The bulk of family doctors' income derives from the state Health Insurance Fund (Haigekassa), but family doctors are permitted to top that up, for example by taking part in clinical trials or performing minor procedures usually carried out in hospitals. They can then pay out dividends to owners.

According to Elle-Mall Sadrak, head of the family doctors' association, the Health Insurance Fund actually encourages this extra work, as the cost per treatment case works out lower at a health center than in hospital.

"With some things, it comes down to this: The more you do it, the more profitable it is for you. The more actively you perform minor surgeries, gynecological procedures, the kind that are permitted for family doctors, the more active you are, the more opportunity there is to earn extra money," said Sadrak.

Anu Valli, chief specialist for family doctor services at the fund, said that her organization does not keep tabs on family doctors' incomes.

"We do not directly interfere with how a facility internally distributes things, what it takes out as dividends and how it pays its wages. With our cost model, wage funds are based on the healthcare workers' collective agreement," Valli said.

Sadrak, head of the family doctors' association, said paying dividends requires a certain amount of frugality, and also optimization.

She said: "There are those who pay very high salaries in line with the market value, while others optimize by allowing a yearly bonus in the form of dividends and paying only slightly more than the collective agreement salary."

ERR asked whether, when a large sum is left over, perhaps family doctors shouldn't be getting money from the state via the Health Insurance Fund, and/or could manage with smaller sums.

"We are currently reviewing the entire system in any case, to find opportunities for greater efficiency. As I said, the funding of family doctors is also under review," Valli said.

One family doctor, the Ristiku perearstikeskus in Pärnu, saw its profits fall slightly last year, with nearly €900,000 paid out in dividends; the dividend income was slightly over a million euros.

It was also a successful year for the Narva Narva perearstikeskus health center, which paid out nearly €810,000 in dividends, €90,000 more than in 2023.

Valentina Mišenkova, co-owner of the family health center, said there are several reasons for its economic success.

"Most of the premises are located on property we own ourselves, so we spend less money on rent, and maintenance costs are lower. We save a lot that way," Mišenkova said.

She added that they negotiate discounts from test providers. At the same time, medical staff salaries remain low — they pay the minimum wage agreed upon in the healthcare workers' collective agreement.

--

Follow ERR News on Facebook, Bluesky and X and never miss an update!