Tervishoiuteenuste korraldamise seadus (TTKS)

§ 2. Health services

(1) Health services are the activities of health care professionals for the prevention, diagnosis or treatment of diseases, injuries or intoxication in order to reduce the malaise of persons, prevent the deterioration of their state of health or development of the diseases, and restore their health. The minister in charge of the policy sector shall establish the list of health services.

(1¹) Pharmacists and assistant pharmacists provide health services in the framework of professional activity only in the case provided for in the law.

(2) In-patient health services are health services for the provision of which a person needs to stay at a hospital twenty-four hours a day.

(3) Out-patient health services are health services for the provision of which a person does not need to stay at a hospital twenty-four hours a day.

(4) Where a health care professional prescribes a medicinal product subject to medicinal prescription for themself in an exceptional situation for the regular treatment of an acute passing disease or to ensure the continuity of previously prescribed treatment due to chronic state, a contract for the provision of health service for the purposes of the Law of Obligations Act shall not be concluded upon the prescription of medicinal product and establishment of the related diagnosis and the Compulsory Liability Insurance of Health Care Providers Act shall not be applied upon the occurrence of damage. The prescription of medicinal products subject to medicinal prescription must be documented according to the requirements specified in § 4² of this Act.

§ 3. Health care professionals

(1) For the purposes of this Act, health care professionals are doctors, dentists, nurses and midwives if they are registered with the Health Board.

(2) A health care professional may provide health services within the acquired profession or speciality based on which they have been registered in the health administration information system.

(4) Health care professionals for the purposes of the Medicinal Products Act are also pharmacists and assistant pharmacists providing pharmacy services in a general pharmacy or hospital pharmacy provided that they have been registered in the health administration information system according to subsection 1 of § 55 of the Medicinal Products Act.

(5) Pharmacists and assistant pharmacists may provide pharmacy services within the acquired profession.

(6) Where a person provides treatment and has been registered in the health administration information system, the following persons are equalised with a health care professional:

1) physiotherapist;

2) clinical psychologist;

3) speech therapist.

§ 3¹. Patient

For the purposes of this Act, a patient means a physical person who has expressed his or her wish to receive health services or who receives health services.

§ 3². Patient safety and quality of health services

(1) For the purposes of this Act, patient safety means the purposeful decrease of the risk of avoidable damage to health related with the provision of health services. The system of patient safety includes activities related with the documentation of patient safety cases, transmission of information to the registrar of patient safety database and analysis and prevention of patient safety cases on the basis of the documented and transmitted information and learning from the cases.

(2) A patient safety case means a case related with the provision of health services which caused or could have caused avoidable damage to the patient’s health.

(3) For the purposes of this Act, the quality of health service means the aggregate of health service qualities which characterises the compliance of the provided health service with the established requirements, modern knowledge, existing resources, professional and vocational requirements and the needs arising from the patient’s state of health and patient satisfaction.

(4) A health care employee is required to document the patient safety cases having accompanied with the provision of health service which caused or could have caused avoidable damage to the patient’s health. Only the health care provider and the investigative body are allowed access to the documented patient safety cases and the documents related with the analysis thereof in the interest of ascertaining the truth in criminal proceedings.

(5) The minister in charge of the policy sector shall, by a regulation, establish the conditions and procedure for the documentation of patient safety cases and submission thereof to the patient safety database, setting out:

1) the data of the health care professionals and relevant employees directly related with the case;

2) the general personal data of the patient;

3) the data related with the patient safety case;

4) the list of patient safety cases submitted to the patient safety database;

5) the data submitted to the patient safety database with regard to a case.

(6) The supporting documents and data of a patient safety case may be created and preserved in digital form. Documents on paper which have been digitised may be destroyed before the term, provided that the preservation of their integrity and authenticity within the term of preservation has been ensured.

(7) The supporting documents and data of a patient safety case shall be preserved for 30 years starting from the registration of the patient safety case.

(8) A health care provider shall:

1) analyse the patient safety cases having occurred and been documented upon the provision of health service and develop measures for the prevention of cases;

2) notify the registrar of patient safety database of patient safety cases in a way which does not enable the direct identification of the patient and health care professional related with the case.

(9) The requirements for ensuring the quality of health services and patient safety shall be established by a regulation of the minister in charge of the policy sector.

§ 3³. Use of means of restraint

(1) A health care provider may, in the provision of emergency care, emergency medical care, specialised in-patient care and in-patient nursing, use means of restraint with regard to a patient if the patient does not possess decision-making capacity due to state of health caused by a mental disorder or physical illness, thereby causing an immediate threat to his or other persons’ life or health, and other measures for elimination of danger, including a conversation, persuasion and verbal calming have been insufficient.

(2) The following measures may be used for restraint:

1) physical restraint – retention of a patient by means of physical strength with the aim of restricting their motion and extent of movements;

2) restraint by means of medicinal products – administration of medicinal products to a patient with the aim of easing the symptoms of anxiety;

3) mechanical restraint – use of mechanical means specifically intended for that purpose with the aim of restricting the patient’s motion and extent of movements.

(3) During mechanical restraint it must be ensured that the person being restrained is out of the range of vision of other patients.

(4) Means of restraint are used only on the basis of decisions of physicians. In inevitable cases, the commencement of physical or mechanical restraint may be decided by a nurse or midwife by promptly notifying a doctor thereof, who shall then decide on the need to continue the use of means of restraint.

(5) The measure of restraint applied to a patient must be proportional to the immediate danger having occurred and infringe the patient’s rights and liberties the least. The use of means of restraint shall be discontinued immediately after the danger ceases to exist.

(6) The health care professional shall explain the grounds for the use of means of restraint to a patient and the specific activities upon the use of means of restraint.

(7) The treatment of a patient shall not be interrupted at the time of use of means of restraint.

§ 3⁴. Observation of use of means of restraint

(1) A patient towards whom a means of restraint has been used shall be under constant supervision of a health care professional.

(2) A doctor or, in inevitable cases a nurse or midwife, shall examine the condition of a patient towards whom a means of restraint has been applied and assess the necessity to apply the means of restraint according to the patient’s condition until the discontinuation of use of the means of restraint. Observation of a patient during the use of means of restraint and the need to continue the use of a means of restraint shall be documented.

(3) The observation frequency regarding the use of means of restraint shall be established by a regulation of the minister in charge of the policy sector.

§ 3⁵. Maintaining records on use of means of restraint

(1) A health care provider shall maintain records on the use of means of restraint in a place and manner enabling a quick and general overview of the means of restraint used by them.

(2) A patient shall be entitled to make notes on their behalf concerning the use of means of restraint with regard to them. A patient’s written notes concerning the use of means of restraint shall be added to the treatment documents. A patient shall be entitled to receive an extract from the data concerning the use of means of restraint.

§ 3⁶. Conversation following use of means of restraint

(1) After discontinuation of the use of means of restraint with regard to a patient, the health care provider shall hold a conversation with the patient upon the first opportunity with the aim of preventing the use of means of restraint in the future and informing the patient of their rights in connection with the use of means of restraint.

(2) The conditions and procedure for holding a conversation following the use of means of restraint and giving explanations to a patient concerning the use of means of restraint shall be established by a regulation of the minister in charge of the policy sector.

§ 3⁷. Notification of use of means of restraint

(1) The legal representative of a patient without decision-making capacity or, in their absence, the patient’s next of kin shall be notified of the use of means of restraint upon first opportunity. Next of kin are deemed to be the patient’s spouse, registered partner, parents, children and siblings. Arising from the patient’s organisation of life, other persons close to the patient may also be deemed as next of kin.

(2) A health care provider is required to notify the Health Board immediately, for the commencement of supervision, of each event in case of which the duration of the means of restraint is longer than twenty-four hours. The patient’s medical history number and the circumstances of use of means of restraint shall be set out in the notice sent to the Health Board.

(3) The procedure for notifying the Health Board of the use of means of restraint as well as the specific list of information to be submitted shall be established by a regulation of the minister in charge of the policy sector.

§ 4¹. Processing of personal data

(1) Health care providers, who have the obligation to maintain confidentiality arising from law, have the right to process personal data, including personal data of special categories, without the permission of the data subject:

1) for the provision of health services;

2) for planning the provision of health services, based on the objective specified in subsection 1 of § 2 of this Act;

3) to the extent and with the aim specified in subsections 5 and 9 of § 3² of this Act.

(1²) The right to process data for planning the provision of health services specified in clause 2 of subsection 1 of this section shall be extended to the provision of family physician care and health services in schools. The right to process data for planning the provision of health services shall be extended to the providers of specialised medical care, independent physiotherapy, speech therapy, psychological treatment, nursing and midwifery care only upon the existence of a previously concluded health services contract and on the condition that the preventive actions have been implemented within a reasonable time after termination of the contract.

(1³) The reason and objective of processing the personal data specified in subsection clauses 2 and 3 of subsection 1 of this section, including personal data of special categories, shall be documented.

(2) Data relating to the state of health of a data subject who is in hospital may be transmitted to or the data may be accessed by those closest to him or her, except if:

1) the data subject has prohibited access to the data or transmission of the data;

2) a body conducting an investigation has prohibited access to the data or transmission of the data in the interests of preventing a criminal offence, of apprehending a criminal offender or ascertaining the truth in a criminal proceeding.

(3) Processing of the personal data of a deceased person shall be permitted upon the provision of health services for protecting the life and health of an ascendant or descendant associated with the deceased person as well as a sibling thereof.

§ 4². Maintaining records and preservation of data concerning provision of health services and health data

(1) Compliance with the requirements for maintaining records, use of the classifications, directories, address details prescribed in the State Information Systems and standards of the Health Information System is mandatory upon maintaining records of the provision of health services.

(2) Documents and data certifying the provision of health services may be created and preserved in digital form. Digitalised paper documents may be may be destroyed before the term, provided that the integrity and authenticity thereof is ensured within the prescribed term of preservation.

(2¹) The health care provider shall ensure the traceability of processing personal data in the information system of the health care provider.

(3) The conditions and procedure for maintaining records of the provision of health services shall be established by a regulation of the minister in charge of the policy sector, setting out:

1) the data of the health care provider;

2) the patient’s general personal data;

3) the patient’s health data;

4) other data connected with the provision of service.

(4) From the data collected pursuant to subsection 3 of this section, the data certifying the provision of in-patient and out-patient health services shall be preserved for 30 years after the approval of data concerning the service provided to a patient.

(5) Differently from the term specified in subsection 4 of this section, the following data certifying the provision of health services shall be preserved by a health care provider as follows:

1) data on a pupil’s health record for five years after graduation or leaving school, also the data on an ambulance card and referral and reply to referral for five years after the approval of data;

2) data on death notice and notice of cause of death for ten years after the approval of data;

3) tissue samples containing health data that have been taken for intravital pathomorphological testing shall be preserved depending on the need for the provision of health services but not longer than for 30 years after the approval of data;

4) autopsy report data for 30 years after approval of data;

5) data on blood chart, transfusion report and report of reaction following the transfusion for 30 years after a person’s death;

6) raw genetic data created within the provision of health services and enabling reuse in studies for 30 years after approval of data.

(5¹) A health care provider is not required to comply with the term of preservation provided for in this section if the data are collected into the Health Information System and the health care provider has sent the data thereto.

(6) Upon processing of data preserved digitally, the term for preservation of logs shall be determined in the regulation of the minister established under subsection 3 of this section.

(7) Supervision proceedings shall not be commenced by a law enforcement agency on the basis of submitted information with regard to a health care professional who has duly documented a patient safety case of which the registrar of patient safety database has also been notified, neither can the employer cancel the employment contract on the basis of a documented patient safety case nor make preparatory actions necessary for cancelling the employment contract, except for in the following events:

1) the activity of the health care professional contained the characteristics of intent;

2) the health care professional caused a patient safety case in a state of intoxication caused by the consumption of alcohol, narcotic or psychotropic substance or another intoxicating substance;

3) the requirements for the provision of health service and good clinical practices were clearly and seriously neglected, whereby direct damage to a person’s health and life was caused.

(8) The regulation specified in subsection 7 of this section shall also be applied to a health care professional for whom, for objective reasons, it was not possible or reasonable to submit information on their activity or inactivity but information on a patient safety case has been submitted by another health care professional or a person responsible for quality and safety authorised by a health care provider.

§ 4³. Participation in provision of health services

(1) The following persons participate in the provision of health services:

1) physicians who have not acquired a specialty, including resident physicians;

2) students studying according to a relevant curriculum with the objective of acquiring a profession;

2¹) persons specified in subsection 3² of § 30 of this Act;

3) persons who act as a specialist or technician arising from the professional or vocational competence thereof;

4) pharmacists and assistant pharmacists engaged in the dispensing of medicinal products subject to medical prescription;

5) persons who directly sell medical devices on the basis of a medical device card.

(2) The activity of a resident physician and a student studying according to a relevant curriculum shall be deemed to be the activity on the person under whose supervision and responsibility the person practices. A physician or dentist who has not acquired a specialty and who is not studying in residency may participate in the provision of specialised medical care and the extent of his or her application in the provision of health services shall be determined by a health care provider depending on the content of the health service and the physician’s or dentist’s competence and experience.

(2¹) The person specified in subsection 3² of § 30 of this Act participates in the provision of health services under the supervision and responsibility of such supervisor who has the same or similar qualification, which the participant in work practice has acquired in a foreign state, and at least five years’ work experience in the relevant specialty. The activity of the person specified in subsection 3² of § 30 of this Act shall be deemed to be the activity of the person under whose supervision and responsibility the person practices.

(3) The persons specified in clauses 1–4 of subsection 1 of this section may participate in the provision of health services if they have been registered in the health administration information system.

(4) The participation of the persons specified in clauses 4 and 5 of subsection 1 of this section in the provision of health services has been regulated with the Medicinal Products Act and Medical Devices Act respectively.

(5) The list of persons participating in the provision of the health service specified in subsection 1 of this section and the procedure of participation shall be established by a regulation of the minister in charge of the policy sector.

§ 4⁴. Mandatory liability insurance of health care providers

Health care providers must perform the obligations arising from the Mandatory Liability Insurance of Health Care Providers Act.

