Patients may be billed again for hospital bed-days after transfer to another hospital
Estonia's Health Insurance Fund has flagged that when a patient is transferred to another hospital to continue treatment for the same illness, the new hospital restarts the bed-day count and can charge for up to ten days again. The Social Affairs Ministry acknowledges the rules need clarifying.
Under Estonia's Health Insurance Act, hospitals may charge insured patients for bed-days during a stay, but only up to ten calendar days per single case of illness. In practice, however, this rule is applied inconsistently across institutions.
When a patient starts treatment at one hospital and is then transferred to another — for instance, one closer to home — to continue treatment for the same condition, the second hospital restarts the bed-day count from zero. This means the patient can again be charged for up to ten days, even though from the patient's perspective the treatment is one continuous process.
Health Fund head raises the issue with the minister
Siiri Lahe, head of the Health Insurance Fund, raised the matter with Social Affairs Minister Karmen Joller. She explained that hospitals and patients may interpret the concept of a "single case of illness" differently, and that there is no unified system between hospitals for checking or sharing information on whether, and how much, a patient has already paid for bed-days at a previous institution. Each hospital uses its own information system, and bed-day payment data is not transmitted to the national Health Portal.
As a comparison, Lahe pointed to specialist doctor consultation fees, which by law cannot be charged again if a patient is seen repeatedly within the same service. She said that, against this backdrop, being charged again for bed-days can feel unfair to patients and cause confusion.
Ministry acknowledges the problem
Heli Paluste, head of the healthcare network at the Social Affairs Ministry, told ERR that from a patient's point of view it genuinely is one continuous treatment process, so charging bed-day fees again upon transfer between hospitals can raise questions. Unlike the rules for doctor consultation fees, where the law specifies exceptions preventing repeat charges when a patient moves between institutions, no such exception exists for bed-day fees. Hospitals are independent institutions, and from the receiving hospital's perspective, a transfer constitutes a new hospitalization case. The Health Insurance Fund likewise reviews and pays for treatment cases separately for each hospital under its contracts with them.
Paluste said the Health Insurance Fund's concern is reasonable from the patient's standpoint. Since current health insurance legislation lacks a clear definition of what counts as a single case of illness across different hospitals, she said it is likely necessary to discuss bed-day charging practices separately with hospitals and the Health Insurance Fund, and to clarify the rules, to ensure patients get a clear and fair calculation of their co-payment share.
