Estonia: Difference between revisions
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Revision as of 20:10, 1 November 2023
Go back to Cancer Centers list.
Cancer Centers
Healthcare System
Estonia operates a universal health care system primarily funded through the Estonian Health Insurance Fund (EHIF), covering about 94% of the population. It's a semi-autonomous organization, gaining more responsibilities post a 2017 reform. Financing comes from a social payroll tax, state and municipal budgets (just under 11% of total healthcare expenditure), and private expenditure, mainly co-payments (about a quarter of all health expenditure).
The Estonian Ministry of Social Affairs supervises the health care system nationally, with some minor and voluntary input from local municipalities. The Health and Labor Market Policy Department designs health policies, while other agencies assure professional certifications and pharmaceutical quality.
Hospitals, primarily state-owned or affiliated with public legal bodies, along with independent general practitioners, form the healthcare service backbone. Additionally, private primary care centres, pharmacies, and outpatient clinics supplement the services. The system ensures primary care, specialist outpatient care, hospital care, maternity services, emergency care, dental care, prescription drugs, rehabilitation services, home nursing, prostheses, medical devices, and preventive services.
For benefits access, individuals need to be insured with the EHIF, which includes employed persons and their dependents, the retired, registered unemployed, children, students, pregnant women, and other certain groups.
Estonia has a sophisticated, largely digital healthcare system. Providers send claims electronically to the EHIF, and patient data is stored in a decentralized system, the Electronic Health Record (EHR), accessible by authorized providers. These records contribute to health registries for analysis and research, maintaining a centralized health information system.
Administrative or Claims Data
Database: Estonian Health Insurance Fund (EHIF) Database
Sponsor, manager or home institution: Estonian Health Insurance Fund (EHIF); The Ministry of Social Affairs
Type of information: Data Dictionary: Estonian Health Insurance Fund (EHIF) Database.
Available type of information: Amount of bills; Numbers of persons; Year; Age group; Gender; Specialist/Family doctor; Diagnosis; THT Type; Quarter; Health care service; Medical facility and speciality [3].
Source of Information: Based on claims data from all Estonian healthcare providers that have signed a contract with EHIF and deliver EHIF-financed healthcare.
Data level: Patient level.
Number of Records: 1.3 million people, i.e. 95% of Estonia's population.
Date Range: 2004 onwards.
Data access: Partially publicly available [4]. Instructions to request data for restricted content [5].
Contact information: Information [6].
Registries
Database: Andmebaas Cancer Screening Registry
Sponsor, manager or home institution: The Health Statistics and Health Research Database; The National Institute for Health Development.
Primary purpose: The register collects and analyzes personalized data about the target group of breast, cervical and colon cancer screenings.
Type of information: Data of persons belonging to the target group of screening studies; Screened research participation data and the results of the basic and additional studies performed [7]. Data dictionary could not be found for this database.
Available type of information: Breast cancer screening target population and women invited to screening; Breast cancer screening coverage by examination in target population; Breast cancer screening invitational coverage and coverage by examination in women invited to screening; Detected cancer cases in breast cancer screening programme; Cervical cancer screening target population and women invited to screening; Cervical cancer screening coverage by examination in target population; Cervical cancer screening invitational coverage and coverage by examination in women invited to screening; Detected cancer cases in cervical cancer screening programme; Colorectal cancer screening target population and men and women invited to screening; Colorectal cancer screening coverage by examination in target population; Colorectal cancer screening invitational coverage and coverage by examination in men and women invited to screening; Detected cancer cases in colorectal cancer screening programme. Filtered by sex, age, county and health insurance. More information about the data contained in the dataset [8].
Source of Information: The register collects data from health service providers through electronic mass requests through the health information system. Data is also inherited from the population register, the cause of death register, the cancer register and the health insurance data set of the health insurance fund via the X-tee data exchange layer.
Data level: Patient level.
Number of Records: Unknown.
Date Range: 2015 onwards.
Cancer Areas of Interest: Breast, cervical and colorectal cancer.
Data access: Partially publicly available [9], to access go to Population > Morbidity > Cancer screening programmes. Instructions to request data for restricted content [10].
Contact information: Information [11].
Database: Andmebaas Cancer Registry
Sponsor, manager or home institution: The Health Statistics and Health Research Database; The National Institute for Health Development.
Primary purpose: The main task of the cancer registry is to ensure the most complete and reliable registration of cancer cases.
Type of information: Diagnosis, i.e. detailed location, time of diagnosis, research methods that confirmed the diagnosis, morphological diagnosis and degree of malignancy, spread of the tumor; Primary treatment by type of treatment - nature of treatment, place of treatment, date of initiation of treatment and method of treatment; Details of the person who completed the cancer notification time and cause of death or time of departure from Estonia; Patient's name, personal identification number, gender, date of birth, place of birth, place of residence at the time of diagnosis and nationality [12]. Data dictionary could not be found for this database.
