1
THE ROLE OF ENTREPRENEURSHIP EDUCATION IN THE HEALTH CARE
SECTOR ON ESTONIA’S EXAMPLE
Epp Toh e -Bula s and Made To oko
Uni e si y o Ta u
Cen e o En ep eneu ship
Na a mn 4-B104
Ta u 51009
Es onia
epp_ b@u .ee
made. o oko @u .ee
2
Abs ac
The heal h ca e sec o is one o he mos p ominen economy sec o s in he Eu opean
Union. Demand o heal h ca e se ices is g owing due o longe li e expec ancies and
changed li es yles. Al hough a g ea sha e o heal h ca e p o essionals a e employees, many
also ope a e as en ep eneu s. Inc easing he sha e o en ep eneu s in he heal h ca e sec o is
one way o coping wi h an inc eased demand o heal h ca e se ices, educing he p essu e
on s a e budge and ensu ing a sus ainable heal h ca e sys em.
This a icle iews he ole o en ep eneu ship educa ion in he heal h ca e sec o on Es onia’s
example. The a icle s a s ou wi h an o e iew o he cu en s a e o a ai s in Es onia’s
heal h ca e sec o . I hen p oceeds o iew how a ious subg oups o heal h ca e
p o essionals in Es onia ela e o en e p ise and desc ibes he ole o en ep eneu ship
educa ion in he aining o heal h ca e specialis s.
In oduc ion
The heal h ca e sec o is one o he mos p ominen economy sec o s in he Eu opean
Union, employing a ound en pe cen o he EU’s wo k o ce (EC 2008b). Demand o heal h
ca e se ices is g owing. On he one hand, i is ela ed o an inc eased a e age li e
expec ancy. Acco ding o he Eu opean Commission, he amoun o 65-yea olds and olde
will g ow by 70% by 2050 in he EU (EC 2009). This also means ha he e will be mo e
people wi h ch onic diseases o disabili ies in need o long- e m ca e. Changes in he s uc u e
o he mode n amily also inc ease demand o o mal ca e se ices.
On he o he hand, inc eased wel a e also aises demand o heal h ca e se ices. People
can spend hei money on se ices ha hey could no a o d in he pas . Technological
de elopmen and o e abundance and apid sp ead o in o ma ion ha e changed he na u e o
heal h ca e se ices.
An ou look o a longe and weal hie li e oge he wi h pe sis en na ional heal h
p omo ion campaigns ha e conside ably inc eased he heal h awa eness o ci izens in
de eloped coun ies. In addi ion o imp o ed heal h beha iou , heal h awa eness also means
highe expec a ions o he medical sys em and p e en ion, diagnos ics and ea men o heal h
p oblems. In o he wo ds, no only he elde ly bu he en i e popula ion need mo e heal h ca e
se ices.
Such a si ua ion poses majo challenges o Eu opean heal h ca e sys ems: hey need o
sa is y an e e -g owing demand o heal h ca e se ices while he amoun o wo king-age
popula ion is dec easing and heal h ca e cos s cons i u e an e e -g ea e sha e o s a e
budge s. The e is a se ious deba e on how o adap heal h ca e sys ems so ha hey would
espond o he needs o he popula ion and emain sus ainable. We need o bea in mind ha
ageing popula ion also means aging heal h ca e wo ke s. We will need a su icien amoun o
young specialis s when he p esen heal h ca e wo ke s e i e. In o de o ain new specialis s
we will need o e alua e which skills hey need conside ing social changes, ageing
popula ion, people’s inc eased mobili y and apid echnological de elopmen .
Heal h ca e used o e e o ea men o heal h p oblems. Today he heal h ca e sec o is
seen, mo e holis ically, o encompass he en i e heal h ca e and medical ca e sys em o heal h
3
p omo ion, p e en ion o diseases and medical ea men . Due o lack o esou ces he
emphasis is shi ing mo e o p omo ing heal h and ac i e ageing. The impo ance o public
heal h is inc easing and so is he ole o heal h p omo ion specialis s. Scien i ic and
echnological de elopmen gi es bi h o new p o essions in he ields o biomedicine, gene
echnology and e-heal h.