§ 5. Definition of emergency care

For the purposes of this Act, emergency care means health services which are provided by health care professionals in situations where postponement of care or failure to provide care may cause the death or permanent damage to the health of the person requiring care.

§ 6. Provision of emergency care

(1) Every person in the territory of the Republic of Estonia has the right to receive emergency care.

(2) Health care professionals are required to provide emergency care within the limits of their competence and with the means available.

(3) Emergency care provided to persons insured by compulsory health insurance and persons equal thereto (hereinafter persons covered by health insurance) shall be paid for from the funds designated for the budget of the Estonian Health Insurance Fund in the state budget.

(4) Emergency care provided to a person not covered by health insurance shall be paid for from the budget of the Estonian Health Insurance Fund on the bases, conditions and pursuant to the procedure provided for in the list of health services of the Estonian Health Insurance Fund.

§ 6¹. Health services provided to persons not covered by health insurance for protection of public health

(1) A person not covered by health insurance shall have the right to receive the health services established under subsection 3 of this section, the objective of which is to ensure the protection of public health.

(2) The costs of health services provided to a person not covered by health insurance for the protection of public health shall be paid for from the budget of the Estonian Health Insurance Fund on the bases, conditions and pursuant to the procedure provided for in the list of health services of the Estonian Health Insurance Fund.

(3) The list of health services provided to a person not covered by health insurance for the protection of public health shall be established by a regulation of the minister in charge of the policy sector, having heard the opinion of the supervisory board of the Estonian Health Insurance Fund in advance.

§ 8. Practice list of family physician

(1) The practice list of a family physician is a list of persons who are to be serviced by the family physician pursuant to this Act. In the cases provided for in this Act, the persons in the practice list of a family physician are serviced by another person.

(2) Each family physician shall have one practice list.

(3) Every citizen of the Republic of Estonia, a person residing in Estonia on the basis of a residence permit or right or residence and a person legally staying in Estonia according to temporary basis for stay and who insured according to subsection 1 of § 5 of the Health Insurance Act (hereinafter foreign national staying temporarily in Estonia) has the right to register in the practice list of a family physician and change a family physician on the basis of a written application. A person shall be transferred to the practice list of a new family physician as of the first day of the calendar month following the transmission of data on the person in the Estonian Health Insurance Fund database.

(3¹) A new-born child born in Estonia shall be automatically registered after birth in the practice list of his or her mother’s family physician if the mother’s place of residence is in Estonia according to the population register.

(3²) If the mother of a new-born child has not been registered in the practice list of any family physician, the child shall be registered, based on a written application of the child’s parent or guardian, in the practice list of the family physician specified in the application or the family physician shall be appointed to the child by the Estonian Health Insurance Fund.

(4) The practice list of a family physician comprises of persons registered with the family physician and, taking into account the maximum number of persons on a practice list provided for in subsection 4¹ of this section, persons determined by the Estonian Health Insurance Fund on the basis of the Estonian population register address and the actual place of residence of a foreign national staying temporarily in Estonia.

(4¹) The maximum number of persons on a practice list shall be:

1) 1200–2000 persons;

2) 2001–2400 persons if at least one health care professional qualified as a physician provides family physician care to persons entered in the list together with the family physician.

3) less than the upper maximum level provided for in clause 1 or 2 of this subsection when approving the practice list of a family physician for the first time for up to two years, upon agreement with the family physician, and taking into account the other practice lists of the service area.

(4³) The Estonian Health Insurance Fund shall appoint a person not registered in a practice list of a family physician to a list based on their written application and shall notify the person and family physician of the change in writing or by electronic means within seven working days after making the decision.

(4⁴) The Estonian Health Insurance Fund shall exclude a person from the practice list of a family physician if the person is not a data subject of the Estonian population register or if the place of residence of a person not covered by health insurance is not in the Republic of Estonia according to the population register and unless otherwise provided in this Act. The Estonian Health Insurance Fund shall notify a person of appointment to and exclusion from a list in writing or by electronic means within seven working days as of making the decision. If a document needs to be delivered to more than a hundred persons of if the data on residence of a person are not known to the Estonian Health Insurance Fund, the decision shall be published in the official publication Ametlikud Teadaanded.

(4⁵) If the number of persons entered in a practice list of a family physician exceeds the maximum number of persons on a practice list or if a family physician or a substitute thereof has not been found by way of competition for a practice list whereto the person belongs, the Estonian Health Insurance Fund may, taking account of the maximum number, appoint the person to the practice list of another family physician based on the address according to the Estonian population register. If a practice list with the maximum number of persons provided for in clause 1 of subsection 41 of this section includes more than 800 persons not covered by health insurance, the Estonian Health Insurance Fund shall be entitled, on the basis of an application of a family physician, to appoint a person not covered by health insurance and whose residence according to the population register is not in the service area of the given family physician, to a practice list of another family physician. The Estonian Health Insurance Fund shall notify the person and family physician of the appointment of the person to a practice list in writing or in electronic form within seven working days after making the decision.

(4⁶) The minister in charge of the policy sector shall establish, by a regulation, the bases of and procedure for the compilation, amendment and comparison of practice lists of family physicians and the maximum number of practice lists.

(4⁷) Upon the establishment of the maximum number of practice lists, the minister in charge of the policy sector shall proceed from the number of persons being the data subjects of the Estonian population register and considering the better organisation and availability of family physician care.

(4⁸) The Health Board shall publish the information on practice lists of family physicians on its website setting out the following:

1) the name of the family physician and the health care professional working together with the family physician;

2) the service area and place of business of the family physician;

3) the independent appointment hours and contact information of the family physician and family nurse;

4) the opening hours and contact information of the place of business;

5) the website address of the place of business, if applicable;

6) the maximum number of persons on a practice list;

7) the data on substitution of the family physician;

8) the name of the sole proprietor or business name of the company through which the family physician provides family physician care.

(4⁹) The holder of an activity licence for the provision of family physician care shall submit to the Health Board a digitally signed notice, setting out the name and address of the place of business of the family physician and the name of the sole proprietor or company through which the family physician provides family physician care, the date on which the change becomes effective and the composition of persons specified in clauses 1–3 of subsection 1 of § 4³ of this Act. The information shall be forwarded immediately upon change. The holder of an activity licence for the provision of family physician care shall submit the following information through the self-service portal of the Health Board:

1) the name of the health care professional working together with the family physician;

2) the independent appointment hours and contact information of the family physician and family nurse;

3) the opening hours and contact information of the place of business;

4) the website address of the place of business, if applicable.

(6) A family physician shall ensure the accessibility and continuity of health services to persons entered in his or her practice list to the extent and pursuant to the procedure prescribed in the work instructions of family physicians and health care professionals working together with family physicians.

(6¹) The work instructions of family physicians and health care professionals working together with family physicians shall be established by a regulation of the minister in charge of the policy sector.

(7) A family physician shall inform persons entered in his or her practice list where and who the persons can turn to in order to receive medical care outside the reception hours of the family physician. The Estonian Health Insurance Fund may enter into a contract with the family physician for the provision of family physician care during evening and night hours and on days off.

§ 8¹. Substitution for family physicians with practice lists

(1) Substitution for a family physician is a situation in which a family physician, due to his or her temporary absence from work, does not personally and directly provide family physician care to persons belonging to his or her practice list, above all, does not personally provide out-patient consultations to persons entered in the practice list. Upon substitution for a family physician the same principles and requirements shall be applied as when practicing as a family physician with a practice list, unless otherwise provided in this Act and in the legislation established on the basis thereof.

(2) The family physician shall ensure the finding of a substitute for a family physician in case of his or her absence from work for up to three months (hereinafter short-term substitution).

(3) The family physician shall ensure the finding of a substitute for a family physician in case of his or her absence from work for more than three months (hereinafter long-term substitution) by submitting a notice in a format which can be reproduced in writing to the Health Board no later than ten calendar days before the substitution setting out the cause of temporary absence from work, duration of substitution, name and qualification of the substitute, place and organisation of provision of family physician care and his or her contact information during the substitution.

(4) A family physician shall notify the local government of his or her service area and the persons entered in the practice list of the family physician of short-term and long-term substitution setting out the duration of substitution, name and qualification of the substitute as well as the place and organisation of provision of family physician care during the substitution. Information regarding the organisation of substitution shall be disclosed by the family physician to the persons entered in the practice list at the place of business of the family physician.

(5) In case of short-term substitution, the family physician shall be substituted for by a health care professional with the qualification of a physician.

(6) In case of long-term substitution, the family physician shall be substituted for by a health care professional with the qualification of a family physician or a resident physician studying in family medicine residency.

(7) Long-term substitution may last for up to one year, in case of training related to professional development for up to two years, and in the case of parental leave, until the termination of parental leave.

(8) The substitute of a family physician shall notify the family physician and the Health Board immediately in a format which can be reproduced in writing of premature or extraordinary termination of substitution for a family physician.

§ 9. Service area of family physician

(1) The service area of a family physician is one or many local authorities, city districts or rural municipality districts determined by the Health Board in which the family physician and health care professionals working together with the family physician ensure the provision of family physician care to persons in the practice list and make house calls if necessary. A family physician shall provide emergency care to persons living or temporarily residing in the service area who are not included in the practice list of a family physician.

(2) If the service area of a family physician includes an area of local governments of several counties, the accessibility of family physician care shall be ensured to the persons living in the service area as required. Upon determination of a service area, the Estonian Health Insurance Fund shall take into account the circumstances affecting the provision and accessibility of family physician care as required caused by the specific character of the area, including the number of residents and organisation of public transport in the area, if necessary.

§ 9¹. Place of business of family physician

(1) The place of business of a family physician is a place in which the facilities of the family physician are located and where the family physician provides family physician care.

(2) If the place of business of a family physician is not located in the service area of a family physician, the accessibility of family physician care shall be ensured to the persons entered in the practice list of a family physician as required. The distance between the place of business and the service area shall not be unreasonably long. There must be a reasonable public transport connection between the place of business and the service area.

(3) The family physician shall notify the persons entered in their practice list at least six months in advance of the change of their place of business, except for in case the change of the place of business is caused by circumstances independent of the family physician.

§ 10. Requirements for facilities and installations of places of business of family physicians

(1) The minister in charge of the policy sector shall establish the requirements for the facilities, installations and equipment of places of business of family physicians.

§ 11. Financing of family physician care

(1) Family physician care provided to persons covered by health insurance shall be paid for from the funds designated for the budget of the Estonian Health Insurance Fund in the state budget in the amounts in which the Estonian Health Insurance Fund has assumed the obligation to pay for it.

(1¹) The Estonian Health Insurance Fund shall determine the list of such practice lists comprised of less than 1200 persons and that are necessary for ensuring the accessibility of regional family physician care by approving the list with the minister in charge of the policy sector.

(2) Persons not covered by health insurance shall pay for family physician care themselves.

§ 12. Legal form of practising as family physician

Family physicians may practise as sole proprietors or through companies providing family physician care.

§ 13. Specifications of companies providing family physician care

(1) The partnership agreement of a company operating as a general partnership or limited partnership shall be entered into in writing and shall be appended to the application for entry of the company in the commercial register.

(2) Companies providing family physician care may merge only with other companies providing family physician care.

(3) Companies providing family physician care shall not be partners or shareholders of companies providing specialised medical care.

§ 14. Area of activity

(1) A company providing family physician care may have no other area of activity besides the provision of family physician care, independent physiotherapy, speech therapy, psychological treatment, nursing and midwifery care and social services, and teaching and scientific research in health care, and granting the use of immovable property.

(2) A family physician entered in the commercial register as a sole proprietor may provide only family physician care, independent physiotherapy, speech therapy, psychological treatment, nursing and midwifery care and social services and engage in teaching and scientific research in health care and granting the use of immovable property under the business name entered in the commercial register.

(3) A provider of family physician care may, within his or her activity licence, provide radiology services to the extent of radiographs and ultrasound examinations, on the condition that the requirements established under subsection 2 of § 21 of this Act and, for the making of radiographs, also the requirements established under the Radiation Act are complied with.

§ 15. Partners and shareholders of companies providing family physician care

(1) The following may be partners and shareholders of a company which provides family physician care:

1) family physicians providing health services through the company;

2) local government or local governments if the place of business of a company providing family physician care is located in at least one of their administrative territories.

(2) If a partner or shareholder specified in clause 1 of subsection 1 of this section has been deprived of the practice list of a family physician, he or she shall transfer his or her share to a family physician who commences provision of health services through this company or to a local authority within three months as of the deprivation of the practice list of a family physician. If the share is not transferred within three months, the company is required to cancel the share and compensate the value of the share to the family physician.

(3) If the partner or shareholder specified in subsection 2 of this section was the only partner or shareholder of the company, he or she shall transfer the share within three months to a local authority or family physician who commences provision of health services through this company, or decide to dissolve the company. If the family physician does not exercise the specified right, the company shall be dissolved by a court judgment at the request of the Health Board.

(4) In the case of the death of a partner or shareholder specified in clause 1 of subsection 1 of this section, the share of the company shall be transferred to his or her successor if the successor is a family physician who commences provision of health services through this company. In other cases, the successor of the family physician shall transfer the share to a family physician who commences provision of health services through this company or to the local government within three months as of acceptance of the succession. If the share is not transferred within the period, the company is required to cancel the share and compensate the value of the share to the successor.

(5) If the partner or shareholder specified in subsection 4 of this section was the only partner or shareholder of the company, the successor may transfer the share within six months as of acceptance of the succession to a local authority or family physician who commences provision of health services through this company, or decide to dissolve the company. If the successor does not exercise the specified rights, the company shall be dissolved by a court judgment at the request of the Health Board.

§ 15¹. Formation of health centre

(1) A health centre is formed by the persons providing family physician care, midwifery care, physiotherapy and nursing, including home nursing service, jointly within the same infrastructure. A health centre may also be formed by one legal person who provides all the aforesaid services. Persons providing speech therapy or psychological treatment may also be among the persons forming a health centre.

(2) A place of business recorded on the activity licence of a provider of family physician care practising in a health centre which is different from the location of the health centre shall be deemed to be a part of the health centre.

(3) The types of health centres and the requirements for the types of health centres shall be established by a regulation of the minister in charge of the policy sector.

