Bill improving the availability of general medical care passed the second reading in the Riigikogu

At today’s plenary sitting, the Riigikogu concluded the second reading of the Bill that, among other things, will ensure the availability of general medical care and improve the continuity of the servicing of the practice lists of family physicians.

Under the Bill on Amendments to the Health Services Organisation Act and Other Acts (533 SE), initiated by the Government, the health system will be made more flexible and human-centred. According to the Bill, from 1 July, general medical care will be organised by the Estonian Health Insurance Fund instead of the Health Board.

The Bill will specify the bases for registering on the practice list of a family physician. With the amendments, according to the Health Services Organisation Act, persons residing in Estonia on the basis of the right of residence and persons with health insurance who are legally staying in Estonia under a temporary basis for stay will have the right to register on the practice list of a family physician and to change their family physician on the basis of a written application. The Bill will enable, upon the first approval of a practice list, to keep the list shorter than the upper limit for a practice list as provided by law, in order to allow the new family physician time to get to know the practice list.

The Bill also provides for the obligation of a family physician to inform the persons on their practice list at least six months in advance if the place of business of the family physician changes. The aim of the amendment is to enable patients to change their family physician if necessary or to make preparations in the organisation of their life so that they could get used to the fact that their family physician is moving to a new place of business.

The Bill provides for the possibility to ensure medical care in the situations where public competitions to find a family physician for a practice list have failed or a practice list unexpectedly remains without a family physician. The conditions for the application for the beginner’s allowance will also be mitigated: the period for the submission of applications will be extended, and legal preconditions will be created for the payment of the beginner’s allowance in a larger amount and for the beginner’s allowance to be used partially. The Bill will create an opportunity to designate a priority region or specialty and to pay the beginner’s allowance for family physicians in an amount of up to three times the rate of the allowance. The rate of the beginner’s allowance will be EUR 5000.

Under the Bill, nurses who have acquired the specialty of nursing (specialised nurses) will also have the right to issue prescriptions for agreed medicinal products in a limited range to the same extent as currently applies to family nurses. The range of people who have the right to issue certificates of incapacity for work will also be amended and nurses will be given the right to issue certificates of incapacity for work.

During the second reading, in view of the feedback received from stakeholders, it was decided to omit from the Bill the provision that would have allowed the hospitals in the hospital network development plan to service the practice lists of family physicians in a situation where it is impossible to ensure the availability of family physician.

Two other Bills passed the second reading

The Bill on Amendments to the Feed Act (499 SE), initiated by the Government, is intended to bring the Feed Act into conformity with a Regulation of the European Parliament and of the Council laying down the requirements for the manufacture, placing on the market and use of medicated feed. The general principles will remain the same.

According to the Bill, certain feed business operators will be subject to an authorisation obligation because, under a Regulation, in the future, feed business operators will have to hold an activity licence if their establishments engage in the manufacture, transport or placing on the market of medicated feed or intermediate products. According to the current procedure, an activity licence is required only in the case of the manufacture of medicated feed. In the case of other activities related to the handling of medicated feed, for example, upon retail of medicated feed for pets, a notice of economic activities must be submitted.

The Bill will also update the maximum penalty rates in place for legal persons in the Feed Act, which will range from 10,000 to 32,000 euro in the future. It will be possible to impose a fine of up to 50,000 euro on a legal person for violation of the requirements for feed, the requirements for the labelling of feed and the requirements for the handling of feed and feeding to animals.

The Bill on Amendments to the Medicinal Products Act and the Veterinary Act (544 SE), initiated by the Government, will amend the Medicinal Products Act and specify the provisions relating to medicinal products in the Veterinary Act in order to better implement the European Union Regulation applicable to veterinary medicinal products and to achieve its aims.

From 28 January, the activity licences of wholesale distributors of veterinary medicinal products will be valid across the European Union. In view of this, the Bill is intended to grant veterinarians and general and veterinary pharmacies the right to import to Estonia veterinary medicinal products from EU wholesale distributors of veterinary medicinal products. Up to now, veterinarians have been able to buy medicinal products from Estonian wholesale distributors of veterinary medicinal products.

In addition, according to the Bill, veterinarians will no longer have to apply for a separate authorisation from the State Agency of Medicines to use veterinary medicinal products without a marketing authorisation. Upon the use of medicinal products without a marketing authorisation in veterinary activities, the veterinarian will have to be guided by the requirements set out in the abovementioned Regulation. As the first option, however, authorised veterinary medicinal products continue to have to be used according to the terms of the marketing authorisation.

