A conciliation meeting held Wednesday failed to produce progress, according to health care unions, which said Minister of Social Affairs Karmen Joller was again unable to meet with representatives of health care workers and medical providers.

The Estonian Health Insurance Fund's budget for next year still does not include funding for health care workers' pay increases. While the state is not formally a party to the collective agreement, labor organizations argued that no deal is possible without government funding.

The unions said the participation of the social affairs minister, who is responsible for organizing and financing health care, is essential to the conciliation process. They noted that previous ministers worked with sector representatives to reach agreements and signed funding arrangements alongside collective labor contracts.

Labor shortages already severe

The collective agreement affects more than 20,000 health care workers, including nurses, caregivers, midwives, physicians, clinical psychologists, clinical speech therapists, physiotherapists, support specialists, and emergency medical personnel.

The unions warned that labor shortages are already severe across the health care system and could worsen if wages are frozen.

"They provide essential services during crises and wartime, which is why maintaining motivation among health care workers within the public health care system is important for national security," the unions said.

"Today, one-fifth of health care workers hold multiple jobs, and the main reason is pay," said Estonian Nurses Union President Kätlin Lillemaa.

"Nurses and caregivers deserve fair pay for their tremendous effort. They work nights and weekends and care for our loved ones during the most critical moments."

She added that the health care system could break down if overworked employees continue leaving the profession.

Union warns of nurse emigration

Ulvi Tasane, president of the Estonian Health Care Workers' Professional Union, said nurse emigration has fallen significantly thanks to pay increases negotiated in previous collective agreements. However, she warned that trend could reverse.

"In recent months, a large number of job offers have come from abroad," Tasane said. "For patients, it is more important to have a health care worker by their side in an ambulance, hospital, or nursing home than it is to have a balanced budget."

Klaus Martin Klettenberg, president of the Estonian Medical Students' Association, said abandoning planned pay increases could also hurt the future supply of doctors.

Health care unions also expressed concern about broader reforms currently underway, including changes to emergency medical services, rehabilitation services, assistive devices, the integration of health and social care systems, and a shift toward e-consultations for specialist referrals.

While medical professionals generally support the goals of the reforms, they argue that implementation plans could reduce access to care because staffing levels are already insufficient.

"Health care needs stability and labor peace," said Estonian Medical Association President Neeme Tõnisson.

"It is difficult to be satisfied with a minister whose actions have not served the interests of either patients or health care workers."

The statement was signed by the Estonian Nurses Union, the Estonian Health Care Workers' Professional Union, the Estonian Medical Association, the Estonian Association of Clinical Psychologists, the Estonian Association of Clinical Speech Therapists, and the Estonian Physiotherapists' Association.

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