PRM system in Estonia (medical and psycho-social)
There is a development plan for the physical and rehabilitation medicine in Estonia made in 2003. The system was built on the different levels of service with the bigger units by the hospitals, based on the multidisciplinary teamwork.
PRM units on the regional hospitals level:
- Tartu Ülikooli Kliinikumi Spordimeditsiini ja taastusravi kliinik/Tartu University Clinic Rehabilitation Clinic www.kliinikum.ee/taastusravi/
- Pediatric Rehabilitation: Tartu University Children’s Clinic www.kliinikum.ee/lastekliinik/index.php?option=com_content&view=article&id=7&Itemid=25
- Põhja-Eesti Regionaalhaigla /North-Estonian Regional Hospital http://www.regionaalhaigla.ee/?op=body&id=86
- Tallinna Lastehaigla /Tallinn Children’s Hospital has PRM service integrated into neurological department www.lastehaigla.ee/index.php?page=126 .
Physical and rehabilitation medicine hospitals
- Haapsalu Neuroloogiline Rehabilitatsioonikeskus / Haapsalu Neurological Rehabilitation Centre www.hnrk.ee
- Keila Taastusravikeskus /Keila Rehabilitation Centre www.taastusravi.ee
Central hospitals (first 3 of them have inpatient PRM units):
- Ida-Tallinna Keskhaigla /East Tallinn Central Hospital www.itk.ee/index.php?page=127
- Pärnu Haigla/Pärnu Central Hospital www.ph.ee/index.php?menuID=8
- Ida-Viru Keskhaigla /East –Estonia Central Hospital www.ivkh.ee/et/Haiglast/struktuur/sisekliinik/taastusravi_osakond
- Lääne-Tallinna Keskhaigla /West Tallinn Central Hospital http://www.ltkh.ee/index.php?page=192
PRM beds in the smaller hospitals:
- Lõuna-Eesti Haigla /South –Estonian Central Hospital http://www.vh.ee/kliinikud/taast.php
- Põlva Haigla Põlva Hospital http://www.polvahgl.ee/index.php?option=com_content&task=view&id=31&Itemid=59
- Kuressaare Haigla /Kuressaare Hospital http://www.saarehaigla.ee/?id=52&keel=ee
- Narva Haigla /Narva Hospital http://www.narvahaigla.ee/index.php?page=323&&PHPSESSID=7cc55725437998c4618a5eebebfffe60
- Viimsi Haigla /Viimsi Hospital http://www.viimsihaigla.ee/index.php?page=73&
Physical and rehabilitation medicine out-patient (private) clinics
Medical rehabilitation (PRM) is covered by the Estonian Health Insurance Fund www.haigekassa.ee
The purpose of health insurance in Estonia is to cover the costs of health services provided to insured persons, prevent and cure diseases, finance the purchase of medicinal products and partly certain medical technical aids and provide the benefit for temporary incapacity for work and other benefits. PRM service got 2,32% of specialized medical service (excl. Primary care) funding in 2008
There are different types of funding of medical rehabilitation service.
- early rehabilitation take place on the other departments by the PRM specialists and was funded by the Estonian Health Insurance Fund (EHIF)
- intensive inpatient rehabilitation take place in PRM departments and was funded by the Estonian Health Insurance Fund. There is a list of diseases (stroke, SCI, TBI, MI) which has covered by EHIF, if there is at least medium level functional deficit.
- in out-patient rehabilitation
- post acute inpatient rehabilitation (10 days and patient has to pay 20 %)
Psycho- social rehabilitation service funded by the social insurance www.ensib.ee
Rehabilitation service is a social service which aims to improve the independent coping of a disabled person, increase involvement in society and promote working or getting employed. During rehabilitation service are estimated the person’s coping and need of personal assistance, proposals are made for adjusting (home) environment, receiving and using technical aid. Also, disabled persons are counselled on various topics in order to enhance the further social coping.
There are a lot of small social rehabilitation units all over Estonia. Some bigger one of them are also PRM units (Adeli, Corrigo).
There is one bigger vocational rehabilitation centre Astangu Kutserehabilitatsioonikeskus and smaller units which are providing vocational/ productive daily activity like JUKS www.juks.ee, where mentally disabled (mental retardation, Down etc) young persons can make hand made products and realize these.
There is also big centres for SCH persons to support them to find work and to communicate with the potential companies offering a job for them. www.mhcenter.ee/teenused/tootamise_toetamine.html
Who has the right for psycho- social rehabilitation service?
1. Children and adults applying for the expertise of difficulty level of their disability.
2. Disabled children and adults.
3. People with 16 years of age until the pensionable age with mental special needs, who have lost at least 40% of their capacity for work.
4. Minor offenders on the basis of the decision of juvenile committee.
Which services are provided?
1. A personal rehabilitation plan is prepared (valid from 6 months to 3 years).
2. The person is instructed how to conduct the activities described in the rehabilitation plan.
3. The following services marked in the rehabilitation plan are provided:
- assessment and planning of rehabilitation;
- instructing the carring out rehabilitation plan and assessing the results;
- the service of physiotherapist (individual and group work);
- the service of occupational therapist and creative therapist;
- the service of social worker (individual, family and group counselling);
- the service of special education teacher (individual, family and group counselling);
- the service of psychologist (individual, family and group counselling);
- the service of speech therapist (individual, for family and group).
To what extent is psycho- social rehabilitation service provided?
Rehabilitation services are listed in the Government of the Republic regulation no 256 of December 20, 2007, where it is also specified how many services may be provided per one calendar year.
Generally one service is allowed to be provided to adults 10 hours and to children 20 hours per calendar year.
The exception is:
- the service of physiotherapist which is provided to adults about 6 hours (as councelling not therapy) , to children about 20 hours and to children with physical disability 30 hours per calendar year;
- the services of social worker and occupational therapist for people with mental special needs – 35 hours per calendar year.
- In the framework of rehabilitation service is provided also the service of accommodation – staying overnight with catering one per day is enabled in the rehabilitation institution during receiving the rehabilitation service (calculated that 24 hour stay would cost the maximum of 375 Estonian crowns):
- for children and adults applying for the expertise of disability or with disability, also for offenders directed by the decision of juvenile committee for the maximum 1,875 Estonian kroons per year;
- for children under 16 year of age 1,875 Estonian crown per year;
- for people with mental special needs the maximum of 13,125 Estonian crown per year.
If the person’s residence and the location of the rehabilitation service provider are in separate rural municipalities or towns then the state will compensate for the transportation to the recipient of psyco-social rehabilitation service and his or her attendant (parent, husband, personal assistant or caregiver) if necessary the maximum of 650 Estonian crown per year.
The bill will be paid by the Social Insurance Board to the rehabilitation institution.