§ 16. Definition of emergency medical care

(1) Emergency medical care means out-patient health services for the initial diagnosis and treatment of life-threatening diseases, injuries and intoxication and, if necessary, for the transportation of the person requiring care to a hospital.

(2) Each person staying in the territory of the Republic of Estonia has the right to receive emergency medical care.

§ 16¹. Police and Border Guard Board’s helicopter emergency medical service

(1) The Police and Border Guard Board enables the helicopter emergency medical service for the transportation of medical devices, blood, organs, medicinal products, health care professionals, patients and other relevant persons if, without it, the regional hospital specified in the plan of the hospital network established under subsection 1 of § 55 of this Act is unable to provide or provide in time the necessary health service or the provision thereof would be significantly impaired. The emergency medical service performed with the helicopter in possession of the Police and Border Guard Board is deemed to be the performance of a state function.

(2) The Police and Border Guard Board’s helicopter emergency medical service is funded by the Estonian Health Insurance Fund on the conditions and pursuant to the procedure provided for in the list of health services of the Estonian Health Insurance Fund concerning the payment for helicopter emergency medical services.

§ 17¹. Organisation of provision of emergency medical care

(1) The Health Board shall:

1) organise the provision of emergency medical care based on the requirements provided for in this Act and other legislation;

2) approve the number and location of service areas of ambulance crews and the distribution of ambulance crews by service areas;

3) organise the temporary substitution of ambulance crews in cooperation with the Estonian Health Insurance Fund.

(2) The service area of an ambulance crew shall be the area of local authority approved by the Health Board or the area of those local authorities within which the ambulance crew is dispatched upon a call.

§ 17². Emergency medical care financing contract

(1) In order to finance emergency medical care, the Estonian Health Insurance Fund shall enter into an administrative contract (hereinafter emergency medical care financing contract) with an owner of an ambulance crew for up to five years pursuant to the conditions provided for in the Administrative Co-operation Act. Such first contract with an owner of an ambulance crew shall be entered into for up to three years.

(2) The Estonian Health Insurance Fund is not required to enter into an emergency medical care financing contract with all the owners of ambulance crews.

(3) Upon deciding on entry into an emergency medical care financing contract and the term of contract, the Estonian Health Insurance Fund shall take into account the following circumstances:

1) the need of the specific service area for emergency medical care and availability of emergency medical care;

2) the quality and conditions of provision of emergency medical care;

3) sustainability of the owner of the ambulance crew;

4) maximum number of ambulance crews;

5) development directions of state health care policy;

6) appropriate implementation of previous emergency medical care financing contracts or similar contracts by the owner of an ambulance crew;

7) existence or absence of tax arrears and general economic situation of the owner of an ambulance crew;

8) appropriate compliance with the legislation regulating the provision of health services by the owner of an ambulance crew;

9) number of ambulance crews established under clause 1 of subsection 3 of § 17 of this Act.

(4) The following conditions shall be agreed on in the emergency medical care financing contract:

1) term of the contract;

2) the amount financed by the Estonian Health Insurance Fund for the readiness of emergency medical care and provision thereof which is payable to the owner of an ambulance crew per unit of time and the total amount payable;

3) the price payable for ensuring the readiness and provision of emergency medical care;

4) the list of ambulance crews whose readiness is financed and who are paid a fee for the provided emergency medical care, and the procedure for notifying of changes in the list and approval thereof with the Estonian Health Insurance Fund;

5) number of hours in unit of time during which the owner of an ambulance crew must be ready to provide emergency medical care;

6) term during which the owner of an ambulance crew must submit to the Estonian Health Insurance Fund information on ensuring the readiness to provide emergency medical care and information on the provided service based on which the owner of an ambulance crew is paid a fee;

7) cases or changes relating to organisation of work requiring a previous written approval of the Estonian Health Insurance Fund;

8) cases upon which the Estonian Health Insurance Fund is not required to pay a fee to the owner of an ambulance crew or may reduce the amount payable;

9) cases upon which the parties are entitled to cancel the contract unilaterally, amend it or suspend the implementation thereof partly or in full and cases upon which violation is excusable;

10) data submission frequency to the Estonian Health Insurance Fund and composition of the submitted data on the provided emergency medical care service;

11) scope of the reporting obligation of an owner of an ambulance crew and scope of data submission obligation on the readiness to provide emergency medical care and on the provided service, and the composition of data;

12) quality and efficiency indicators of emergency medical care;

13) liability of the contracting parties upon violation of the contract;

14) other conditions necessary for ensuring the efficient and expedient use of funds allocated for the provision of emergency medical care.

(5) A new contract shall be entered into with an owner of an ambulance crew who has provided service according to the conditions provided for in subsection 4 of this section and in the emergency medical care financing contract. Parties to the emergency medical care financing contract may amend the contract only taking account of the circumstances provided for in subsection 3 of this section.

§ 17³. Public competition for emergency medical care

(1) The Estonian Health Insurance Fund shall organise a public competition for selecting an owner of an ambulance crew if at least one of the following circumstances exists:

1) the owner of an ambulance crew who has provided the service so far withdraws from providing the service and the need for emergency medical care remains in this specific service area in the former extent;

2) it is decided not to enter into a new administrative contract with the owner of an ambulance crew who has provided the service so far or to terminate the contract due to non-compliance of the owner of the ambulance crew or the service provided thereby with the requirements established by this Act or the emergency medical care financing contract;

3) the activity licence for the provision of emergency medical care of the owner of an ambulance crew has been revoked;

4) the division of service areas is changed;

5) temporary substitution lasts for more than three months.

(2) A competition shall be announced within fifteen days as of the occurrence of a circumstance specified in subsection 1 of this section.

(3) If necessary, the Health Board shall, in cooperation with the Estonian Health Insurance Fund, organise the provision of the service through temporary substitution until entry into a contract with the winner of the competition.

§ 18. Legal form of provision of emergency medical care

(1) A company, sole proprietor, foundation or a state or local government agency which holds a corresponding activity licence may be the owner of an ambulance crew.

(2) A legal person which owns an ambulance crew may have no other area of activity besides the provision of emergency medical care, teaching and scientific research in health care, transport of patients relating to the provision of health services with a non-emergency vehicle or ambulance crew. A sole proprietor who owns an ambulance crew may provide only emergency medical care under the business name entered in the commercial register.

(3) The restriction on area of activity specified in subsection 2 of this section does not apply to providers of specialised medical care who own an ambulance crew.

§ 19. Financing of emergency medical care

(1) Emergency medical care shall be paid for from the Estonian Health Insurance Fund budget on the basis of a contract for financing emergency medical care entered into between the Estonian Health Insurance Fund and an owner of an ambulance crew.

(2) The procedure of payment for emergency medical care, the method for calculation of the payment to be made to an owner of an ambulance crew and the price of emergency medical care shall be established by a regulation of the minister in charge of the policy sector on the proposal of the supervisory board of the Estonian Health Insurance Fund.

(3) An owner of an ambulance crew may not request a visit fee for the provision of emergency medical care.

§ 20. Definition of specialised medical care

(1) Specialised medical care means out-patient or in-patient health services which are provided by medical specialists or dentists and health care professionals working together with them.

(1¹) Day care means out-patient health services the provision of which requires the short-term observation of a person’s condition and after which the person leaves from the health care provider on the same day.

(2) The list of specialties and additional competences of specialised medical care shall be established with a regulation of the minister in charge of the policy sector.

§ 21. Provision of specialised out-patient care

(1) Companies, sole proprietors or foundations which hold corresponding activity licences may provide specialised out-patient care.

(2) The minister in charge of the policy sector shall establish the requirements for the facilities, installations and equipment necessary for the provision of specialised out-patient care.

§ 23. Financing of specialised medical care

(1) Specialised medical care provided to persons covered by health insurance shall be paid for from the funds designated for the budget of the Estonian Health Insurance Fund in the state budget in the amounts in which the Estonian Health Insurance Fund has assumed the obligation to pay for it.

(2) Persons not covered by health insurance shall pay for specialised medical care themselves.

§ 23¹. Physiotherapy

Physiotherapy means out-patient or in-patient health services, which are provided by a physiotherapist together with a family physician or medical specialist, or independently.

§ 23². Independent provision of physiotherapy for treatment purposes

(1) Companies, foundations or sole proprietors which hold corresponding activity licences may independently provide physiotherapy for treatment purposes.

(2) Only out-patient physiotherapy is allowed to be provided independently.

(3) The conditions of and requirements for the independent provision of physiotherapy for treatment purposes shall be established by a regulation of the minister in charge of the policy sector.

§ 23³. Funding of independent physiotherapy

(1) Independent physiotherapy provided for treatment purposes to persons covered by health insurance shall be paid for by the Estonian Health Insurance Fund pursuant to the procedure provided for in the Health Insurance Act.

(2) Persons not covered by health insurance shall pay for independent physiotherapy themselves.

§ 23⁴. Speech therapy

Speech therapy means out-patient or in-patient health services, which are provided by a speech therapist together with a family physician or medical specialist, or independently.

§ 23⁵. Independent provision of speech therapy

(1) Companies, foundations or sole proprietors which hold corresponding activity licences may independently provide speech therapy.

(2) Only out-patient speech therapy is allowed to be provided independently.

(3) The conditions of and requirements for the independent provision of speech therapy shall be established by a regulation of the minister in charge of the policy sector.

§ 23⁶. Funding of independent speech therapy

(1) Independent speech therapy provided to persons covered by health insurance shall be paid for by the Estonian Health Insurance Fund pursuant to the procedure provided for in the Health Insurance Act.

(2) Persons not covered by health insurance shall pay for independent speech therapy themselves.

§ 23⁷. Psychological treatment

Psychological treatment means out-patient or in-patient health services, which are provided by a clinical psychologist together with a family physician or medical specialist, or independently.

§ 23⁸. Independent provision of psychological treatment

(1) Companies, foundations or sole proprietors which hold corresponding activity licences may independently provide psychological treatment.

(2) Only out-patient psychological treatment is allowed to be provided independently.

(3) The conditions of and requirements for the independent provision of psychological treatment shall be established by a regulation of the minister in charge of the policy sector.

§ 23⁹. Funding of independent psychological treatment

(1) Independent psychological treatment provided to persons covered by health insurance shall be paid for by the Estonian Health Insurance Fund pursuant to the procedure provided for in the Health Insurance Act.

(2) Persons not covered by health insurance shall pay for independent psychological treatment themselves.

§ 24. Definition of nursing

(1) Nursing means out-patient or in-patient health services which are provided by nurses and midwives together with family physicians, medical specialists or dentists, or independently.

(2) The minister in charge of the policy sector shall establish the list of nursing specialties.

§ 25. Independent provision of nursing

(1) Companies, foundations or sole proprietors which hold corresponding activity licences may provide nursing independently.

(1¹) The restriction on the legal form of the provision of nursing specified in subsection 1 of this section does not apply to the providers of social services specified in § 100 of the Social Welfare Act and to the institutions providing 24-hour social services specified in § 20 of the Social Welfare Act in case of provision of home nursing service specified in the regulation established under subsection 3 of § 25 of this Act.

(2) The requirements for the facilities, installations, equipment, instruments and medicinal products necessary for the independent provision of out-patient nursing shall be established by a regulation of the minister in charge of the policy sector.

(3) The list of out-patient nursing services which are permitted to be provided independently and the operations being part thereof as well as the conditions of provision of nursing services shall be established by a regulation of the minister in charge of the policy sector.

§ 25¹. Nursing hospital

(1) A nursing hospital is an economic unit formed in order to provide out-patient and in-patient nursing services which are permitted to be provided independently.

(2) A company or foundation which holds a corresponding activity licence may own a nursing hospital.

(3) A company or foundation which operates a nursing hospital, except for the owner of a hospital providing specialised medical care, may have no other area of activity besides the provision of nursing services permitted to be provided independently, out-patient specialised medical care, physiotherapy service and social services, maintaining a hospital pharmacy, teaching and scientific research in health care and granting the use of immovable property.

(4) The list of nursing services which are permitted to be provided independently at a nursing hospital and the operations being part thereof and the requirements for the staff, facilities, installations, equipment and instruments necessary for the independent provision of in-patient nursing shall be established by a regulation of the minister in charge of the policy sector.

§ 26. Financing of independent nursing

(1) Independent nursing provided to persons covered by health insurance shall be paid for from the funds designated for the budget of the Estonian Health Insurance Fund in the state budget in the amounts in which the Estonian Health Insurance Fund has assumed the obligation to pay for it.

(2) Persons not covered by health insurance shall pay for independent nursing themselves.

(3) Independent nursing care provided within the 24-hour special care service shall be financed from the state budget through the Estonian Health Insurance Fund regardless of whether the person is or is not covered by health insurance.

§ 26¹. Midwifery care

Midwifery care means out-patient or in-patient health services which are provided by midwives together with a family physician or medical specialist or independently.

§ 26². Independent provision of midwifery care

(1) Companies, foundations or sole proprietors which hold the corresponding activity licences may provide midwifery care independently.

(2) Midwifery care may be provided independently only as out-patient service.

(3) The list of midwifery services which are permitted to be provided independently and the operations being part thereof as well as the conditions of and procedure for obstetrical home care shall be established by a regulation of the minister in charge of the policy sector.

(4) The requirements for the facilities, installations, equipment, instruments and medicinal products necessary for the independent provision of midwifery care shall be established by a regulation of the minister in charge of the policy sector.

§ 26³. Financing of independent midwifery care

(1) Independent midwifery care provided to persons covered by health insurance shall be paid for from the funds designated for the budget of the Estonian Health Insurance Fund in the state budget in the amounts in which the Estonian Health Insurance Fund has assumed the obligation to pay for it.

(2) Persons not covered by health insurance shall pay for independent midwifery care themselves.

§ 26⁴. Health administration information system

(1) The purpose of the health administration information system is to:

1) register health care professionals, pharmacists and assistant pharmacists to ensure the provision of health services and pharmacy service by persons with the required qualification and with the objective of protecting the health of the recipients of the service;

2) maintain records on sole proprietors and legal persons having received an activity licence to ensure an efficient official control;

3) ensure the necessary data for performing the functions of management and organisation of the field of health care;

4) ensure supervision;

5) process necessary data for the preparation of health statistics and health policy.