Available type of information: Cases of malignant neoplasm; Age-specific incidence rate of malignant neoplasms per 100.000 inhabitants; Incidence rate of malignant neoplasms per 100.000 inhabitants filtered by specified site, sex, age group, year and county. More information about the data contained in the dataset [13].
Source of Information: Data is updated from the Estonian population register (personal data, including time of leaving the country) from the register of causes of death (death data, including the cause of death). Reporting cancer cases is mandatory for all doctors working in Estonia who diagnose or treat cancer. Forensic experts also submit data to the register.
Data level: Patient level.
Number of Records: Unknown.
Date Range: 1968 onwards.
Cancer Areas of Interest: All malignant tumors (C00-C97); Tumors in situ (D00–D09); Benign and unclear and unspecified tumors of the brain and central nervous system, as well as endocrine glands located in the brain region (D32.0–D33.9, D35.2–D35.4, D42.0–D43.9, D44.3–D44.5); Other neoplasms of lymphoid and hematopoietic tissue and similar tissues (D45-D47).
Data access: Partially publicly available [14], to access go to Population > Morbidity > Malignant neoplasms. Instructions to request data for restricted content [15].
Contact information: Information [16].
Database: Andmebaas Cause of Death
Sponsor, manager or home institution: The Health Statistics and Health Research Database; The National Institute for Health Development.
Primary purpose: The register collects and processes data on causes of death for various purposes, including the development of social policy, assessment of population health, and planning of preventive activities in the social and health sectors.
Type of information: Personal data of the deceased (sex, county, month, age group, year and municipality); Causes and circumstances of death; Socio-demographic data of the deceased (education, last place of residence, citizenship, etc.); Details of the basic documents and their authors [17]. Data Dictionary: Andmebaas Cause of Death.
Available type of information: Data of cause of death by sex; county; month; age group; year and municipality. Data of causes of death, Autopsies, Preventable deaths, Amenable deaths, Infant deaths, Standardised mortality rates per 100.000 inhabitants and deaths per 100.000 inhabitants. More information about the data contained in the dataset [18].
Source of Information: The socio-demographic data of the deceased is provided by the Estonian population register, submitted by the doctors and coroners who have established the death.
Data level: Patient level.
Available data level: National level.
Number of Records: Unkown.
Date Range: 1989 onwards.
Cancer Areas of Interest: Cancer Areas of Interest: Andmebaas Cause of Death.
Data access: Partially publicly available [19], to access go to Population > Deaths. Instructions to request data for restricted content [20].
Contact information: Information [21].
Database: Statistics Estonia Cause of Death
Sponsor, manager or home institution: Statistics Estonia.
Primary purpose: The database provides information on deaths of Estonian permanent residents, including causes of death, to be used for population statistics, mortality rate assessment, population forecasting, and comparison with other EU member states, as well as by various state institutions, statisticians, and international organizations.
Type of information: The number of deaths registered during the calendar year and the distribution of the dead by demographic indicators and medical causes of death; indicators are published in absolute and relative numbers (multipliers). By type of deceased settlement unit, place of residence and month of death, gender, age group, nationality, marital status, education level, cause of death. Perinatal deaths; Stillbirths. Infant deaths by gender, age, place of residence, date of birth, mother's age, mother's marital status, mother's level of education.
Available type of information: Total deaths, death rate, standardized death multiplier, death per 100,000 population, cause of death, sex, and age.
Source of Information: Census.
Data level: Patient level.
Available data level: National level.
Number of Records: Unknown.
Date Range: 1989 onwards.
Cancer Areas of Interest: Cancer Areas of Interest: Statistics Estonia Cause of Death.
Data access: Partially publicly available [22] to access go to Population > Population indicators and composition > Population and population composition. Instructions to request data for restricted content [23].
Contact information: Information [24].
Statistics Estonia: Malignant Tumors
Sponsor, manager or home institution: Statistics Estonia.
Primary purpose: Provides information about the morbidity and incidence of malignant tumors in Estonia (1950-2013).
Available type of information: Sex; Year; Number of first cases; Morbidity rate per 100.000 population; Incidence rate per 100.000.
Source of Information: Census.
Data level: Patient level.
Available data level: National level.
Number of Records: Unknown.
Date Range: 1950-2013.
Cancer Areas of Interest: Unknown.
Data access: Partially publicly available [25]. Instructions to request data for restricted content [26].
Contact information: Information [27].
Database: Activity License Registry
Primary purpose: A search tool for any pharmacy, wholesale distributor or manufacturer with an Estonian activity licence for handling medicines.
