Provision of Health-care Service over the Internet - the Legality of E-consultations in Estonia

• Author: Marika Zmenja
• Pages: 47-55

47

JURIDICA INTERNATIONAL 26/2017

Marika Žmenja

Doctoral student

University of Tartu

Provision of Health-care Service

over the Internet – the Legality

of E-consultations in Estonia

1. Introduction

Medical consultation over the Internet goes back more than 15 years in Estonia (with services such as kli-

inik.ee, inimene.ee, and arst.ee). In more recent years, several new Web sites for that purpose have been

set up (e.g., amor.ee and peaasi.ee), along with ones that of‌f er new services in this domain, among them

medical and genetic testing for various pathological conditions – which may include laboratory services

coupled with sales of medical devices (as with sportsgene.ee, testikodus.ee, and fertify.eu) and treatment

(e.g., koneravi.ee).

A new type of service was added to the Estonian Health Insurance Fund (EHIF) list of health-care ser-

vices*1 in 2013 – e-konsultatsioon, consultation between a specialist and general practitioner*2 that takes

place via the health-information system for meeting with regard to a specif‌i c patient.

In 2015, the portal netiarst.ee*3 was launched. It soon found itself the subject of a Health Board inves-

tigation. On the basis of the explanation it received from the portal operator, the Health Board maintained

the position that the service of‌f ered via the portal was a health-care service and therefore required an activ-

ity licence.*4

As online medical consultation encompasses diverse services – general information and advice, patient

instruction, general and personalised counselling (whether for a fee or free of charge), and others – the fol-

lowing question arises: at what point may online medical consultation become provision of a health-care

service – i.e., an e-consultation, which would be governed by the same legal rules as conventional health-

care services? Is e-consultation possible in the existing legal framework, or must the legal norms be adapted

accordingly?

 Vabariigi Valitsuse .. määrus nr  „Eesti Haigekassa tervishoiuteenuste loetelu“ [‘Government of the Republic

regulation no.  of  December , ‘List of Estonian Health Insurance Fund health-care services’]. – RT I, ..,

Subsection  (). The EHIF currently funds e-consultation in  specialities.

 The general practitioner is the f‌i rst person to consult with in the event of illness. The general practitioner refers the patient

to a medical specialist; gives advice pertaining to the prevention of diseases; takes preventive measures; and issues health

certif‌i cates, certif‌i cates of incapacity for work, and prescriptions.

 At the moment, netiarst.ee is temporarily out of service.

 In response, netiarst.ee’s operator chose not to apply for an activity licence and instead redesigned its service such that it

intermediates a specialist service supplied by health-care service providers. The Health Board letter on the subject is in the

possession of the author.

https://doi.org/10.12697/JI.2017.26.05