(2) The health administration information system shall be founded and the statutes thereof shall be established by a regulation of the minister in charge of the policy sector, setting out:

1) the processor of the information system if a processor has been determined and the functions of processors;

2) the specific composition of data collected into the information system and the procedure for entry thereof in the information system;

3) the specific procedure of access to and issue of data and the composition of open data;

4) the list of persons submitting data and the data received therefrom;

5) financing of the information system;

6) other organisational issues.

(3) The following data shall be processed in the health administration information system:

1) biographical data of health care professionals, persons participating in the provision of health services, pharmacists and assistant pharmacists;

2) information certifying the qualifications of health care professionals, pharmacists and assistant pharmacists;

3) information concerning the place of employment of health care professionals, persons participating in the provision of health services, pharmacists and assistant pharmacists;

4) registration process data of health care professionals, pharmacists and assistant pharmacists;

5) data on the activity licence of a health care provider and the processing thereof;

5¹) data related with entry into the liability insurance contract of health care provider;

6) general data on the economic activity of a health care provider;

7) information system logs.

(4) Data shall be preserved in the health administration information system as follows:

1) data on health care professionals, persons participating in the provision of health service, pharmacists and assistant pharmacists for up to 30 years after a person’s death;

2) data on health care providers for 30 years after expiry of the activity licence or termination of economic activity;

3) logs and source data according to the provisions of the statutes of the information system but not longer than for 30 years after acceptance of the data in the information system.

(5) The specific procedure for maintenance, preservation, archival processing and deletion of data shall be provided for in the statutes of the health administration information system established under subsection 2 of this section.

(6) The controller of the health administration information system is the Health Board.

(7) The holder of an activity licence for the provision of health service shall be required to notify the Health Board of the change of data related to the activity licence and of the persons specified in subsection 2¹ of § 59³ of this Act. The alteration of data is ensured by electronic means. The specific procedure for the submission of data shall be provided for in the statutes of the health administration information system established under subsection 2 of this section.

(8) The provisions of the General Part of the Economic Activities Code Act shall be applied to the health administration information system, taking account of the specifications provided for in this Act.

(9) The Health Board shall publish the data on the qualification and activity licence of health care professionals registered in the health administration information system for public use to an extent provided for in the statutes of the health administration information system established under subsection 2 of this section.

(10) The data registered in the health administration information system shall have legal effect to the extent provided for in this Act and in the Medicinal Products Act.

§ 27. Legal effect of registration

(1) Health care professionals are registered in the health administration information system. Registration grants a health care professional the right to provide health services within the limits of the profession or specialty based on which they have been registered.

(2) A health care professional may provide only the services as the provider of which he or she has been registered in the Health Board.

§ 28. Registration proceedings

(1) A person applying for registration shall submit to the Health Board a registration application and a copy of a document certifying their qualifications if the data certifying the person’s qualification are not contained in the Estonian education information system, and the data on the European professional card upon the existence thereof.

(1¹) State fee shall be paid for the review of a registration application pursuant to the rate provided for in the State Fees Act.

(2) The minister in charge of the policy sector shall establish the list of information to be submitted in registration applications.

(3) The minister in charge of the policy sector shall establish a list of the documents certifying qualifications which are the bases for the registration of health care professionals.

(4) Upon receipt of a registration application the Health Board shall verify the data on the person’s qualifications from the Estonian education information system. If the data on the person’s qualifications have been entered in the Estonian education information system and the person has paid state fee for the review of registration application, the person shall be automatically registered in the health administration information system as a health care professional, except for in the case provided for in subsection 9 of § 28 of this Act.

(4¹) In case of missing or incomplete data in the Estonian education information system, the applicant for registration shall also submit to the Health Board a copy of a document certifying qualifications. The Health Board shall verify the correctness of information submitted in the documents certifying qualifications and shall make a registration decision within one month as of submission of the document, except in the cases specified in subsections 1¹ of § 29 and subsection 2 of § 30 of this Act.

(5) A person shall not be registered as health care professional if:

1) he or she knowingly submits false information or

2) he or she has been deprived of the right to work in the profession or speciality specified in the application for registration.

(6) If a person is not registered with the Health Board, he or she shall be notified thereof in writing within ten working days as of the date of making the decision.

(9) A person having acquired the qualification of a doctor, dentist, nurse or midwife in Estonia, who submits a registration application more than five years after acquiring the qualification shall pass a theory examination and practice examination of health care professionals, pay up to 1000 euros for it, and submit a document certifying the results of the examination to the Health Board.

(10) In order to apply for the registration of himself or herself as health care professional, a person whose document certifying qualifications is not included in the list established pursuant to subsection 3 of this section shall pass a theory examination and practice examination of health care professionals, pay up to 1000 euros for it, and submit a document certifying the results of the examination to the Health Board.

(11) The procedure of preparation, organisation and assessment of the theory examination and practice examination of health care professionals specified in subsections 9 and 10 of this section as well as the size of the fee shall be established by a regulation of the minister in charge of the policy sector.

§ 29. Registration of persons who have acquired qualifications in Member States of European Union, Member States of European Economic Area or in Switzerland

(1) Subsections 1–2 and 5–6 of § 28 of this Act apply to the registration of persons who have acquired qualifications in the Member States of the European Union, Member States of the European Economic Area (hereinafter Member States of the European Economic Area) or in Switzerland.

(1¹) The Health Board shall submit an acknowledgement of receipt of an application for registration to the person applying for registration within one month as of submission of the documents specified in subsection 1 of § 28 of this Act and, if necessary, shall notify the person of the missing documents. The Health Board shall verify the correctness of the data submitted in documents certifying the qualifications and make a decision on registration within two months as of submission of all the requisite documents. If, in the course of registration proceedings, the need arises to assess the circumstances specified in subsection 3 of § 29 of this Act, the Health Board may extend the term for making the decision on registration to three months by notifying the person applying for registration immediately of the extension of the term and the reasons for extension.

(2) The qualifications acquired in a Member State of the European Economic Area or Switzerland shall be certified by a document which grants a health care professional the right to provide health services in the profession or speciality set out in the document in the corresponding Member State of the European Economic Area or in Switzerland.

(3) If a person has acquired a speciality of specialised medical care in a Member State of the European Economic Area or Switzerland and the speciality is not included in the list established pursuant to subsection 2 of § 20 of this Act or the speciality acquired by the person is not automatically recognised, the Health Board shall decide on the recognition of the person’s qualifications or obligation to take an aptitude test pursuant to the provisions of the Recognition of Foreign Professional Qualifications Act.

(4) The list of documents certifying the qualifications acquired in a Member State of the European Economic Area or in Switzerland and the procedure for the assessment of the correspondence of the qualifications shall be established by the minister in charge of the policy sector.

(5) If an European professional card has been taken into use with the Commission Implementing Regulation in the profession of a health care professional based on Article 4a (7) of Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications (OJ L 255, 30.09.2005, p. 22–142) and the competent authority of a Member State of the European Economic Area or Switzerland has forwarded an application to the competent authority of Estonia for a person to work in Estonia, §§ 21¹, 21⁴ and 21⁵ of the Recognition of Foreign Professional Qualifications Act shall be applied to the application for and proceeding the applications for the European professional card.

§ 30. Registration of persons who have acquired qualifications in other foreign states

(1) Subsections 1–2 and 5–6 of § 28 of this Act apply to the registration of persons who have acquired qualifications in foreign states not specified in § 29 of this Act.

(1¹) If a person who has acquired his or her qualifications in a foreign state not specified in § 29 of this Act and a Member State of the European Economic Area or Switzerland has recognised the qualifications beforehand and the person has obtained three years’ work experience in the corresponding profession or speciality in the Member State of the European Economic Area or Switzerland where his or her qualifications were recognised, the Health Board shall decide on the recognition of the person’s qualifications or obligation to take an aptitude test pursuant to the provisions of the Recognition of Foreign Professional Qualifications Act. Upon application for registration, the person shall submit a document certifying the required work experience and the right of the person to provide health services in a Member State of the European Economic Area or in Switzerland in addition to the documents required in subsection 1 of § 28 of this Act.

(2) The Health Care Board shall compare the qualifications of a person applying for registration with the qualifications required in Estonia, shall verify the correctness of information submitted in the documents certifying the qualifications within three months after the submission of documents specified in subsection 1 of § 28 of this Act, and make a registration decision within one month after the person applying for registration has passed the compliance examination.

(2¹) The procedure for comparing the qualifications acquired in a foreign state with the qualifications required in Estonia shall be established by a regulation of the minister in charge of the policy sector.

(3) In order to assess the compliance of professional qualifications with the requirements, the person having acquired qualifications in a foreign state that has not been specified in § 29 of this Act shall pass a compliance examination for the assessment of which the person shall pay to the University of Tartu, Tallinn Health Care College or Tartu Health Care College (hereinafter the two latter together health care college) not more than 1000 euros. The amount of fee for the assessment of a compliance examination shall be determined with a regulation established under subsection 3⁷ of this section.

(3¹) A compliance examination shall be organised by the University of Tartu or health care college and it is comprised of work practice and theory examination. A compliance examination shall be taken in Estonian.

(3²) The University of Tartu or health care college shall send a person to a work practice at a residency teaching hospital of the University of Tartu or at a practice base of the health care college. The fee of a person sent to a work practice during practice, the organisation expenses of the University of Tartu or health care college and the fee for supervising work practice shall be covered from the state budget through the budget of the Ministry of Social Affairs, except where the person applies to be registered as a dentist. The person sent to a work practice must be registered during the work practice in the health administration information system.

(3³) The duration of work practice shall be one up to six months. Work practice may be extended for up to one year at the request of a supervisor.

(3⁴) The University of Tartu or health care college shall organise a theory examination for the persons having passed the practice within 12 months after termination of the work practice. If a person fails to pass the work practice for the first time, he or she may, after six months, submit a new application for the assessment of compliance of qualifications with the requirements.

(3⁵) If a person fails to pass the work practice for the second time, the Health Board shall have the right to request additional documents from the person concerning the compliance with the requirements and refuse from the assessment of qualification in a justified case.

(3⁶) If a person fails to pass the theory examination for the first time, he or she shall be able to take the examination for the second time after six up to twelve months. If a person fails to pass the theory examination for the second time, he or she may submit a new application for the assessment of compliance of qualifications with the requirements.

(3⁷) The procedure for preparation, organisation and assessment of a compliance examination for a person having acquired professional qualifications in a foreign state as well as the amount of the fee shall be established by a regulation of the minister in charge of the policy sector.

(4) A person shall not be registered as health care professional if he or she has knowingly submitted false information or if the qualifications of the person do not comply with the qualifications required for working in this profession or speciality in Estonia.

(5) In the case specified in subsection 1¹ of this section if an European professional card has been taken into use with the Commission Implementing Regulation in the profession of a health care professional based on Article 4a (7) of Directive 2005/36/EC of the European Parliament and of the Council and the competent authority of a Member State of the European Economic Area or Switzerland has forwarded an application to the competent authority of Estonia for a person to work in Estonia, §§ 21¹, 21⁴ and 21⁵ of the Recognition of Foreign Professional Qualifications Act shall be applied to the application for and proceeding the applications for the European professional card.

§ 31. Certificate

(1) Certificates concerning registration in the health administration information system shall be issued to health care professionals upon their request.

(2) State fee shall be paid for the issue of registration certificate pursuant to the rate provided for in the State Fees Act.

§ 31¹. Recognition of professional qualifications

(1) If a person who has been registered as health care professional wishes to work outside of the Republic of Estonia, he or she shall apply for recognition of his or her professional qualifications pursuant to the procedure established in this section.

(2) A person applying for recognition of his or her professional qualifications shall submit an application to the Health Board setting out the following information:

1) given name and surname;

2) registration number;

4) the state in which he or she intends to apply for recognition;

5) the profession or speciality in which recognition is applied for.

(3) State fee shall be paid for the review of an application for the recognition of professional qualifications pursuant to the rate provided for in the State Fees Act.

(4) The Health Board shall issue a certificate of recognition of professional qualifications to a person within one month as of the submission of the application.

(5) A certificate of recognition of professional qualifications is valid for three months as of the issue of the certificate.

(6) In the case of loss, theft or destruction of a certificate of recognition of professional qualifications, a duplicate of the certificate shall be issued to the person on the basis of his or her application.

(7) If an European professional card has been taken into use with the Commission Implementing Regulation in the profession of a health care professional based on Article 4a (7) of Directive 2005/36/EC of the European Parliament and of the Council and the person applying for registration applies for the issue of the European professional card for working outside the Republic of Estonia, §§ 211, 21⁴ and 215 of the Recognition of Foreign Professional Qualifications Act shall be applied to the application for and processing of the applications for the European professional card.

§ 32. Revocation of registration

The Health Board shall revoke the registration of a health care professional in the health administration information system after the death of a health care professional.

§ 32¹. Suspension of registration

(1) The Health Board may suspend the registration of a health care professional in the health administration information system for up to one year if the health care professional has failed to comply with the precept.

(2) The Health Board shall suspend the registration of a health care professional in the health administration information system for up to three years if the health care professional has been disqualified with a court judgment from the professional or vocational practice specified in the document certifying qualifications or in the information system.

§ 32². Application of alert mechanism

The Health Board applies the alert mechanism pursuant to the procedure provided for in Chapter 32 of the Recognition of Foreign Professional Qualifications Act.

§ 33. Temporary provision of health services

A person who has acquired his or her qualifications in a Member State of the European Economic Area or in Switzerland may temporarily provide health services in Estonia without the registration obligation required pursuant to § 27 of this Act and an activity licence required pursuant to § 40 of this Act, based on the provisions of Chapter 3 and 3¹ of the Recognition of Foreign Professional Qualifications Act. The competent authority for the purposes of Chapter 3 and 3¹ of the Recognition of Foreign Professional Qualifications Act is the Health Board.

§ 34. Compiling of practice lists

(1) In order to grant the right to compile a practice list, the Estonian Health Insurance Fund shall conduct a public competition pursuant to the procedure established by the minister in charge of the policy sector.

