned the government’s plan. According to the federation, it would worsen the availability of healthcare services, endanger the quality of treatment and cause another wave of migration among healthcare workers.

However, the Estonian Employers’ Confederation (Eesti Tööandjate Keskliit, ETTK) approved the proposal to introduce cuts, arguing in favour of its necessity to restore businesses’ hope of entering the eurozone. According to ETTK, the trade unions’ criticisms were unjustified, as EHIF reserves are used in a maximum range that is legally permitted.

Liina Osila and Kirsti Nurmela, PRAXIS Centre for Policy Studies

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