Sponsor, manager, or home institution: Estonian Agency of Medicine.
Available information: Site name, activity license holder, activity license number, county, city/town/village and type of activity license.
Data level: City/town/village level.
Database: Medical Products Registry
Primary purpose: To have an account of all medicinal products and their packages sold in Estonia.
Sponsor, manager, or home institution: Estonian Agency of Medicine.
Available information: Active substance, pharmaceutical form, strength, information about the marketing authorization, the last date of import, reference price, discount prices and rates, unique codes for package sizes, among other information.
Databases for Clinical Trials, Surveys and Biobanks
Survey: The Survey on Health, Ageing and Retirement in Europe (SHARE)
Primary purpose: A pan-European longitudinal survey of the elderly (50+) population, which focuses on the study of the course of the individual aging process and the causal relationships that influence it, for the monitoring of existing policy measures as well as the research-based initiation of new measures.
Sponsor, manager or home institution: The Max Planck Society Munich Centre for the Economics of Aging (MEA); The Estonian Institute for Population Studies.
Type of information: Self-assessment of health; Limitations in coping and daily activities; Health condition; Use of medicines; Mental health; Use of health and social services; Physical activity and body weight; Nutrition; Alcohol consumption; Smoking; A social network; Expectations and Satisfaction; Economic activity and material livelihood; Socio-economic background characteristics; Longitudinal indicators; Health status; Living conditions and employment; Longitudinal data; Health and activity indicators for the 3rd wave and elderly poverty, coping and social relationships [30]. Variables: SHARE Estonia. More information about the data contained in the dataset [31]. Questionnaires information [32], in SHARE wave 4, 5 and 6. More methodological information [33].
Data level: Respondent level.
Available data level: National and regional level.
Number of Records: Unknown.
Date Range: 2010 onwards.
Cancer Areas of Interest: Unknown.
Data access: Partially publicly available [34]. Instructions to request data for restricted content [35]
Contact information: Information [36].
Survey: The Estonian Health Interview Survey (ETeU)
Primary purpose: The aim of ETeU is to assess the health status of the Estonian population, the factors influencing it, the restrictions caused by health, the need for assistance, the use of health care services and to compare the results with previous surveys.
Sponsor, manager or home institution: National Institute for Health Development; Statistics Estonia.
Type of information: General data on the household and household members; Health status; Accidents and injuries; Mental health; Emotional feeling; Physical and sensory functional limitations; Taking care of yourself; Housework; Preventive actions; Sexual behavior; Studies and work; Place of residence; Childhood home; Social support; Use of outpatient care; Use of hospital and day care; Use of medicines; Smoking, Alcohol consumption; Drug use; Weight, Growth and physical activity, Eating habits, and attitudes [37]. More information about the data contained in the dataset [38], in Health behavior and health > Estonian Health Survey. Questionnaires information [39], in Results and Publications > 2019 Survey.
Data level: Respondent level.
Available data level: Estonian residents aged 15 and older are surveyed.
Number of Records: Unknown.
Date Range: 1996 onwards.
Cancer Areas of Interest: Unknown.
Data access: Publicly available [40], in Health and health behaviour > Estonian Health Interview Survey.
Contact information: Information [41].
Electronic Health Records
Database: Health Information System
Primary Purpose: Allowing healthcare service providers to see and share patient information and healthcare data across the country.
Sponsor, manager, or home institution: Ministry of Social Affairs (sponsor); Health and Welfare Information Systems Centre - TEHIK (manager).
Number of records: Any Estonian citizen who used a healthcare service since 2008.
Data source: Data inserted by healthcare providers.
Date range: 2008 onwards.
Contact information: Information [43].
Clinical Practices Guidelines
Good Practices Guidelines for Clinical Trials
Primary purpose: To ensure the rights, safety, and well-being of the participant according to the principles of the Declaration of Helsinki [45].
Sponsor, manager or home institution: European Medicines Agency.
Data level: National level.
Cancer Areas of Interest: All.
Availability in English: Yes [46].
Latest Policymaking Initiatives
National Plan: Action Plan for Cancer Control
Sponsor, manager or home institution: Ministry of Social Affairs; National Institute of Health Development; Estonian Cancer Society.
Primary purpose: Reducing the number of cancer cases and deaths, and improving the quality of life of cancer patients.
Data level: National level.
Cancer areas of interest: All.
Information access: Information access [47].
National Plan: Population Health Development Plan 2030
Sponsor, manager or home institution: Ministry of Social Affairs.
Primary purpose: National health plan to increase life expectancy and quality of life during later years, and decrease healthcare inequalities.
Type of information: A detailed plan to deliver on the goals stated above, with data to support policy decisions, which includes cancer-related decision-making.
Data level: National level.