(1¹) A competition shall be conducted for granting the right to compile a new practice list or organising the provision of family physician care for a practice list which has become available.

(2) An applicant for the right to compile a practice list shall submit the following documents and information to the Estonian Health Insurance Fund:

1) an application which sets out the name, personal identification code or date of birth, residence and telecommunications numbers of the applicant and the location and address of the proposed place of business;

2) the names and personal identification codes of the health care professionals working together with the family physician.

(3) In the event there is a practice list not approved on the basis of a public competition, a family physician with a practice list shall have the right, within one year after the public competition, to apply from the Estonian Health Insurance Fund, outside of competition, for the partial transfer of persons entered in the practice list of a family physician as a new list to a health care professional qualified as a family physician who has provided family physician care to persons entered in the practice list together with a family physician within the six months prior to submission of an application (hereinafter transfer of part of practice list).

(4) The transfer of part of a practice list shall be based on the following principles:

1) upon transfer of part of a practice list the approval of a new practice list with the service area not approved by way of public competition is allowed on the condition that the service area of the family physician applying for the transfer of part of a practice list and the service area of the new practice list coincide;

2) the number of persons entered in the practice list of a family physician applying for the transfer of part of a practice list shall not decrease below the minimum number of persons on a practice list as the result of the transfer;

3) upon transfer of part of a practice list the number of persons to be entered in the new approved practice list shall be at least 1200 persons;

4) the persons registered in the practice list of the family physician applying for the transfer of part of a practice list have granted their written consent for their entry in the new practice list;

5) the continuous provision of family physician care as required has been ensured to the persons entered in the practice list of a family physician applying for the transfer of part of a practice list and to the persons to be entered in the new practice list.

(5) In the event there is a practice list unfilled by way of public competition, a family physician with a practice list may apply for the transfer of part of a practice list in a reasoned manner from the Estonian Health Insurance Fund also in a case unspecified in subsection 3 of this section if the principles provided for in clauses 2–5 of subsection 4 of this section are complied with upon transfer of part of a practice list and the transfer of part of a practice list promotes the general accessibility and organisation of family physician care in the service area being applied for. Submitting of applications is not permitted if a public competition for granting the right to compile a practice list in the service area of the family physician specified in the application is being held at the time of submitting applications.

(6) The family physician applying for the transfer of part of a practice list shall submit the following documents and information to the Estonian Health Insurance Fund:

1) an application which sets out the name, personal identification code or date of birth in case of lack thereof, residence, telecommunications numbers of the applicant and the location and address of the place of business of the family physician and service area of the family physician;

2) the applied service area of family physician upon approval of a new practice list;

3) description of measures ensuring the continuous provision of family physician care as required to the persons entered in the practice list of the family physician applying for the transfer of part of a practice list and to the persons to be entered in the new practice list;

4) the names and personal identification codes of the health care professionals who commence work together with the family physician after transfer of part of a practice list;

5) the written application for acceptance of part of a practice list of the person to whom part of a practice list shall be transferred setting out the name, personal identification code, residence and telecommunications numbers of the applicant and the location and address of the proposed place of business as well as the names and personal identification codes of the health care professionals who commence work together with the applicant;

6) the written consent of the persons registered in the practice list of the family physician applying for the transfer of part of a practice list for their registration in the new practice list.

(7) Upon proceeding the application for transfer of part of a practice list the Estonian Health Insurance Fund shall have the right to request the submission of additional information or explanations concerning the compliance of the transfer of part of a practice list with the principles provided for in this Act.

§ 35. Right to practice as family physician

(1) Family physicians with a practice list may practice as sole proprietors holding an activity licence for the provision of family physician care or through companies holding an activity licence for the provision of family physician care.

(2) The practice list of a family physician shall be approved and the service area and maximum number of persons on a practice list of a family physician shall be determined or amended by the Estonian Health Insurance Fund.

(3) The Estonian Health Insurance Board shall decide not to grant an application for transfer of part of a practice list if the requirements for transfer of part of a practice list specified in subsections 3–6 of § 34 of this Act have not been complied with.

(4) The Estonian Health Insurance Fund shall decide not to grant an application for transfer of part of a practice list if:

1) approval of an additional practice list for a service area unfilled by way of public competition is not justified on the grounds of better organisation and accessibility of family physician care;

2) approval of a practice list with the service area of a family physician applied for in the application for transfer of part of a practice list is not justified on the grounds of organisation and accessibility of family physician care of the area;

3) application for transfer of part of a practice list does not comply with the requirements specified in this Act and the applicant has failed to eliminate the deficiencies within the term determined by the Estonian Health Insurance Fund;

4) applicant for transfer of part of a practice list refuses to comply with the requirement of the Estonian Health Insurance Fund provided for in subsection 7 of § 34 of this Act;

;

5) knowingly incorrect or false information has been submitted in the application for transfer of part of a practice list;

6) in case of other significant public interest.

(5) On the grounds of better organisation and accessibility of family physician care the Estonian Health Insurance Fund may assign an additional service area to a family physician.

(6) The Estonian Health Insurance Fund shall communicate the decision specified in subsections 2–5 of this section to the family physician, local authority of the service area of the family physician and the Health Board within five working days as of making the decision.

(7) The family physician shall commence the provision of family physician care on the date determined in the decision specified in subsection 2 of this section.

(8) The Estonian Health Insurance Fund may approve a practice list for a resident physician studying in family medicine residency on the condition that by the time of commencing practice as a family physician with a practice list, they have specified family physician as their specialty in the register of the Health Board.

(9) On the grounds of better organisation and accessibility of family physician care the Estonian Health Insurance Fund may add a practice list without a family physician to a practice list of a family physician if as a result of adding the practice lists the number of persons on the practice list is less than the maximum level of the practice list. If there are more than 2000 persons on the new practice list, the consent of the family physician shall be required.

§ 36. Duty to disseminate information

(2) A family physician is required to submit to the Health Board:

3) a digitally signed notice concerning the legal form of practicing as a family physician and providing family physician care or a change thereof.

(4) A family physician is required to submit to the Estonian Health Insurance Fund the application specified in clause 1 of subsection 1 of § 37 but at least six month before withdrawing from the employment of a family physician with a practice list.

§ 37. Deprivation of family physician of practice list

(1) The Estonian Health Insurance Fund shall deprive a family physician of the practice list if:

1) so requested by the family physician himself or herself;

2) a prohibition to practice in the specialty of a family physician has been applied to a family physician by a court judgment;

3) the family physician cannot be substituted in the case of his or her long-term incapacity of work;

4) long-term substitution of the family physician lasts longer than the period established in subsection 7 of § 8¹ of this Act;

5) the family physician is declared to be missing;

6) the family physician dies or he or she is declared dead.

(2) The Health Board shall deprive a family physician of the practice list if:

1) the family physician has failed to start the provision of family physician care on the date determined in the decision specified in subsection 2 of § 35 of this Act or has discontinued the provision of family physician care for more than 60 calendar days;

2) the quality of the provided health services is not in compliance with the requirements established pursuant to subsection 9 of § 3² of this Act;

3) the family physician does not comply with the requirements prescribed in the work instructions established under subsection 6¹ of § 8 of this Act upon ensuring the accessibility and continuity of health services to persons entered in his or her practice list;

4) the family physician or a health care professional working together with him or her materially violates personal data processing requirements;

5) substitution of a family physician has lost its temporary nature considering the combined effect of duration, frequency, regularity, occasionality and continuity of practicing of and substituting for a family physician and the continuous provision of family physician care by a family physician with an approved practice list is not ensured.

(3) Before making a decision on the basis provided for in subsection 2 of this section, the Health Board may issue a precept to the family physician.

(4) If the Estonian Health Insurance Fund has approved the practice list of a family physician on the basis of subsection 2 of § 35 of this Act and the Health Board makes a decision to deprive a family physician of the practice list on the basis of subsection 2 of this section, the rights and obligations arising from the decision of the Estonian Health Insurance Fund shall be deemed to be terminated after the decision of the Health Board enters into force.

(5) A family physician shall be notified of a decision made on the basis provided for in clauses 1–4 of subsection 1 of this section and in subsection 2 within five working days after making the decision. A decision on the deprivation of a practice list from a family physician shall be published in the official publication Ametlikud Teadaanded.

(6) The Estonian Health Insurance Fund shall immediately notify the Health Board of a decision made on the basis of subsection 1 of this section. The Health Board shall immediately notify the Estonian Health Insurance Fund of a decision made on the basis of subsection 2 of this section.

§ 38. Procedures upon deprivation of family physician of practice list

(1) Upon deprivation of a family physician of the practice list, the Estonian Health Insurance Fund shall organise the servicing of persons entered in the practice list of the family physician and the servicing of the service area until approval of the practice list to a new family physician.

(1¹) Upon deprivation of a family physician of the practice list in the cases provided for in subsection 1 or 2 of § 37 of this Act, the holder of an activity licence for the provision of family physician care through which the family physician operated, shall be required to preserve the documents concerning the practice list and to deliver them to the sole proprietor or company through which the provision of family physician care to the persons entered in the list is continued, or in case lack thereof, to the Estonian Health Insurance Fund pursuant to the procedure provided for in subsection 2 of this section.

(2) The procedure for delivery of documents concerning the family physician’s practice list shall be established by a regulation of the minister in charge of the policy sector.

(3) If the family physician was the sole shareholder of the company providing family physician care or a sole proprietor and the family physician has been deprived of the practice list in the case provided for in clauses 5 or 6 of subsection 1 of § 37 of this Act, the Estonian Health Insurance Fund shall organise the preservation and delivery of documents concerning the practice list to the sole proprietor or company through which the provision of family physician care to the persons entered in the list is continued.

(4) The sole proprietor or company through which the provision of family physician care to the persons entered in the list is continued shall be required to accept the documents concerning the practice list from the holder of an activity licence for the provision of family physician care or from the Estonian Health Insurance Fund in the cases provided for in subsections 1¹ and 3 of this section.

§ 39. Restrictions on activities of family physicians

Family physicians shall not be partners or shareholders of companies engaged in providing specialised medical care, or partners or shareholders of companies which are the partners or shareholders of such companies.

§ 40. Requirement for activity licence

(1) An activity licence is required for operation in the following areas of activity:

1) the provision of family physician care on the basis of a practice list of a family physician;

2) the provision of emergency medical care;

3) the provision of specialised medical care;

3) the independent provision of nursing;

4) the independent provision of midwifery care;

6) the independent provision of physiotherapy for treatment purposes;

7) the independent provision of speech therapy;

8) the independent provision of psychological treatment.

(2) An activity licence for the provision of health services shall be issued to an owner of a hospital specified in the plan of the hospital network only with respect to a type of hospital approved for the owner in the plan of the hospital network.

(3) An activity licence grants the right to provide health services in the place of business specified in the activity licence.

§ 41. Application for activity licence

(1) An application for an activity licence shall be adjudicated by the Health Board with the grant of or refusal to grant an activity licence within sixty days after the submission of an application.

(2) In addition to the data provided for in the General Part of the Economic Activities Code Act, an application for an activity licence shall set out the following data:

1) in order to provide health services in the Defence Forces or in the case of application for a licence for the provision of emergency medical care in the Defence Forces, the location and statutes of the structural unit of the Defence Forces and the name of its superior government agency;

2) the list of health services for the provision of which the activity licence is being applied for;

3) upon application for an activity licence, the written consents of the health care professionals to commence work at the health care provider which applies for the activity licence except in case of application for a licence for the provision of family physician care on the basis of a practice list of a family physician;

4) upon application for a licence for the provision of emergency medical care by a state rescue service agency, the seat of the agency, the number of registration in the state register of state and local government agencies, the statutes and the name of its superior government agency;

5) upon application for a licence for the provision of emergency medical care, the number, staff and equipment of ambulance crews being applied for;

6) upon application for a licence for the provision of specialised in-patient care, the type of hospital being applied for;

6¹) upon application for a licence for the provision of nurse’s appointment service specified in the regulation established on the basis of subsection 3 of § 25 of this Act in the framework of independent provision of nursing care, the documents certifying the competence of a nurse;

6²) upon application for a licence for the provision of nurse’s appointment service specified in the regulation established on the basis of subsection 3 of § 25 of this Act in the framework of independent provision of nursing care, the name, personal identification code and contact data of the consulting physician if the company, foundation or sole proprietor itself does not have the activity licence of specialised medical care;

7) upon application for a licence for the provision of independent in-patient nursing, the name, personal identification code and contact data of the consulting physician;

7¹) upon application for a licence for the provision of obstetrical home care specified in the regulation established on the basis of subsection 3 of § 26² of this Act in the framework of independent provision of midwifery care, the documents certifying the competence of a midwife;

7²) in case of independent provision of physiotherapy for treatment purposes, the documents certifying the competence of a physiotherapist;

7³) in case of independent provision of speech therapy, the documents certifying the competence of a speech therapist;

7⁴) in case of independent provision of psychological treatment, the documents certifying the competence of a clinical psychologist;

8) the part of the plan pertaining to the medical technology of facilities which contains information on the facilities, installations and equipment;

10) information concerning compliance with the requirements set for data exchange with the Health Information System.

§ 42. Subject of review of activity licence

An activity licence shall be granted if:

1) the facilities, installations and equipment for the provision of family physician care on the basis of a practice list of a family physician comply with the requirements established for the place of business of a family physician on the basis of this Act;

2) the staff, facilities, installations and equipment necessary for the provision of specialised medical care comply with the requirements established on the basis of this Act;

3) the staff and equipment of ambulance crew for the provision of emergency medical care comply with the requirements established on the basis of this Act;

4) the facilities, installations, equipment, instruments and medicinal products and the competence of a midwife comply with the requirements established on the basis of this Act;

5) the staff, facilities, installations, equipment, instruments and medicinal products, and the competence of a nurse necessary for the independent provision of nursing comply with the requirements established on the basis of this Act;

5¹) the conditions of and requirements for the independent provision of physiotherapy for treatment purposes have been complied with and the competence of a physiotherapist complies with the requirements established under this Act;

5²) the conditions of and requirements for the independent provision of speech therapy have been complied with and the competence of a speech therapist complies with the requirements established under this Act;

5³) the conditions of and requirements for the independent provision of psychological treatment have been complied with and the competence of a clinical psychologist complies with the requirements established under this Act;

6) the information technology readiness of the applicant complies with the requirements set for data exchange with the Health Information System.

