Activity licence for the provision health services

You need to apply for an activity licence for providing the services of specialised medical care, emergency medical care, and general medical care, based on a family physician’s practice list, independent provision of nursing and independent provision of midwifery.

  • Specialised medical care means outpatient or inpatient health services, which are provided by medical specialists or dentists and health care professionals working together with them.
  • Emergency medical care means outpatient health services for the initial diagnosis and treatment of life-threatening diseases, injuries and intoxication and, if necessary, for the transportation of the person requiring care to a hospital.
  • General medical care means outpatient health services, which family physicians and health care professionals provide working together. A family physician is a specialist, who has acquired the corresponding speciality and who practises, based on a practice list of the family physician or as a specialist without a practice list. A family physician’s practice list is a list or persons serviced by a family physician.
  • Nursing means outpatient or inpatient health services which are provided by nurses and midwives, together with family physicians, medical specialists or dentists, or independently.
  • Midwifery care means outpatient or inpatient health services, which midwives provide together with a family physician or medical specialist or independently.

Provision of health services is regulated by the following legislation of the Republic of Estonia:

And by the following EU legislation:

  • Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011;
  • Regulation (EU) No. 1231/2010 of the European Parliament and of the Council of 24 November 2010;
  • Regulation (EC) No. 883/2004 of the European Parliament and of the Council of 29 April 2004;
  • Regulation (EC) No. 987/2009 of the European Parliament and of the Council of 16 September 2009;
  • Council regulation (EC) No. 859/2003 of 14 May 2003.

Requirements for the applicant

Requirements for an applicant for the provision of general medical care based on a family physician’s practice list

  • Family physicians may practise as sole proprietors or through companies providing general medical care.
  • The partnership agreement of a company operating as a general partnership or limited partnership shall be entered into in writing and shall be appended to the application for entry of the company in the commercial register.
  • Companies providing general medical care may merge only with other companies providing general medical care.
  • Companies providing general medical care shall not be partners or shareholders of companies providing specialised medical care.
  • A company providing general medical care shall not have another area of activity besides provision of general medical care, independent provision of nursing, independent provision of midwifery care, provision of social services, and teaching and scientific research in health care.
  • A family physician entered in the commercial register as sole proprietor may provide only general medical care, independent nursing, independent midwifery care, social services and engage in teaching and scientific research in healthcare under the business name entered in the commercial register.
  • Family physicians providing health services through the company or local governments in whose administrative territory the place of business of the company, which provides general medical care, is located may be partners and shareholders of a company which provides general medical care.

Requirements for an applicant for the provision of emergency medical care services

  • A company, sole proprietor, foundation or a state or local government agency, which holds a corresponding activity licence, may be the owner of an ambulance crew.
  • A legal person, which owns an ambulance crew, shall engage in no other area of activity than the provision of emergency medical care or teaching and scientific research in health care.
  • A sole proprietor who owns an ambulance crew may provide only emergency medical care under the business name entered in the commercial register, with the exception of providers of specialised medical care who own an ambulance crew.

Requirements for an applicant for the provision of specialised medical care services

  • Companies, sole proprietors or foundations that hold corresponding activity licences may provide specialised outpatient care.
  • A hospital is an economic unit formed in order to provide outpatient and inpatient health services.
  • A company or foundation, which holds a corresponding activity licence, may operate a hospital.
  • A company or foundation, which operates a hospital, shall not have another area of activity besides providing specialised medical care, emergency medical care, independent provision of nursing services and social services, teaching and scientific research in health care, maintaining a hospital pharmacy, manufacture of full blood and blood components and procurement and handling of cells, tissues and organs.

Requirements for an applicant for the provision of nursing services

  • Companies, foundations or sole proprietors that hold corresponding activity licences may provide nursing independently. The restriction on the legal form of the provision of nursing does not apply to the providers of social services specified in clause 10 16) of the Social Welfare Act and to 24-hour social welfare institutions for the elderly and disabled persons in case of provision of home nursing service specified in the regulation established under subsection 25 (3) of the Health Services Organisation Act.
  • The list of outpatient nursing services, which are permitted to be provided independently, and the operations being part thereof shall be established by a regulation of the Minister of Social Affairs.
  • A nursing hospital is an economic unit formed in order to provide outpatient and inpatient nursing services which are permitted to be provided independently.
  • A company or foundation, which holds a corresponding activity licence, may own a nursing hospital.
  • A company or foundation which operates a nursing hospital, except for the owner of a hospital providing specialised medical care, shall not have another area of activity besides independent provision of nursing services, outpatient specialised medical care and social services, teaching and scientific research in health care and operating a hospital pharmacy.
  • The list of nursing services, which are permitted to be provided independently at a nursing hospital and the operations being part thereof and the requirements for the staff, facilities, installations, equipment and instruments necessary for the independent provision of inpatient nursing, shall be established by a regulation of the Minister of Social Affairs.

