Dear Katarzyna Wroblewska,

Thank you for reaching out and for your thoughtful questions regarding the legal framework applicable to healthcare providers in Estonia.

To address your inquiries, please find our clarifications below:

1. 1. Do state-owned/public hospitals in Estonia hold a medical license or other form of healthcare operating authorization issued by the relevant Estonian authority?

Yes. Under the Estonian Health Services Organisation Act (Tervishoiuteenuste korraldamise seadus, TTKS), healthcare services may only be provided on the basis of an activity licence issued by the Estonian Health Board (Terviseamet). This requirement applies to all healthcare providers irrespective of their legal form or ownership.

The activity licence authorises the provider to deliver healthcare services at the location and within the scope specified in the licence. Information on all licensed healthcare providers is publicly available in the Estonian Health Board's public register (MEDRE): https://medre.tehik.ee.

1. 2. Are hospitals in Estonia required by law to maintain professional liability (medical malpractice) insurance?

Yes. As of 1 November 2024, all healthcare providers holding an activity licence under the Health Services Organisation Act are required to maintain compulsory liability insurance (also referred to as patient insurance). Pursuant to § 4(1) of the Healthcare Provider's Compulsory Liability Insurance Act (Tervishoiuteenuse osutaja kohustusliku vastutuskindlustuse seadus, TOKVS), all licensed healthcare providers, whether legal entities or sole proprietors, must conclude a liability insurance contract covering all of their valid activity licences (TOKVS § 6(2)).

1. 3. Are private physicians and dentists required by law to carry professional liability (medical malpractice) insurance in order to practice?

Yes, with the following clarification: under the TOKVS, the obligation to maintain liability insurance applies to the healthcare provider holding the activity licence, i.e. the legal entity or sole proprietor, rather than to each individual practitioner personally. Accordingly, private physicians and dentists who operate as licensed healthcare providers themselves (either as sole proprietors or through their own company) are required to conclude a liability insurance contract. Physicians and dentists employed by a licensed healthcare provider (for example, a clinic or hospital) are covered by the compulsory liability insurance maintained by their employer and are not required to obtain separate individual insurance.

1. 4. Legal basis

The legislation is available in Estonian in the official online publication Riigi Teataja:

• * Healthcare Provider's Compulsory Liability Insurance Act (TOKVS): https://www.riigiteataja.ee/et/akt/121062024030?leiaKehtiv
• * Health Services Organisation Act (TTKS): https://www.riigiteataja.ee/et/akt/110072012005?leiaKehtiv

English translations of Estonian legislation are available at https://www.riigiteataja.ee/en. Please note that in the event of any discrepancies, the Estonian text prevails.

Further guidance is available on the websites of the Ministry of Social Affairs (www.sm.ee/patsiendikindlustus) and the Health Board (www.terviseamet.ee/patsiendikindlustus).

Should you require further information, please do not hesitate to contact us.

Kind regards