§ 42¹. Secondary conditions of activity licence

(1) The following shall be added to the activity licence as secondary conditions:

1) the health services for the provision of which an activity licence has been issued;

2) the type of organ allowed to be transplanted if the activity licence for the provision of specialised medical care has been issued for the transplantation of an organ;

3) insurance protection obligation within the provision of health services.

(2) The provision of health services may be commenced from the beginning of the period of insurance of the liability insurance contract or the time specified in the Health Information System if the latter is later. The provisions of this section are also applied in the proceedings for alteration of activity licence and suspension and termination of economic activity.

(3) Alteration of the period of insurance of the liability insurance contract does not cause alteration of the activity licence.

§ 47. Obligation to prepare health care statistics and reports on economic activities concerning health care

An undertaking who has been issued an activity licence shall be required to prepare health care statistics and reports on economic activities concerning health care in accordance with the requirements established on the basis of clause 1 of subsection 1 of § 56 of this Act and submit these to an institution determined by the Ministry of Social Affairs or the minister in charge of the policy sector.

§ 47¹. Specification for submission of data of the Defence Forces

The Defence Forces shall submit the data concerning the alteration or change of data belonging under the subject of review of an activity licence and the data specified in § 47 of this Act to the Ministry of Defence who shall forward it to the Health Board or an institution determined by the Ministry of Social Affairs or by the minister in charge of the policy sector.

§ 48¹. Revocation of activity licence

The Health Board may revoke an activity licence if the health care provider has failed to comply with the health care provider’s insurance obligation required in the Compulsory Liability Insurance of Health Care Providers Act.

§ 50³. Cross-border health services

(1) Cross-border health service means the health service prescribed for or provided in another Member State of the European Union to the insured person for the purposes of § 5 of the Health Insurance Act, including the prescription and issue of medicinal products subject to medicinal prescription and medical devices or the health service prescribed for or provided in Estonia to a person covered by health insurance in another Member State of the European Union, including the issue of medicinal products subject to medicinal prescription upon the provision of pharmacy services and the sale of medical devices on the basis of a medical device card.

(2) In case of cross-border health services, the Member State of affiliation shall be a Member State of the European Union competent to grant a prior authorisation to the insured person for the receipt of the necessary health services outside the Member State of residence according to Regulation (EC) No 883/2004 of the European Parliament and of the Council on the coordination of social security systems (OJ L 166, 30.04.2004, p. 1–123); Regulation (EC) No 987/2009 of the European Parliament and of the Council laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems (OJ L 284, 30.10.2009, p. 1–42); Regulation (EC) No 1231/2010 of the European Parliament and of the Council extending Regulation (EC) No 883/2004 and Regulation (EC) No 987/2009 to nationals of third countries who are not already covered by these Regulations solely on the ground of their nationality (OJ L 344, 29.12.2010, p. 1–3), or Council Regulation (EC) No 859/2003 extending the provisions of Regulation (EEC) No 1408/71 and Regulation (EEC) No 574/72 to nationals of third countries who are not already covered by those provisions solely on the ground of their nationality (OJ L 124, 20.05.2003, p. 1–3), or where the person is insured or where he or she is entitled to health insurance benefit according to the legislation of the relevant Member State.

(3) In case of cross-border health services, the Member State providing treatment shall be the Member State of the European Union in whose territory health services are provided to a patient. In case of telemedicine it shall be deemed that health services are provided in the Member State in which the health care provider has been established.

(4) Costs accompanying the provision of cross-border health services shall be compensated to the persons insured in Estonia pursuant to the procedure provided for in the Health Insurance Act.

§ 50⁴. Restriction on access for receipt of cross-border health services in Estonia

(1) On the proposal of the supervisory board of the Health Insurance Fund, the minister in charge of the policy sector may establish by a regulation the restriction of access for patients covered by health insurance in another Member State of the European Union for the receipt of cross-border health services in Estonia.

(2) The reasons for the establishment of restriction on access may be:

1) the need to ensure sufficient and permanent access to the balanced selection of high-quality health services, or

2) the need to control expenditures and to avoid the misuse of financial, technical or human resources.

(3) Health services to which the restriction on access shall be established, the objective of establishing the restriction and the period of time for reassessment of the need to establish the restriction shall be provided for in the regulation specified in subsection 1 of this section.

(4) The restriction on access can only be established for health services which are provided by the health care provider on the basis of contracts for financing medical treatment entered into with the Health Insurance Fund.

(5) The established restriction on access shall be published on the website of the Ministry of Social Affairs, the Health Insurance Fund, the concerned health care providers and on the website of the national contact point in cross-border health services (hereinafter contact point).

(6) The procedure for the establishment of restriction on access for the receipt of cross-border health services in Estonia shall be established by a regulation of the minister in charge of the policy sector.

§ 50⁵. Obligations of health care providers, providers of pharmacy services and sellers of medical devices upon provision of cross-border health services

(1) The health care provider shall submit to the patient all the relevant information specified in § 766 of the Law of Obligations Act, including information on the treatment possibilities, the availability, quality and safety of health services, information on the liability insurance cover of a health care provider or another individual or collective insurance cover relating to professional liability, and unambiguous invoices and information on the prices and, at the patient’s request, information on activity licences.

(2) Upon dispensing of medicinal products subject to medicinal prescription, the provider of pharmacy services shall notify the recipient of the medicinal product of the circumstances specified in subsection 5 of § 33 of the Medicinal Products Act and shall submit unambiguous invoices and information on prices to the recipient of the medicinal product and, upon the request of the recipient of medicinal product, information on activity licences.

(3) The seller of medical devices on the basis of a medical device card shall notify the buyer of the circumstances specified in § 32¹ of the Medical Devices Act and shall submit unambiguous invoices and information on prices to the buyer and, upon the request of the buyer, information on activity licences.

(4) In its territory, the health care provider shall apply the same price scale of health services to the patients originating from other Member States of the EU as to Estonian patients in a similar medical situation or prices calculated on the basis of objective and non-discriminatory criteria if there are no comparable prices available for Estonian patients.

(5) Patients who wish to receive or who receive cross-border health services shall have remote access to their treatment documents or have the possibility to receive copies thereof.

§ 50⁶. National contact point of cross-border health services

(1) A contact point shall be established for the notification of patients of the circumstances related to the provision of cross-border health services and to facilitate the communication between the authorities of the Member States of EU, health care providers and health care professionals.

(2) The functions of the contact point shall be performed by the Ministry of Social Affairs or the person with whom the Ministry of Social Affairs enters into an administrative contract law for the performance of functions of a contact point.

(3) The activity of the contact point upon dissemination of data is based on cooperation with patient organisations, health insurance providers, health care providers and other interest groups. A contract shall be entered into between the participants in the cooperation network and the contact point, setting out the rights and obligations of the parties and other conditions.

(4) The Estonian Health Insurance Fund, the Health Board and the State Agency of Medicines provide their assistance to the contact point for the solution of issues that fall under their competence.

(5) The function of the contact point shall be the dissemination of data to Estonian patients, above all concerning the covering of costs of cross-border health services, existence and extent of the system of prior authorisations and the general rules for the provision of cross-border health services in Estonia to patients covered by health insurance in other Member States and the established restrictions on access.

(6) The specific functions of the national contact point of cross-border health services upon dissemination of data shall be established by a regulation of the minister in charge of the policy sector.

(7) The data disseminated by the contact point shall be published in electronic format and in a format accessible to disabled persons.

(8) The activity of the contact point shall be financed by the Ministry of Social Affairs.

§ 50⁷. Cross-border health record exchange platform

(1) Cross-border health record exchange platform (hereinafter record exchange platform) is a digital environment for mediation of a patient’s medical summary and the electronic prescription specified in subsection 1¹ of § 33 of the Medicinal Products Act between Estonia and another Member State of the European Union, member state of the European Economic Area and Switzerland if the latter has joined the record exchange platform.

(2) For the purposes of this chapter, patient’s medical summary means a summary of the person’s state of health composed on the basis of the person’s data in the health information system.

§ 50⁸. Data processed via record exchange platform

(1) The following data relating a patient’s medical summary shall be processed via the record exchange platform:

1) patient’s general personal data;

2) data on the health care provider;

3) patient’s health record;

4) other important data relating to the person’s state of health.

(2) The following data relating to an electronic prescription specified in subsection 1¹ of § 33 of the Medicinal Products Act shall be processed via the record exchange platform:

1) patient’s general personal data;

2) data on the prescribed medicinal product;

3) data on the issuer of prescription;

4) data on the pharmacy purchase price of a medicinal product.

(3) The record exchange platform processes the data of the following databases:

1) health administration information system;

2) population register;

3) register of activity licences of the State Agency of Medicines;

4) register of medicinal products;

5) digital prescription centre;

6) health information system;

(4) The specific composition of data processed via the record exchange platform, organisation of data exchange and the term for preservation of logs shall be established by a regulation of the minister in charge of the policy sector.

§ 50⁹. Administration of record exchange platform and access thereto

(1) Functioning of the record exchange platform shall be ensured by the Ministry of Social Affairs.

(2) In case of data transmitted by a foreign state, access to the record exchange platform shall be ensured for the health care professionals specified in § 3 of this Act according to his or her competence. Access of a person of a foreign state to the record exchange platform shall be ensured in compliance with the laws of such foreign state.

(3) A patient shall have the right, via the health information system, to forbid the transmission of data specified in this chapter to a foreign state specified in subsection 1 of § 50⁷ of this Act.

§ 51. Sources of financing health care

(1) Health care shall be financed:

1) from the state budget;

2) from rural municipality and city budgets;

3) by the patients;

4) from other sources.

(2) The state budget proportion of the sources of financing health care specified in clause 1 of subsection 1 of this section is composed of:

1) proportion of social tax corresponding to the rate specified in subsection 3 of § 7 and subsection 2 of § 10 of the Social Tax Act;

2) state budget allocation which is calculated based on the amount of state pension of non-working pensioners to which an allocation rate equal to the proportion of social tax transferred into the state health insurance funds provided for in subsection 2 of § 10 of the Social Tax Act shall be applied. The amount of state pension of non-working pensioners is composed of the recipients of state pension with no work relationship according to the data of the employment register;

3) other sources provided for in § 52 of this Act.

(3) The Estonian National Social Insurance Board shall calculate the amount of state budget allocation specified in clause 2 of subsection 2 of this section and transfer it to the Estonian Health Insurance Fund no later than by the last date of each calendar month.

(4) The bases for calculation of the state budget allocation, non-working recipients of state pension included in the calculation of the allocation and the procedure for submission of data shall be established by a regulation of the Government of the Republic.

§ 53. Financing of health care from rural municipality or city budget

Provision of health services and other expenses related to health care shall be financed from rural municipality or city budgets on the basis of the decisions of the rural municipality and city councils.

§ 54. Financing of health care by patients

In the cases not provided for in §§ 52 and 53 of this Act, a patient shall pay for the provision of health services.

§ 54¹. Beginner’s allowance for medical specialists and nurses

(1) Beginner’s allowance is a lump-sum allowance paid to a person who commences work as a medical specialist or a nurse.

(2) Beginner’s allowance may be applied for within one year after commencing work or practice in the acquired speciality by a physician who complies with the requirements provided for in subsection 3 or 4 of this section and in the regulation established under subsection 7 of § 54² of this Act.

(3) A medical specialist except for a physician having acquired the speciality of family medicine may apply for the beginner’s allowance if they commence work as a medical specialist in the acquired specialty:

1) at one or many hospital(s) specified in the plan of the hospital network established under subsection 1 of § 55 of this Act;

2) with the work load of at least thirty hours a week at a place of work or places of work outside Tallinn or Tartu City.

(4) A physician having acquired the speciality of family medicine may apply for beginner’s allowance if he or she commences practice as a family physician on the basis of a practice list and the practice list and service area of family physician are located outside of Tallinn, Tartu or the local governments immediately adjacent thereto.

(5) Beginner’s allowance may be applied for by a nurse who:

1) has been registered as a nurse in the health administration information system for more than five years;

2) has not worked as a nurse for at least five years before the commencement of work in the location specified in clause 3 of this section;

3) commences work as a nurse with a work load of at least 30 hours a week at one or many hospital(s) specified in the plan of the hospital network established under subsection 1 of § 55 of this Act or with one or many health care providers who provide family physician care outside Tallinn City, Tartu City or the local governments immediately adjacent thereto;

4) applies for the beginner’s allowance within one year after commencement of work as a nurse at the place specified in clause 3 of this subsection;

5) complies with the conditions established under subsection 7 of § 54² of this Act.

§ 54². Amount of beginner’s allowance, application for, payment and recovery of beginner’s allowance

(1) A person entitled to receive beginner’s allowance shall submit to the Health Board the application for beginner’s allowance.

(2) The grant of beginner’s allowance shall be decided by the Health Board within two months after the submission of an application. The beginner’s allowance shall be paid to the person’s bank account within one month as of making the decision to grant beginner’s allowance.

(3) The rate of beginner’s allowance is 15 000 euros. Beginner’s allowance may be paid in up to triple rate of beginner’s allowance if it is caused by the need to ensure the health service in the area.

(5) A person who has received the beginner’s allowance is required to return the allowance paid to them or part of the allowance in proportion to the time worked less if their continuous employment or practice on the conditions specified in subsections 3–5 of § 54¹ of this Act ends before five years have passed from the award of the allowance.

(5¹) If the physician who has received the beginner’s allowance wishes to work less than five years and notifies thereof upon applying for the allowance, the beginner’s allowance shall be paid in proportion to the planned time of work. In this case the working obligation provided for in subsection 5 of this section shall be deemed to be performed after expiry of the term designated upon grant of the application. If the physician who has received the beginner’s allowance decides to work longer than set out in the decision on the grant of beginner’s allowance, the physician may submit an application for amendment of the decision and for extending the term of work for up to five years. The Health Board shall decide on the additional payment of beginner’s allowance within 60 days after receipt of the application.

