The Tallinn home care service physician is based full-time in the Cancer Centre but contributes one-quarter time, funded by the Estonian Cancer Society, to the home care team. Each home care visit is reimbursed through the sickness fund to the amount of US$8. The contract with the sickness fund is held by the Estonian Cancer Society, but is not adequate to the known needs: in 2000, funds ran out by November.
One respondent stated that 100% funding for palliative care on the part of the state or the sickness fund should be guaranteed and that people cannot afford to pay for their own palliative care. Current attention is heavily weighted towards active treatment, with a neglect of psychological and social support. When patients need symptomatic treatment only they become the responsibility of the family doctors, who have no palliative care education and often seek to avoid such patients. External help from EAPC, according to this source, should focus on two issues:
representing the need for palliative care to the government and the sickness funds;
encouraging the adoption of palliative care within the university medical curriculum.2
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