The Bill will specify the tasks of the competent authorities in the field of veterinary medicinal products, i.e. the State Agency of Medicines and the Agriculture and Food Board, update the regulation for the fees of the State Agency of Medicines and give the State Agency of Medicines the right to allow exemptions with regard to the requirements for the packages of veterinary medicinal products.

Three Bills passed the first reading

The Bill on Amendments to the Population Register Act (609 SE), initiated by the Government, is intended to give local governments an opportunity to terminate the validity of the data on residence of a person if his or her residential address is in the population register to the accuracy of city and city district or rural municipality but the local authority has established that the person is not residing in its territory or anywhere else in Estonia and no data of a place of stay specified in the Population Register Act, for example, a social welfare institution, has been entered in the population register as the place of stay of the person.

The explanatory memorandum notes that, in the case of Ukrainian war refugees, there have been cases where local authorities have hesitated whether to enter data on residence to the accuracy of local government into the population register, as there is no possibility to terminate the validity of such data if no new notice of residence is submitted. The amendment of the Population Register Act is necessary in order to give local governments an opportunity to terminate the validity of the data on residence in the population register for people who have left the local authority and Estonia. Besides Ukrainian war refugees, this also applies to all other people who have a place of residence to the accuracy of local government.

During the debate, Mart Helme took the floor on behalf of the Estonian Conservative People’s Party Faction.

The Bill on Amendments to the Fertilisers Act, the Chemicals Act and the Product Conformity Act (614 SE), initiated by the Government, will transpose and implement the European Union Regulation harmonising and updating the manufacturing and quality requirements for fertilizers marketed in the European Union. The new requirements for the manufacturing and marketing of fertilizers will mark a transition to an approach based on circular economy. This means that, in the future, by-products of various branches of industry will be allowed to be recovered as fertilising products. As a result of this, it will be easier for manufacturers to combine products based on different component materials, and the range of fertilising products will be expanded.

For the first time, limit values for heavy metal content for fertilising products will be established. The limit values for heavy metals and pathogens that European Union fertilizers can contain have been set out by product category. The limit values for heavy metals have been established for organic and inorganic fertilizers, liming materials, soil improvers, growing media and plant biostimulants. The limit values for heavy metals have been established for cadmium, chromium, arsenic, mercury, nickel, lead, copper and zinc. The quality requirements for EU fertilising products ensure that the use of these products does not harm people, animals, plants or the environment.

According to the Draft Resolution “Amendment of the Resolution of the Riigikogu “The Fundamentals of Climate Policy until 2050”” (616 OE), submitted by the Environment Committee, amendments will be made to the Resolution of the Riigikogu “The Fundamentals of Climate Policy until 2050” of 5 April 2017. They provide that, by 2050, Estonia will be a competitive country with knowledge-based society and economy. It will ensure a high-quality living environment rich in species, and willingness and capacity to reduce the adverse effects caused by climate change and to make the best use of the positive effects. The amendment also provides that Estonia’s long-term target is to achieve a balance between greenhouse gas emissions and removals by 2025 at the latest and to reduce net greenhouse gas emissions to zero by that time.

The explanatory memorandum notes that the fundamentals were an agreement on the long-term vision of Estonian climate policy, sectoral policy objectives covering the whole economy that set out a clear route to mitigating climate change, that is, reducing greenhouse gas emissions, and at the same time adaptation to climate change, until 2050. The interim changes in climate policy and its objectives both in the European Union and in Estonia have caused a conflict with the fundamentals of climate policy in place. The purpose of the draft Resolution is to bring the fundamentals into conformity with the climate targets agreed in the EU.

The current text of the fundamentals sets out that Estonia’s long-term goal is to reduce its greenhouse gas emissions by 2050 by approximately 80% compared to the 1990 baseline. By now, steps have been taken in the European Union and Estonia to achieve climate neutrality by 2050.

During the debate, Andres Metsoja took the floor on behalf of Faction Isamaa, Peeter Ernits on behalf of the Estonian Conservative People’s Party Faction and Yoko Alender on behalf of the Reform Party Faction.

Verbatim record of the sitting (in Estonian)

The video recording of the sitting will be available on the Riigikogu YouTube channel.
(Please note that the recording will be uploaded with a delay.)

Source: Parliament of Estonia