Public relation activities of Estonian Health Insurance Fund

1. Public relation activities of Estonian Health Insurance Fund Evelin Koppel Estonian Health Insurance Fund Jurmala, 11.09.2008

2. Estonia (2005) • Health Indicators: • Population 1 351 000. • Life expectancy at birth 71,8 years • men 66,3 years • women 77,6 years Responsible for health care and public health: • Ministry of Social Affairs (health, social care, employment) • Responsible for compulsory health insurance: EHIF

3. Health Care Expenditure5,5 % GDP Source: Estonian National Health Accounts

4. The components of health insurance • Health insurance is a compulsory insurance, regulated by Social Tax Act, comes from the revenues (13% for health insurance, 20% for pensions). • cover the costs of health services provided to insured persons; • prevent and cure diseases; • finance the purchase of medicinal products and medicinal technical aids; • provide the benefits for temporary incapacity for work; • other benefits.

5. Health Insurance Revenues (mill EEK)

6. Estonian Health Insurance Fund (EHIF) • Funds: independence/separation from the Government • EHIF is a public independent legal body: • Supervisory board consisting of state, employer and insured people representatives 5:5:5 • Management board: 3 members • Since 2001 EHIF is formed of 4 regional departments + central department (incl public relations) • Main role – an active purchasing agency

7. EHIF dilemma Are we: An insurance agency? A health institution? Both? We are on our way to act as a representative of insured

8. EHIF: Goals • Through solidarity-based insurance the EHIF finances health care services in a transparent and patient-centred manner, maintaining the sustainability of health care institutions. • Innovation • Respect • Collaboration • Increase knowledge among insured and partners about their rights and responsibilities.

9. How do we do it • Public Relations • EHIF functions, options and obligations, • Informing people and partners about their rights and responsibilities • Health promotion • Campaigns • Special health oriented additions in newspapers • Networking and collaboration

10. Distribution of EHIF’s Budget, in 2006

11. Public relations • Principles for communication today : • Honest communication • Clear and easy to understand • Dialogical model • Research in every level • Problems: • Messages are not clear yet • Changes around • Limited resources • Reputation ofbureaucracy

12. Public Relations • EHIF’s strategy of public relations • Target groups: Media,health care providers, medical unions, clients (patients), EHIF personnel • Annual communication plans: central department and regional departments • Annual brochure (EHIF’s courant) • Leaflets about different topics (cure in EU, general practitioners advisory phone 1220 etc) • Press-releases (changes in legislation, campaigns-health messages etc)

13. Public Relations • EHIF’ s information phone 16363 (questions about health insurance and health care organization mainly) • Clients could ask questions via EHIF’s web-page: quick answers • Patient education materials in EHIF-s web-page • General Practitioners Advisory Phone line 1220 (EHIF finances the service, 24h, advice in Estonian and Russian language, without an extra charge): family doctor gives a primary medical advice. Advice can be asked by e-mail as well.

14. Inner Relations • Intranet • Regional seminars about the EHIF’s strategy and development plan • Weekly working meetings between departments (horizontal communication) • New: active seminar about the values of EHIF • EHIF has been passed the EFQM Excellence Model for assessing organization for the Quality Award.

15. 24.05.1994certain percent (0,5%) from health insurance dedicated to health promotion/ disease prevention projects. Since 2004 Health Promotion Fund: demand driven funding of projects (bottom- up). Since 2005; all health promotion actions are part of the national public health strategies (top-down planning). 1/3 of the health promotion activities are carried out through media (social campaigns, information in daily newspapers, brochures for patients etc). Health promotion funding by EHIF

16. Priorities • 2005- ... Prevention of coronary-heart diseases, early detection of cancer, prevention of home and leisure-time injuries,prevention of alcohol abuse. • Priority setting followed a consultation process with the Ministry of Social Affairs and the main stakeholders: to avoid duplicate actions from different organizations.

17. Social marketing campaigns • 2005: alcohol causes injuries: for youngsters • 2005: avoid passive smoking • 2006: nutrition and overweight • 2006: physical activity is healthy • 2006: keep your 0-2 year child supervised: prevention of injuries • 2007: alcohol is bad for woman’s health • 2007: physical activity is healthy • 2008: keep your 10-14 year child supervised: prevention of injuries • 2008 : alcohol is bad for your brain and health • Coming up – campaign about asking women to take part of cancer screening

18. Some examples • http://www.youtube.com/results?search_query=ehkmedia&search_type=&aq=f

19. Focus on availability and equal access • Equal distribution of actions (Estonian and Russian language, actions in all counties) • Equal opportunities to the partners: for social media campaigns the partners are found by using national procurement procedures • Health promotion campaigns have an impact to the health supportive policy • Campaigns about alcohol abuse were carried out from 2005-2008. After the active discussion in society government approved chances in Alcohol Law ( selling is prohibited from 22 pm-10 am).

20. Problems arised • Close cooperation with other players are needed (timing of the communication) • The different contributors do not implement the actions in cooperation • Cooperation with private partners is possible, but those companies do not have competence in health promotion • The lack of competent and active personnel is one of the biggest problems (lack of spokespersons) • The outcomes of the health promotion could be presented after many years, therefore still the effectiveness of HP projects is not well proved for the decision makers

21. Evaluation of actions • Annual representative survey with Ministry of Social Affairs: the knowledge of clients (patients rights, knowledge about preventive services etc) satisfaction with health care system: availability and accessibility, media use • Notification of campaigns (over 75% is expected) • Annual survey among partners: health care providers, pharmacies, family doctor • Annual survey among EHIF’ s workers

22. Additional information • Estonian Health Insurance Fund • www.haigekassa.ee • Patient education materials (in Russian language: Руководства для пациентов ) • http://www.haigekassa.ee/rus/juhendid/ • Main partner: Estonian Institute for Health Development • www.terviseinfo.ee (in Estonian and Russian language) • All clips are available in Youtube; • search ehkmedia • Public Relations: Evelin.koppel@haigekassa.ee • Health promotion and disease prevention: sirje.vaask@haigekassa.ee