Requirements for an applicant for the provision of midwifery care services

  • Midwifery care means outpatient or inpatient health services which are provided by midwives together with a family physician or medical specialist or independently.
  • Companies, foundations or sole proprietors that hold the corresponding activity licences may provide midwifery care independently.
  • Midwifery care may be provided independently only as an outpatient service. The list of midwifery care services, which are permitted to be provided independently, and the operations being part shall be established by a regulation of the Minister of Social Affairs.
  • The requirements for the facilities, installations, equipment, instruments and medicinal products necessary for the independent provision of midwifery care shall be established by a regulation of the Minister of Social Affairs.

Cross-border activity

Health services may be provided in the Republic of Estonia only based on an activity licence issued by the Health Board. If you wish to provide services outside Estonia, then you must seek the right for service provision from the competent authority of the destination country.

A person who has acquired his or her qualifications in a Member State of the European Economic Area or in Switzerland may temporarily provide health services in Estonia without the registration obligation required pursuant to section 27 of the Health Services Organisation Act and an activity licence required pursuant to section 40 of the Health Services Organisation Act in compliance with the provisions of Chapter 3 of the Recognition of Foreign Professional Qualifications Act. The competent authority for the purposes of Chapter 3 of the Recognition of Foreign Professional Qualifications Act is the Health Board.

Temporary service means that the operator is not taking part in the economy of the country permanently, is not persistently looking for customers from a specific country or promoting itself. An example of temporary service provision may be a situation, where an operator participates in a public procurement or competition. Participation in fairs is considered as temporary service provision as well. A situation where a customer privately finds a service provider from another country is also considered a temporary service provider.

Completing and submitting an application

For the receipt of an activity licence, please submit an application with the additional documents. An application for an activity licence must contain the following data in addition to the data specified in section 19 of the General Part of the Economic Activities Code Act:

  • in order to provide health services in the Defence Forces or in the case of application for a licence for the provision of emergency medical care in the Defence Forces, the location and statutes of the structural unit of the Defence Forces and the name of its superior government agency;
  • list of the health services that an activity licence is applied for;
  • upon application for an activity licence, the written consents of the health care professionals to commence work at the health care provider applying for the activity licence except in case of application for a licence for the provision of general medical care based on a practice list of a family physician;
  • upon application for a licence for the provision of emergency medical care by a state rescue service agency, the seat of the agency, the number of registration in the state register of state and local government agencies, the statutes and the name of its superior government agency;
  • upon application for a licence for the provision of emergency medical care, the number, staff and equipment of ambulance crews being applied for;
  • upon application for a licence for the provision of specialised inpatient care, the type of hospital being applied for;
  • upon application for a licence for the provision of independent inpatient nursing, the name, personal identification code and contact details of the consulting physician;
  • the part of the plan pertaining to the medical technology of facilities which contains information on the facilities, installations and equipment; the requirements have been set forth for each type of service (please refer to Requirements for the applicant);
  • information concerning registration of processing of sensitive personal data with the data protection supervision authority;
  • information concerning compliance with the requirements set for data exchange with the Health Information System.

Health services may be provided in a building or premises, which have been granted a relevant permit. The existence of such a permit can be checked from the construction works register.

You can submit the application:

Payment of the state fee

Before submitting the application, the applicant must pay the state fee in the following amounts:

  • 145 euros for an activity licence for the provision of general medical care based on a family physician’s practice list per each place of business;
  • 195 euros for an activity licence for the provision of emergency medical care per each service area;
  • 145 euros for an activity licence for the provision of specialised outpatient care per each place of business;
  • 87 euros for an activity licence for the independent provision of nursing per each place of business, except for independent inpatient nursing;
  • 145 euros for an activity licence for the independent provision of midwifery care per each place of business.

The state fee for the provision of specialised inpatient care is paid based on the type of hospital:

  • local hospital: 505 euros;
  • general hospital: 730 euros;
  • central hospital: 1050 euros;
  • regional hospital: 1,460 euros;
  • special hospital: 505 euros;
  • rehabilitation hospital: 505 euros.

If a new speciality of specialised medical care is added to an activity licence for the provision of specialised inpatient care or the place of provision of the health care services changes, a state fee of 145 euros shall be paid per each speciality but not more than the state fee rate provided by subsection 287 (2) of the State Fees Act for the corresponding type of hospital.

A state fee of 505 euros shall be paid for the review of an application for an activity licence for the independent provision of inpatient nursing.

A state fee of 13 euros shall be paid for the issue of a duplicate of an activity licence.

The state fee is paid to one of the bank accounts of the Ministry of Finance:

  • SEB Pank: EE891010220034796011 (SWIFT: EEUHEE2X);
  • Swedbank: EE932200221023778606 (SWIFT: HABAEE2X);
  • Danske Bank: EE403300333416110002 (SWIFT: FOREEE2X);
  • Nordea Bank: EE701700017001577198 (SWIFT: NDEAEE2X).

