Estonia

Go directly to legislation of specific CAM therapies in Estonia:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy – Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) – Other treatments

Estonia regained its independence from the Soviet Union in 1991, and became a member of the European Union in 2004 (11). Estonia became a member of the Council of Europe in 1993 (12).

The legal and regulatory status of CAM and CAM practices

There is no specific CAM legislation in Estonia (41, 43). However, health professionals may provide CAM treatments and consequently CAM is regulated within legislation for health care providers (see chiropractic, massage, osteopathy).

Estonian health care regulation has been rapidly changed firstly after independence from the Soviet Union in 1991 and later after joining the European Union in 2002. The system is changing towards more decentralized primary health care and towards more evidencebased medicine.

Estonia has a long tradition of use of herbal products, and healthcare based on traditions and practice experience is accepted and developed in the transition of the Estonian society (93).

The Health Services Organisation Act regulates health care service and health personnel (94). § 2. The act defines health services as: “(1) the activities of health care professionals for the prevention, diagnosis or treatment of diseases, injuries or intoxication in order to reduce the malaise of persons, prevent the deterioration of their state of health or development of the diseases, and restore their health. The Minister of Social Affairs shall establish the list of health services” (94).

No CAM health services were found in Estonian health regulations (94). There are no restrictions of CAM treatment provided by listed health personnel as long as the treatment is according to The Health Services Organisation Act (94).

Health care professionals are doctors, dentists, nurses and midwives if they are registered with the Health Board (§3, the health services organisation act) (94). A health care professional may provide health services within the acquired specialty with regard to which the Health Board has issued a certificate of registration of the person as a health care professional. Health care providers are health care professionals or legal persons providing health services, §4 (94). The Health Board maintains the registers of health care professionals and activity licences §57 (94).

Regulated professions are regulated according to the Professions act 2008 (95). §14 states; “The register of professions is a state database used to collect, preserve and systemize information on professional councils, professions, professional standards, awarders of profession and valid professional certificates”(95).

According to the Professions act registered professions follow the criteria set in the EU regulated professions database or the national professions database (95). We could not find any CAM professions from Estonia in the EU regulated professions database (7). In the Estonian professions database there are several CAM-related professional standards and certificated professionals (96). Main professions are aroma-therapist, homeopath, reflexologist, physiotherapist, masseur and Chinese natural therapist (95).

The Estonian Manual Medicine & Chiropractic Association (EMMCA) is a professional association and governing body representing and regulating Estonian health care professionals in the fields of manual and natural medicine (97). EMMCA represents the chiropractic, osteopathic and massage therapy professions (97). The EMMCA intends to create the Manual Medicine Doctor “M.M.D.” to be recognized and regulated. “All M.M.D.’s in Estonia will have subspecialties in their respective areas of expertise such as Chiropractic Medicine.

The governmental supervision of CAM Practices

Health care professionals like doctors, dentists, nurses and midwives registered with the Health Board, are supervised according to the health services organisation act, §55 (94).

The classifications indicated in the health services list, section 1, shall serve as the basis for organisation of financing, quality control, and supervision of national statistical health observations and health-related activities (98). CAM providers are not included in the health supervision regulative system.

The reimbursement status of CAM practices and medicinal products

We did not find any direct regulation of CAM treatments in the health insurance regulations. According to the health insurance act 2002, § 29 and 30, health services are covered if entered in the list of the health insurance fund and the provision thereof is therapeutically justified (99). According to §31 the following criteria shall be taken into account upon entry of a service in the list of health services:

1. the proven medical efficacy of the health service;
2. the cost-effectiveness of the health service;
3. the necessity of the health service in society and the compatibility of the service with
   national health policy;
4. correspondence to the financial resources of health insurance.

Regulation No. 13 of Minister of Social Affairs of 10 January 2002 § 1 regulates the following health services to be included in the health services list:

1. Health services associated with diagnosis and treatment of diseases listed in the
   International Statistical Classification of Diseases and Related Health Problems Tenth Revision (ICD-10).
2. Surgical procedures listed in the Classification of Surgical Procedures of the Nordic
   Medico-Statistical Committee (NOMESCO NCSP)(98).

Since 1997 acupuncture is excluded from the list of medical services covered by
government medical insurance. Acupuncture is occasionally reimbursed in very small
amounts under the title of rehabilitation packages (100). Homeopathy is not listed as a regulated health service, thus homeopathic treatment is not reimbursed (41).