(6) A person who has received the beginner’s allowance is not obligated to repay the allowance paid to him or her if, due to a fundamental breach of an obligation by the employer, he or she has terminated the employment contract extraordinarily or if the employer has terminated the employment contract extraordinarily, because the continuance of the employment relationship on the agreed conditions becomes impossible due to a decrease of the volume of work or reorganisation of work or in another event of cessation of work (lay-off). A family physician practising on the basis of a practice list who has received beginner’s allowance is not obligated to repay the allowance paid to him or her if his or her activity as a family physician ceases in circumstances beyond his or her control.

(7) The conditions for the grant of and the procedure for application for, payment and recovery of beginner’s allowance shall be established by a regulation of the minister in charge of the policy sector.

(8) The specific areas of commencement of work of the person entitled to receive the beginner’s allowance in connection with the need of ensuring the health services in the area may be established by the minister in charge of the policy sector in the regulation specified in subsection 7 of this section.

§ 55. Plan of hospital network

(1) A plan of the hospital network shall be established by a regulation of the Government of the Republic and the plan shall set out:

1) the list of regional hospitals, central hospitals, general hospitals, local hospitals, rehabilitation hospitals and nursing hospitals (hereinafter list of hospitals) in order to ensure uniform access to health services;

2) the investments required for the construction, renovation and restructuring of hospitals specified in the list of hospitals.

(3) A plan of the hospital network shall be developed for at least fifteen years and shall be amended by the Government of the Republic, if necessary. The Ministry of Social Affairs shall organise the preparation of the plan of the hospital network and shall involve appropriate non-governmental organisations therein.

(4) The list of hospitals set out in the plan of the hospital network may be amended on the proposal of the minister in charge of the policy sector which has been approved by the Estonian Health Insurance Fund.

(5) The minister in charge of the policy sector has the right to make a proposal, which has been approved by the Estonian Health Insurance Fund, to the Government of the Republic regarding amendment of the list of hospitals set out in the plan of the hospital network if the owner of a hospital has acted in accordance with law and the activity licence issued to the owner, and has not violated the contract for payment for health services entered into with the Estonian Health Insurance Fund.

(6) The minister in charge of the policy sector has the right to make a proposal, which has been approved by the Estonian Health Insurance Fund, to the Government of the Republic regarding exclusion of an owner of a hospital from the list of hospitals set out in the plan of the hospital network if the owner of the hospital does not act in accordance with law or the activity licence issued to the owner, or violates the contract for payment for health services entered into with the Estonian Health Insurance Fund. If the activity licence of the owner of a hospital is revoked or the hospital has terminated its activities, the minister in charge of the policy sector shall make a proposal to the Government of the Republic regarding immediate exclusion of the owner of the hospital from the list of hospitals set out in the plan of the hospital network. This proposal need not be approved by the Estonian Health Insurance Fund.

(8) The conditions and procedure for investment from the state budget funds into hospitals specified in the list of hospitals shall be established by the Government of the Republic.

(9) The costs of preparation of a plan of the hospital network shall be covered from the state budget.

§ 56. Duties of minister in charge of policy sector

(1) In addition to legislation specified in this Act, the minister in charge of the policy sector shall establish:

1) the requirements for the preparation of reports on health care statistics and economic activities in the field of health care, the composition of the data and the procedure for the submission of these;

3) the requirements for the functional development plans of hospitals and the medical technology part of building design documentation and the procedure for approval of the functional development plan of hospitals;

4) the requirements for the accessibility of health services and for maintaining waiting lists;

12) the conditions of and procedure for making the decision specified in subsection 1 of § 49¹ of the Vital Statistics Registration Act, according to which the medical assessment committee formed by the minister in charge of the policy sector shall make the decision based on the persistence of gender incongruence and the assessment of health care providers.

(2) An institution appointed by the Ministry of Social Affairs or by the minister in charge of the policy sector shall publish statistical data pursuant to the procedure provided for in the statutes of the authority.

§ 57. Duties of Health Board and Estonian Health Insurance Fund

(1) The Health Board shall perform the duties provided for in Chapter 2 and Chapter 3 of this Act within the extent provided for in this Act.

(1¹) The Estonian Health Insurance Fund shall perform the duties provided for in Subchapter 2 of Chapter 2 and Subchapter 2 of Chapter 3 of this Act within the extent provided for in this Act.

(3) If necessary, the Estonian Health Insurance Fund shall organise the temporary substitution for family physicians practicing under practice lists, including the finding of a temporary substitute for a family physician in cases not specified in subsections 2 and 3 of § 81 of this Act or upon occurrence of an unforeseeable and inevitable necessity and transmit the data on substitution to the Health Board.

(3¹) In the case provided for in subsection 3 of this section, a health care professional with the qualification of a physician may substitute a family physician for up to one year in case of long-term substitution.

(3²) In the event there is a practice list of a family physician unfilled by way of public competition, long-term substitution may last more than one year.

(3³) In the case provided for in subsection 3 of this section, the persons in a practice list of a family physician may be serviced by a company providing family physician care on the basis of a practice list, based on a decision of the Estonian Health Insurance Fund:

1) in a health centre, or

2) outside the health centre if the position of a family physician cannot be filled by way of public competition and a substitute physician or health centre cannot be found for the practice list.

(3⁴) Upon the provision of service pursuant to the procedure specified in subsection 3³ of this Act, the same principles and requirements must be applied as in the event of substitution of a family physician, unless otherwise provided by this Act or legislation established on the basis of this Act.

(3⁵) The organisation of work specified in subsection 3³ of this section may last for up to one year. If the position of a family physician cannot be filled by way of public competition and it is necessary, considering the strategic directions of health care, long-term substitution may last for up to five years.

(3⁶) The Estonian Health Insurance Fund notifies the local authority of the practice list service area, the Health Board and the persons entered in the practice list of the family physician about a decision specified in subsection 3³ of this section, setting out the duration of substitution, the person providing family physician care, the place of provision of family physician care and the organisation thereof. This information is also displayed in an accessible and visible place at the former place of business of the family physician.

(5) In the cases provided for in subsection 3 of this section, the temporary substitution for family physicians shall be paid for from the budget of the Estonian Health Insurance Fund based on the Health Insurance Act.

§ 57¹. Health care statistics and reports on economic activities in field of health care

(1) Collection of health care statistics and reports on economic activities in the field of health care from the health care providers and publication of consolidated data shall be the duty of an institution determined by the Ministry of Social Affairs or by the minister in charge of the policy sector.

(2) An institution determined by the Ministry of Social Affairs or by the minister in charge of the policy sector shall have the right to delegate performance of the duties assigned thereto by this Act to the local government on the basis of an administrative contract.

§ 57². Compilation, maintenance, use and renewal of national stockpile of antidotes

(1) National stockpile of antidotes (hereinafter stockpile of antidotes) is an aggregate of antidotes used for the provision of health care services necessary for the treatment of life-threatening intoxications.

(2) The Health Board shall determine the list, quantities and division of antidotes.

(3) The Estonian Health Insurance Fund ensures the stockpile of antidotes and issue for use, preservation and transportation of the stockpile and functioning of the cold chain.

(4) The Estonian Health Insurance Fund delivers the antidotes to the health care provider free of charge. The health care provider may not receive compensation therefor.

(5) The Health Board ensures the availability of information on the stockpile of antidotes to the health care providers.

(6) The health care provider shall ensure the proper maintenance, use for the intended purposes of antidotes delivered by the Estonian Health Insurance Fund and rendering harmless of aged antidotes and shall inform the Health Board of the use of antidotes.

§ 57³. Assessment of health technologies

(1) The Ministry of Social Affairs shall coordinate the activity of the network for health technology assessment incorporating the agencies and persons engaged in the assessment of health technologies. The given network is based on the principle of good governance including transparency, objectivity, and independence of expert assessments, fair proceedings and relevant consultations with associated groups.

(2) The objective of the establishment of a network for the assessment of health technologies shall be to:

1) support cooperation between agencies and persons;

2) support the members of the network upon preparation of impartial, reliable, timely, transparent, comparable and transmittable information on the relative efficiency of health technologies and if necessary, on the short-term and long-term efficiency of health technologies and to enable the exchange of the given information between agencies and persons;

3) support the analysis of the content and type of the exchanged data;

4) avoid the repetition of assessments;

5) give opinions, where necessary, to the Ministry of Social Affairs, Health Insurance Fund, Health Board, State Agency of Medicines and National Institute for Health Development on preparation of the list of compensated health services, medical devices and medicinal products, procurement of medicinal products and immunological preparations and preparation of public health programmes.

§ 57⁵. Patient safety database

(1) Patient safety database is maintained in order to organise patient safety, prevent and analyse patient safety cases and to learn from the cases, assess the prevention measures, develop the health policy, produce statistics and perform scientific research.

(2) The database is maintained in a form which does not enable the direct identification of a patient or health care professional related with a patient safety case.

(3) The data entered in the database are prescribed for internal use.

(4) The data are issued only for the performance of functions prescribed for in a law or in a legislation issued on the basis thereof, to the necessary extent, to the persons or databases specified in the statutes of the database.

(5) The database shall be founded and the statutes thereof shall be established by a regulation of the minister in charge of the policy sector.

(6) The following shall be set out in the statutes specified in subsection 5 of this section:

1) the processor of the database if a processor has been determined and the functions of processors;

2) the specific composition of data collected into the database and the procedure for entry thereof in the database;

3) the procedure of access to and issue of data;

4) the list of persons submitting data and the data received therefrom;

5) other organisational issues related with the maintenance of the database.

(7) The following data shall be processed in the database:

1) on each notified patient safety case;

2) on the analysis results of notified patient safety cases;

3) on the development of prevention measures by a health care provider for the prevention of similar cases.

(8) The controller of the database has the obligation to analyse the data, present generalised statistics on patient safety cases at least once a year and make proposals to health care providers, professional associations, educational institutions, the Ministry of Social Affairs and other persons and institutions for improving the situation of patient safety, forming advisory committees of experts therefor if necessary.

(9) Data shall be preserved in the database for 30 years. Logs and source data shall be preserved according to the provisions of the statutes.

(10) The controller of the database is the Health Board.

§ 57⁶. Formation, administration, renewal and release of national health care stockpile

(1) The national health care stockpile means the medicinal products, medical devices and other critically necessary means in health care needed for ensuring the continuity of health care policy sector and preparing for an emergency, emergency situation, increased defence readiness and a state of war and for resolving the situation. The national health care stockpile shall be formed, administered, renewed and introduced by a regional hospital established with the participation of the state (hereinafter stockpile manager).

(2) The national health care stockpile is in the ownership of the stockpile manager.

(3) The method of formation of the national health care stockpile shall be decided by an administrative act of the minister in charge of the policy sector, considering the risk assessment, capability of the stockpile managers to maintain and renew the stockpile and other important information.

(4) The national health care stockpile shall be formed on the basis of the decision of the Health Board which also includes the division of the stockpile among the stockpile managers.

(5) The costs of formation, maintenance, renewal and release of the national health care stockpile shall be covered from the funds of the state budget and on the account of funds received by the hospital pharmacy from the sale of the stockpile.

(6) Release of the stockpile shall be decided by the Health Board based on the regulation of the minister in charge of the policy sector established under subsection 7 and the Health Board shall notify the minister in charge of the policy sector thereof as well as other authorities and persons concerned.

(7) The conditions of and procedure for the formation, maintenance, renewal and release of the national health care stockpile, writing off and destruction of expired stockpile and reporting shall be established by a regulation of the minister in charge of the policy sector.

§ 59¹. Health Information System

(1) The Health Information System processes the data related to the area of health care for entry into and performance of contracts for the provision of health services, for ensuring the quality of health services and the rights of patients and for the protection of public health, including for maintaining registers concerning the state of health, for the organisation of health statistics and for the management of health care.

(2) The co-controllers of the Health Information System are the Ministry of Social Affairs and the Estonian Health Insurance Fund.

(3) The Health Information System shall be founded and the statutes thereof shall be established by a regulation of the Government of the Republic, setting out:

1) the functions of the co-controllers and processor of the information system;

2) the composition of data collected into the information system and the procedure of transmission thereof;

3) the procedure of ensuring the correctness of data;

4) the declarations of intention of a person and the procedure of processing thereof;

5) the specific procedure of access to and issue of data;

6) the list of persons submitting data and the data received therefrom;

7) financing of the information system;

8) other organisational issues.

(4) The following data shall be processed in the Health Information System:

1) general data of the patient – personal identification code and date of birth, sex, first name and surname and contact details;

2) other data of the person – data on place of employment, educational institution and family physician, data on health insurance, health insurance benefit and limitation on additional fee related with a health service and image of signature and data on declarations of intention, guardian or representative;

3) medical and other health data concerning the patient – data describing the treatment process and state of health, genetic data, data on health risks, health behaviour and lifestyle and other health related data;

4) data on the person who prepared the document or data – name, registration code, activity licence, profession or specialty and contact details;

4¹) data related with services provided to the patient – invitations, recommendations and notifications and feedback questionnaires related with a health service;

5) data relating to maintaining of waiting list and digital registration;

6) data processing logs and system notifications.

(5) Data shall be preserved in the Health Information System without a term starting from the acceptance thereof in the information system, taking account of the following specifications:

1) data relating to ambulance card, waiting list and digital registration, invitations, recommendations and notifications and data related with feedback to a health service for five years;

2) medical images for 30 years, except for images relating to dental care which shall be preserved for 15 years;

3) data of a death notice and notice of cause of death for ten years;

3¹) certificates of compliance for two years, unless a shorter term has been provided for in the statutes of the information system;

4) logs according to the provisions of the statutes of the information system.

(6) For the purposes specified in subsection 1 of this section, the previous general data of a person entered in the population register such as the person’s first name and surname, personal identification code and sex, may also be processed.

(7) For the protection of personal life, the restriction on access to personal data in the information system is valid until the expiry of the term for preservation of data.

§ 59². Forwarding of data to Health Information System

(1) Health care providers are required to submit to the Health Information System information:

1) for maintaining a waiting list pursuant to the provisions based on clause 4 of subsection 1 of § 56 of this Act;

2) for making medical images available pursuant to the provisions based on subsection 3 of this section;

3) concerning the health services provided to patients and for management of health care, including for maintaining registers concerning the state of health established on the basis of law, in compliance with the provisions based on subsection 2 of this section.

