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

Author:Marika Zmenja

The number of Web sites providing medical consultations is growing constantly. They offer common information and advice, patient education, and general and individualised consulting. In certain cases wherein Web sites offer consultations, the service is subject to the same legal regulation as conventional health-care provision. The article discusses when consulting via the Internet (i.e., e-consul... (see full summary)

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-,, and In more recent years, several new Web sites for that purpose have been
set up (e.g., and, along with ones that o 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,, and and treatment
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 speci c patient.
In 2015, the portal*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 o 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
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 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
certi cates, certi cates of incapacity for work, and prescriptions.
At the moment, is temporarily out of service.
In response,’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.

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