The Health Insurance Act states that an insured patient may be charged an inpatient fee for a hospital stay, but for no more than 10 calendar days per case.

In practice, however, a concern has arisen when a patient is initially treated at one hospital but is then transferred to another to continue treatment, for example to a hospital closer to home. Even though the patient's health issue remains the same, the second hospital may start charging the inpatient fee again for up to 10 days.

Siiri Lahe, chair of the Health Insurance Fund's management board, therefore contacted Social Affairs Minister Karmen Joller, pointing out that the meaning of a single case or course of treatment differs from the perspective of hospitals and patients. Hospitals also have no system for tracking or exchanging information on whether and how much a patient paid in inpatient fees at the previous hospital.

"Each hospital uses its own information system and information about inpatient fees is not transferred to the nationwide digital health record," Lahe said.

She compared this with specialist doctor appointment fees where the law does not allow another fee to be charged for a follow-up appointment for the same service. Against that background, she noted, charging inpatient fees again can strike patients as unfair and cause confusion.

The Health Insurance Fund chief asked the Ministry of Social Affairs for its position on whether the term "single case" means, for the purposes of the law, only the period spent at the same hospital. She also pointed out that, to the Health Insurance Fund's knowledge, Estonian law contains no separate definition of the term "case."

Heli Paluste, a healthcare network expert at the Ministry of Social Affairs, told ERR that from the patient's perspective, it is indeed a single course of treatment and having to pay another inpatient fee when moving between hospitals can raise questions.

"Unlike appointment fees, for which the law sets out specific exemptions governing when a patient moving between institutions may not be charged another appointment fee, no similar exemption applying across hospitals has been established for inpatient fees. Hospitals are independent institutions and when a patient is transferred and admitted to another hospital, that hospital considers it a new case," Paluste said.

She added that the Health Insurance Fund likewise treats and funds such cases as separate hospital-specific courses of treatment under its contracts with hospitals.

According to the Ministry of Social Affairs expert, the Health Insurance Fund's observation is entirely understandable from the patient's perspective.

"Since the current Health Insurance Act does not explicitly define a case across hospitals, it will probably be necessary to discuss separately with hospitals and the Health Insurance Fund whether the rules and practices governing inpatient fees need to be clarified to ensure that patients' cost-sharing is calculated clearly and fairly," Paluste said.

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