(1¹) A forensic pathologist-expert of a state forensic institution has the obligation to transmit to the Health Information System:

1) data on the cause of death, according to the Establishment of Cause of Death Act, if in the course of forensic medical examination or forensic medical autopsy it appears that the death has arrived as a result of an illness or injury;

2) data on infectious diseases discovered in the course of forensic medical autopsy according to the list of infectious diseases established under the Communicable Diseases Prevention and Control Act.

(1²) Patients shall have the right to forward personal data, including personal data of special categories, to the Health Information System for the provision of services and taking contact therewith, also for the receipt of better health services and assessment of their state of health, including for the use of a software solution and receipt of invitations.

(1³) Health care providers shall have the right to forward personal data to the Health Information System for the use of a software solution according to the provisions of the statutes of the Health Information System established under subsection 3 of § 59¹ of this Act.

(1⁴) The controller of Estonian Biobank is required to, after receipt of a person’s declaration of intention thereon, forward the genetic data of an Estonian Biobank gene donor and the data related therewith to the Health Information System pursuant to the procedure provided for in the statutes of the Health Information System.

(2) The minister in charge of the policy sector shall establish, by a regulation, the data compositions of the documents and data to be forwarded to the Health Information System and the conditions and procedure of submission thereof.

(3) The types of medical images, the requirements of information technology therefor and the conditions and procedure for making them available shall be established by a regulation of the minister in charge of the policy sector.

§ 59⁴. Research ethics committee

The research ethics committee, an independent body consisting of scientists and experts of various fields, specified in § 26 of the Organisation of Research and Development and Innovation Act, shall assess whether the issue of personal data from the database specified in § 591 of this Act for the purposes of research or statistics is ethical and justified.

§ 60. State supervision

(1) State supervision over compliance with the requirements established for health care providers shall be exercised by the Health Board. The Health Board is entitled to receive personal data, including personal data of special categories, for exercising supervision if the data are needed for the performance of functions of the Health Board.

§ 61. Special state supervision measures

(1) For the execution of state supervision provided for in this Act, the Health Board may apply the special state supervision measures provided for in §§ 30, 31, 32, 49, 50 and 51 of the Law Enforcement Act on the basis of and pursuant to the procedure provided for in the Law Enforcement Act.

(2) For the execution of state supervision provided for in this Act, the emergency medical staff may apply the special state supervision measures provided for in §§ 50 and 51 of the Law Enforcement Act on the basis of and pursuant to the procedure provided for in the Law Enforcement Act.

§ 64. Issue of activity licences

(1) A person whose area of activity upon the entry into force of this Act is the provision of health services and who, pursuant to this Act, requires an activity licence for the provision of health services shall apply for the activity licence within three years as of entry into force of this Act.

(2) Upon failure to submit an application within the term specified in subsection 1 of this section or if an activity licence is not issued to a person on the bases listed in clauses 1–4 of subsection 1 of § 45 of this Act, the person loses the right to provide health services.

§ 65. Practising as family physician

(1) General practitioners and paediatricians may practise as family physicians on the basis of practice lists until 1 January 2005 provided that they have received the right to practise as family physicians before entry into force of this Act and they currently undergo family practice residency training or participate in training courses to specialise in family medicine.

(2) The date of commencement of the time of absence from work specified in clause 10 of subsection 1 of § 37 of this Act shall be taken into account from 1 July 2007.

(3) A family physician regarding whose practice list a county governor has, with the approval of the Estonian Health Insurance Fund, before 1 January 2013 allowed for deviations from the maximum number of persons on a practice list shall bring his or her practice list into compliance with the requirements specified in subsections 4¹ and 4² of § 8 of this Act no later than by 1 January 2014.

(4) If the number of persons entered in the practice list specified in subsection 3 of this section exceeds the maximum rate provided for in clause 1 of subsection 4¹of § 8 of this Act, the family physician shall no later than by 1 January 2015 ensure to the persons entered in the practice list the provision of family physician care in a manner that at least one health care professional qualified as a physician provides family physician care together with the family physician.

§ 66. Reorganisation of health care institutions administered by state and local governments

(1) Health care institutions administered by the state shall be reorganised into legal persons in private law pursuant to the procedure provided for in the Foundation of and Participation in Legal Persons in Private Law by the State Act.

(2) Health care institutions administered by local governments shall be reorganised into legal persons in private law pursuant to the procedure provided for in the Local Government Organisation Act.

(3) Upon reorganisation of health care institutions administered by the state or a local government into legal persons in private law, valid contracts of employment shall be transferred to the legal persons in private law being founded.

§ 66¹. Validity of contracts entered into with owners of ambulance crews

The contracts entered into with the owners of ambulance crews before 1 January 2007 shall be renewed under the conditions provided for in subsection 4²of § 17 of this Act and the Administrative Co-operation Act.

§ 66². Implementation of Act

The national register of health care professionals and the national register of activity licences for provision of health services established before 1 January 2008 shall be brought into conformity with the provisions of §§ 27¹ and 50¹ of this Act by 1 April 2008.

§ 66³. Organisation of introduction of Health Information System

(1) The schedule of transfer to the Health Information System by the data subject to entry in the Health Information System shall be established by the minister in charge of the policy sector.

(2) The Health Information System as a whole shall be introduced not later than on 1 January 2013.

§ 66⁴. Application for beginner’s allowance in 2012

Beginner’s allowance in 2012 may be applied for by physicians who acquire the speciality of specialised medical care specified in clause 1 of subsection 2 of § 54¹ of this Act and complete residency in 2012.

§ 66⁵. Transfer of duties to organise family physician care, health care statistics and reports on economic activities in field of health care to Health Board and institutions determined by Ministry of Social Affairs or by minister in charge of policy sector

(1) Upon transfer of the organisation of family physician care into the competence of the Health Board, the county governors shall transfer to the Health Board the administration and documentation connected with the organisation of family physician care.

(2) All the rights and obligations connected with the organisation of family physician care which the persons had in front of county governors until 31 December 2012, they shall have in front of the Health Board as of 1 January 2013. All periods of time and terms specified in this Act shall not discontinue with the transfer of organisation of family physician care into the competence of the Health Board.

(3) Family physicians providing family physician care as sole proprietors and companies providing family physician care on 31 December 2012 shall apply for an activity licence for the provision of family physician care from the Health Board no later than by 30 June 2014. Application for an activity licence shall be exempt from state fees.

(4) Upon transfer of collection of health care statistics and reports on economic activities in the field of health care into the competence of an institution determined by the Ministry of Social Affairs or by the minister in charge of the policy sector, the county governors shall transfer to the institution the reporting and documentation connected with the organisation of health statistics.

(5) Health care statistics and reports on economic activities in the field of health care shall be collected and the consolidated data shall be published by an institution determined by the Ministry of Social Affairs or by the minister in charge of the policy sector as of 1 January 2013.

(6) All the rights and obligations connected with health care statistics and reports on economic activities in the field of health care which the health care providers had in front of the county governor until 31 December 2012, they shall have in front of an institution determined by the Ministry of Social Affairs or by the minister in charge of the policy sector as of 1 January 2013. The periods of time and terms provided for in this Act shall not discontinue in connection with the transfer of health care statistics and reports on economic activities in the field of health care.

§ 66⁶. Transfer of contractual obligations of emergency medical care and financing thereof

(1) The rights and obligations of parties provided for in an administrative contract for the provision of emergency medical care applicable between the Health Board and an owner of an ambulance crew shall be valid until 31 December 2018.

(2) The rights and obligations of the Health Board provided for in the financing contract for specific purposes entered into between the Health Board and an owner of an ambulance crew shall be valid until 31 December 2018.

(3) The wording of this Act in force until 31 December 2017 shall be applied to the contracts specified in subsections 1 and 2 of this section.

(4) The Estonian Health Insurance Fund shall, instead of the Health Board, assume the financing obligation provided for in the contracts specified in subsections 1 and 2 of this section as of 1 January 2018 and shall finance the services specified in the contracts which are provided from 1 January 2018.

(5) In each calendar month in 2018 the Health Board shall, upon first opportunity, submit to the Estonian Health Insurance Fund a report for every owner of an ambulance crew on the service provided in the previous calendar month and the amount of monetary obligation. The Estonian Health Insurance Fund shall pay the monetary obligation to the service provider to the extent of the monetary obligation specified by the Health Board within five working days after receipt of the report and amount of the monetary obligation.

§ 66⁷. Transfer of contractual obligations related to organisation of temporary substitution for family physicians and financing thereof

(1) The Estonian Health Insurance Fund shall, instead of the Health Board, assume the financing obligation contained in the contracts related to the organisation of temporary substitution as of 1 January 2018.

(2) From 1 January 2018 to 31 December 2020, the Health Board shall, upon first opportunity, submit to the Estonian Health Insurance Fund a report on the provision of substitution service in the previous calendar month and the amount of monetary obligation. The Health Board shall pay to the provider of temporary substitution a substitution fee for the provision of service by the 4th date of the calendar month following the provision of service.

§ 66⁸. Implementation of clause 2 of subsection 2 of § 51 of this Act

The state budget allocation rate specified in clause 2 of subsection 2 of § 51 of this Act shall be:

1) 7 per cent in 2018;

2) 10 per cent in 2019;

3) 11 per cent in 2020;

4) 12 per cent in 2021.

§ 66⁹. Transfer of duties of organisation of family physician care to Estonian Health Insurance Fund

If the Health Board has announced a public competition before 1 July 2022 for granting the right to form a practice list or organising the provision of family physician care for a practice list which has become available on the basis of subsection 1¹ of § 34 of this Act, the Health Board shall finalise the given competition. The Health Board shall approve the practice list of a family physician to the chosen candidate or deems the competition failed if no applications were submitted for running as a candidate in the competition or if none of the candidates were found suitable.

§ 66¹⁰. Termination of activity of expert committee on quality of health services

(1) The wording of this Act in force until 31 October 2024 shall be applied to processing of complaints submitted to the expert committee on the quality of health services on the basis of this Act until 31 October 2024 and to the activity of the aforesaid committee.

(2) The activity of the expert committee on the quality of health services shall be terminated on 31 March 2025 at the latest. The termination shall be organised by the minister in charge of the policy sector.

§ 67

–

§ 72

[Omitted from this text.]

§ 72¹. Validity of activity licences

The activity licences for the provision of specialised medical care issued for the provision of nursing care before 1 January 2014 shall be valid until the expiry thereof.

§ 72². Implementation of subsections 4–6 of § 4² of this Act

The terms specified in subsections 4–6 of § 4² of this Act shall be applied to the documents prepared from 15 March 2019. The documents prepared before 15 March 2019 shall be preserved pursuant to the previously established procedure.

§ 72³. Implementation of subsection 2 of § 54¹ of this Act

A person who commenced work as a medical specialist in the acquired speciality or started to practice as a family physician with a practice list during the period from 1 January 2019 to 31 December 2021, who has not been paid the beginner’s allowance and who complies with the requirements provided for in subsection 3 and 4 of § 54¹ of this Act shall have the right to apply for beginner’s allowance until 31 December 2022.

§ 72⁴. Implementation of subsection 4 of § 54¹ of this Act

Upon the implementation of subsection 4 of § 54¹ of this Act, the administrative division of the territory of Estonia in force until 30 June 2017 shall be applied until 31 December 2025 for the determination of local authorities directly adjacent to Tallinn and Tartu City.

§ 72⁵. Implementation of subsection 1 of § 9 of this Act

The service areas of family physicians not in compliance with subsection 1 of § 9 of this Act shall be brought into compliance with the given provision by 31 December 2023.

§ 72⁶. Provision of physiotherapy, speech therapy and psychological treatment without activity licence

Physiotherapy for treatment purposes, speech therapy and psychological treatment without an activity licence may be provided until 30 June 2024.

§ 72⁷. Processing of beginner’s allowances

The applications for beginner’s allowance for medical specialists submitted before 1 January 2024 are processed by the Ministry of Social Affairs.

§ 72⁸. Assessment of effect of beginner’s allowance

The Ministry of Social Affairs shall, by 1 January 2028 at the latest, analyse whether the objective of the beginner’s allowance for nurses has been achieved and the effect related with the implementation thereof and shall submit, if necessary, proposals for the amendment of the regulation.

§ 72⁹. Ex-post assessment of impact of servicing persons outside practice list

The Ministry of Social affairs shall, by 1 January 2029 at the latest, carry out the ex-post assessment on the impact and efficiency of implementing the regulation provided for in subsections 2¹ and 22 of § 7 of this Act and shall submit, if necessary, proposals for amending the provisions.

§ 72¹⁰. Ex-post assessment of impact of servicing persons belonging to practice list by provider of family physician care

The Ministry of Social affairs shall, by 1 January 2029 at the latest, carry out the ex-post assessment on the impact and efficiency of implementing the regulation provided for in clause 2 of subsection 3³ and in subsection 3⁵of § 57 of this Act concerning the provision of service outside a health centre, by way of substitution, to persons belonging to a practice list of a family physician, by a person holding the activity licence of a family physician and shall submit, if necessary, proposals for amending the provisions.

§ 72¹¹. Implementation of § 57⁶ of this Act

(1) The health care stockpile managed by the Health Board and included in a stockpile for the purposes of subsection 6 of § 18¹ of the Emergency Act before entry into force of § 57⁶ of this Act shall be delivered free of charge to a regional hospital established with the participation of the state within three months after entry into force of § 57⁶.

(2) The Health Board shall adopt the decision specified in subsection 4 of § 57⁶ of this Act within one month after entry into force of § 57⁶.

§ 72¹². Implementation of § 59⁴ of this Act

Where the research ethics committee has not made a decision on the application for the use or issue of data for the purposes of research by 1 April 2026, the application and the paid procedure fee shall be returned to the applicant.

§ 73. Entry into force of Act

(1) This Act enters into force on 1 January 2002.

(2) Subsection 2 of § 22 of this Act enters into force on 1 January 2003 and §§ 12–15 enter into force on 1 January 2005.

(3) Subsection 1¹ of § 59² of this Act enters into force on 1 January 2013.