Information access: Information access [48].
Report: The State of Healthcare Integration in Estonia Report
Sponsor, manager or home institution: Estonian Health Insurance Fund.
Primary purpose: Assess healthcare integration in Estonia.
Type of information: Overview of the Estonian healthcare system, information about avoidable admissions to hospitals and specialist visits, hospital stay, NMIS procedures, patient behavior, provider behavior, care continuity, preventive services, and other various information.
Data level: National level.
Information access: Information access [49].
Report: "Quality Bonus System Needs Adjustment" Report
Sponsor, manager or home institution: Estonian Health Insurance Fund.
Primary purpose: Point out flaws in the QBS system and suggest easy-to-make adjustments.
Type of information: Analysis of QBS score distribution including tables and graphs for various data, list of proposals for adjustments to the QBS system with details, among other information.
Data level: National level.
Information access: Information access [50].
Report: Healthcare Costs 2019
Sponsor, manager or home institution: National Institute for Health Development.
Primary purpose: Provide information about healthcare costs for anyone interested in healthcare.
Type of information: Total national health expenditure, comparisons to previous years, share of public sector and other details, household expenditures, and healthcare insurance fund expenditures, among others.
Data level: National level.
Information access: Information access [51].
Guideline: Estonian Handbook for Guideline Development
Sponsor, manager or home institution: Estonian Health Insurance Fund.
Primary purpose: To serve as an up-to-date practical resource for developing health guidelines.
Type of information: Guideline development process, topic proposals, evidence retrieving, report, dissemination of recommendations, among other topics.
Data level: National level.
Information access: Information access [52].
Policy: Marketing Authorization for a Drug
Sponsor, manager or home institution: Medicines Board
Primary purpose: Legislation and Forms to inform the marketing authorization for drugs.
Type of information: Medicine-related laws, regulations, conditions, requirements and statutes related to the authorization of drug marketing, guides, and manuals to inform the process as well as forms that are required to be authorized.
Data level: National level.
Information access: Information access [53].
Policy: Handling of Medicine
Sponsor, manager or home institution: Medicines Board
Primary purpose: Legislation and Forms to inform the handling of drugs.
Type of information: Medicine-related laws, regulations, conditions, requirements and statutes related to the handling of drugs, guides to inform the handling of drugs as well as forms that are required to be authorized to handle drugs.
Data level: National level.
Information access: Information access [54].
Reports: The Health Fund's
Sponsor, manager or home institution: Tervisekassa.
Primary purpose: To outline the vision, mission, and strategic goals of the Health Insurance Fund in Estonia, focusing on ensuring the availability of health insurance benefits and improving healthcare services through prevention, early intervention, and better-coordinated treatment.
Type of information: Health care costs; Medicine costs; Costs of disease prevention; total health costs in general.
Data level: National level.
Access to information: Access Information [55].
Report: EU Country Cancer Profile 2023
Sponsor, manager or home institution: OECD and European Commission.
Primary purpose: To provide reliable data on cancer prevention and care, identifying trends, disparities, and inequalities among EU Member States and regions to guide interventions under Europe's Beating Cancer Plan.
Type of information: National cancer burden; Cancer incidence and mortality; Risk factors for cancer; Early detection programs (screenings); Cancer care performance, The impact of COVID-19 on cancer care.
Data level: National level.
Access to information: Access Information [56].
Report: Cancer in Estonia: morbidity and survival
Sponsor, manager or home institution: Tervise Arengu Instituut.
Primary purpose: To provide comprehensive and up-to-date cancer incidence statistics in Estonia, based on data from the cancer registry, enabling analysis of cancer survival and scientific research.
Type of information: More common cancer sites; Cancer incidence and morbidity; Distribution of primary cases by cancer site and spread at diagnosis; Cancer prevalence and survival.
Data level: National level.
Access to information: Access Information [57].
Compilation: Other Estonian Health Legislation
Information access: Information access [58].
Patient Association: "Gift of Life" Foundation
Primary purpose: To support cancer treatment not covered by the Estonian Health Insurance Fund.
Data level: National level.
Information access: Information access [59].
Compilation: ESMO Patient Guides
Sponsor, manager or home institution: European Society for Medical Oncology
Primary purpose: To translate complex medical language into understandable information for patients.
Available guides: Cancer Care During the COVID-19 Pandemic; Bone Sarcoma; Colorectal Cancer; Non-Small-Cell Lung Cancer; Soft Tissue Sarcomas.
Type of information: Information on each guide varies for each cancer type. Generally, guides provide definitions, explanations of causes, diagnosis, treatment, treatment options, and care after treatment, among others.
Access to information: List of guides [60].
Quality of Life and Palliative Care Research
List of Articles: Quality of Life [61] and Palliative Care [62].
