"The offer made by the public conciliator after talks which have lasted for more than a year, one part of which is a document containing obligations, does not fill us with certainty — therefore healthcare workers cannot accept the offer," the Estonian Medical Association, the Estonian Union of Healthcare Professionals and the Estonian Nurses' Association said in a joint statement.

The healthcare workers stated that in the past five years, the volume of specialized care has consistently been reduced and this year, hospital care receives 18 percent or 35,000 patients less than in 2013. "This year's budget of the Health Insurance Fund is €70 million smaller than needed," the statement highlighted. "The prices of several medical services have been cut under the labels of systemization and modernization to an extent that, according to professional associations, these do not cover real costs and do not allow for the provision of quality medical care.

"The Minister of Health and Labour is ready to promise that he will propose to the government increasing healthcare funding, but he does not wish to take on binding commitments which would enable the Health Insurance Fund to pay for all necessary medical care in the future." it continued. "The agreement no longer contains promises to raise the volume of hospital care by 2020 to at least 2013 levels and implement a price list which includes all epenses necessary for quality treatment."

According to the healthcare workers, Minister of Health and Labour Jevgeni Ossinovski promised them a few weeks ago that the number of medical cases would be raised in 2017. They added that unfortunately that is not how it went.

"The obligation to refrain from striking can remain in force if the minister signs a concrete obligation for patients to get the medical care they need," Iivi Luik, president of the Estonian Union of Healthcare Professinals, said.

Hospitals likewise reject offer

In addition to healthcare workers, the Estonian Hospitals Association has also rejected the collective agreement offer made by the public conciliator, citing that the funding of the healthcare sector is not sufficient.

"As hospitals, we have to assume an obligation for several years as employers to pay the salaries agreed upon in the agreement — this cannot be done in a situation where we know that medical volumes are insufficient for all medical establishments," Urmas Sule, head of the association, told BNS.

According to Sule, the previous collective agreement draft had information regarding paying for extra hours, but there was no such information in the new agreement and thus it would not be possible to sign the it. It would be possible to sign were it to reflect the same principles currently in effect, he added.

Ossinovski: Part of healthcare workers' demands inappropriate

According to Ossinovski, the demands of healthcare workers which require decisions to be made on the government level are inappropriate in the context of wage talks as the core of collective agreement talks is to reach an agreement on the salaries and working conditions of medical personnel.

"All healthcare workers, especially caregivers and nurses, will lose as a result of rejecting the public conciliator's offer," the minister said in a press release. "Doctors as well as the representatives of nurses and caregivers wanted the agreement to be reached. All participants have previously said that the proposal made by the public conciliator was acceptable to them. Unfortunately, at least one delegation representing healthcare workers has jeopardized the salary raise of healthcare workers and the obligation to refrain from striking in the medical sector with their decision. It is definitely not an example of good social partnership nor does it protect the interests of healthcare workers or patients."

According to Ossinovski, the state has by now done everything it could for the collective agreement to be reached — funds for a pay increase were found in the Health Insurance Fund's 2017 budget, the issue of the sustainability of healthcare funding was to be solved in the spring as confirmed by the prime minister as well as Ossinovski himself, and as a gesture of goodwill, an additional €10 million of funding was found already this year to increase the number of medical cases.

Ossinovski said that the supervisory board of the Health Insurance Fund is to convene on Feb. 17 to decide what to do next.