Reference number: 2900082333. The explanation should state the establishment for which the state fee is paid.

NB! Please check the payable state fee rate from the State Fees Act.

Processing of an application

An activity licence is adjudicated by the Health Board with an issue or refusal of an activity licence within 60 days as of the submission of the application.

The Health Board issues an initial response to the applicant within 3 working days as of the submission of the application with the following information:

  • the day of commencement of proceeding of the application;
  • the time limit for adjudication of the application;
  • the period of validity or maximum period of validity of the activity licence, if it is provided by law;
  • references to the economic activity requirements in the subject of review of the activity licence and the legal provisions containing the legal remedies that can be used by the undertaking for contesting the activity of the economic administrative authority.

If the service provider fails to submit some of the required data with the application, then the Health Board shall notify the service provider no later than on the working day following the day the deficiencies were discovered, stating the missing data, providing a reasonable time limit for their submission and explaining that failure to submit the data within the given time limit gives Health Board the right to dismiss the application.

The Health Board grants an activity licence without a term, unless law due to an overriding reason relating to the public interest prescribes the limitation of the term of validity or the service provider itself applies for it.

If a person entitled wishes to resume economic activities in the field of health services, then the person must apply for a transfer of an activity licence within 30 days after the arising of the right to resume economic activities. The transfer of an activity licence means the amendment of the addressee of the activity licence, for which an application must be submitted to the Health Board and a state fee must be paid according to the type of service.

Amendments to the circumstances of an activity licence

If you wish to change the conditions of an activity licence, then you must submit an application for the amendment of the licence.

You can submit an application for the amendment of an activity licence :

Suspension of an activity licence and termination of economic activity

If you wish to terminate activity in the field of health services, then please submit a written application to the Health Board. The application must state the reason for suspending/terminating the activity and the beginning and end of the suspension period.

You can submit the application:

If a provider of a service of vital importance wishes to at least partially or temporarily renounce the provision of services of vital importance, including renouncing the provision of services due to circumstances, which prevent it, then the Health Board must be notified at least three months in advance.

The Health Board may issue a precept to the provider of services of vital importance to continue to provide the services of for a period of up to nine months, if it is impossible or unreasonably expensive to obtain the service elsewhere during the period of renunciation.

Revocation of an activity licence

If you violate the conditions of an activity licence or legal requirements, then your activity licence will be revoked.

The Health Board revokes an activity licence on the following grounds:

  • the service provider intentionally submitted incorrect information in the application for an activity licence, which could affect the adjudication of the application, if, upon failure to submit such information, the grant of the activity licence should be refused;
  • renouncement of economic activities by the service provider. An activity licence is revoked for the area of activity, on which the service provider renounced economic activity, and in case of services of vital importance – only on a field of activity for which the service provider has submitted a notice on renouncement of provision of services of general interest;
  • the service provider is subject to a prohibition on economic activities on the appropriate area of activity imposed by a court judgment or pursuant to law, except for prohibitions on economic activities applied pursuant to the General Part of the Economic Activities Code Act;
  • based on an application of the holder of the activity licence, if the revocation is conditioned by an amendment of basic regulation of the activity licence.

The Health Board may also revoke an activity licence on the following grounds:

  • not commencing or not executing economic activities within two years after the issue of the activity licence; or in case of services of general interest – not commencing or not executing economic activities within 12 months after the issue of an activity licence or not commencing with the secondary conditions of the activity licence within the prescribed time limit;
  • severe violation of an economic activity requirement in the subject of review of the activity licence or a secondary condition of the activity licence;
  • significant damage or danger to public order is caused by the activity permitted by the activity licence, which was not known at the time of grant of the activity licence and which overrides the interest of the owner of the activity licence in continuing the activity and which cannot be eliminated by amending the activity licence;
  • the arising of a resolutive condition which has been imposed as a secondary condition of the activity licence and which serves as a prerequisite for the validity of the activity licence in the relevant area of activity;
  • a notice on renouncement of provision of services of general interest.

If an activity licence has been revoked during the preceding year because of violation of an economic activity requirement in the subject of review of the activity licence or a secondary condition of the activity licence, then the service provider must add a plan for compliance with diligence obligation to an application for an activity licence for the same activity. The plan of compliance with diligence obligation must demonstrate how the service provider plans to ensure the future fulfilment of economic activity requirements in the subject of review of the activity licence or secondary conditions of the activity licence, the violation of which was the cause for revocation of the previous activity licence.

Supervision

The supervision department of the Health Board exercises governmental supervision over the compliance with requirements for health service providers.

Contact information

Substantive information

Aivi Sagur

The Health Board, phone: +372 650 9865, e-mail aivi.sagur@terviseamet.ee

Last amended: 17-02-2017 11:01 | Compiled by: Health Board