Inc eased demand o heal h ca e se ices also means oppo uni ies o job-c ea ion and
en e p ise. Al hough a g ea sha e o heal h ca e p o essionals a e employees, se e al
specialis s (e.g. amily doc o s, den is s, psycho he apis s and psychologis s) o en ope a e as
en ep eneu s. En e p ise is seen as an impo an d i e o economic g ow h and inno a ion
in he EU. Tha is why he EC is commi ed o suppo ing and de eloping en ep eneu ship in
all ields o economy, including he heal h ca e sec o . En ep eneu ship educa ion is opical
in all EU membe s a es (EC 2006). Inc easing he sha e o en ep eneu s in he heal h ca e
sec o is seen as one way o coping wi h an inc eased demand o heal h ca e se ices,
educing he p essu e on s a e budge and ensu ing sus ainable heal h ca e sys ems.
This a icle iews he ole o en ep eneu ship educa ion in he heal h ca e sec o on
Es onia’s example. The a icle s a s ou wi h an o e iew o he cu en s a e o a ai s in
Es onia’s heal h ca e sec o . I hen p oceeds o iew how a ious subg oups o heal h ca e
wo ke s in Es onia ela e o en e p ise and desc ibes he cu en si ua ion o en ep eneu ship
educa ion in he aining o heal h ca e specialis s.
Heal h sec o in Es onia
A e se e al ounds o e o ms, Es onia’s heal h ca e sys em de eloped in i s p esen
o m by 2002. The heal h ca e sys em is s ee ed by he Minis y o Social A ai s (MSA). The
o ganisa ional s uc u e o he heal h ca e sys em is complex, s a ing wi h se e al ins i u ions
go e ned by he MSA (S a e Agency o Medicines, Heal h Boa d, Na ional Ins i u e o
Heal h De elopmen , Heal h P o ec ion Inspec o a e), public ins i u ions (Es onian Heal h
Insu ance Fund), hospi als and p ima y heal h ca e ins i u ions ha ope a e acco ding o he
p i a e law, and ending wi h a numbe o NGOs and p i a e associa ions.
Es onia’s heal h ca e sys em is mainly unded om he social ax, elying on he p inciple
o solida i y. Social ax is collec ed as an ea ma ked heal h insu ance ax and accoun s o
almos wo hi ds o he o al heal h ca e cos s. P i a e sec o spending accoun s o almos a
qua e o all heal h ca e cos s, mainly h ough cos -sha ing upon pu chasing medicines and
den al ca e se ices.
The main buye o heal h ca e se ices o he insu ed is he Es onian Heal h Insu ance
Fund. The heal h insu ance sys em is obliga o y and co e s 94% o he popula ion (Ees i
Haigekassa 2011). The heal h insu ance ax is pa o he social ax and is ied o employmen .
A he same ime, almos hal o he insu ed popula ion (child en and pensione s) a e exemp
om he ax, which in a longe un may pose a h ea o he sus ainabili y o he unding o he
heal h ca e sys em. As he na ow e enue basis is mainly ied wi h sala ies, employmen has
a di ec impac on how well he heal h ca e sys em wo ks.
Es onia has a well-de eloped in as uc u e o gene al medical ca e elying on amily
doc o s and nu ses. Gene al medical ca e is suppo ed by eme gency medical ca e a ailable
all o e Es onia. High- ech medical aid is a ailable in designa ed heal h ca e ins i u ions.
4
Some o he bigges p oblems o he popula ion a e long wai ing lis s in ou -pa ien ca e and
he o e all a ailabili y o heal h ca e se ices (incl. home nu sing, physio he apy) due o a
es ic ed ange o p ima y ca e se ices and lack o quali ied specialis s especially in he
pe iphe y (Koppel 2008).
The p o ision o heal h ca e se ices is almos en i ely decen alised. The law egula es
ou ypes o heal h ca e se ices: gene al medical ca e p o ided by amily doc o s,
eme gency medical ca e, specialised medical ca e and nu sing ca e. All se ice p o ide s
ha e he legal igh o ope a e acco ding o he p i a e law. Mos hospi als a e ei he public
limi ed companied owned by local municipali ies o ounda ions owned by he s a e, local
municipali ies o o he public ins i u ions. Mos ou -pa ien ca e p o ide s a e p i a ely
owned. All amily doc o s a e ei he en ep eneu s (sel -employed) o employees in
companies (owned by amily doc o s).
P i a e companies play a bigge ole in p o iding mos o he ou -pa ien specialised ca e
se ices, such as gynaecologic, psychia ic and o hopaedic se ices. They also p o ide den al
ca e and plas ic su ge y.
In he public heal h sec o he pic u e is agmen ed. Mos o ganisa ions a e non-p o i able
o ounda ions, mainly p ojec -based. Al hough se e al o ganisa ions p o ide simila se ices
o simila a ge g oups (e.g. HIV/AIDS ela ed se ices), collabo a ion and coo dina ion a e
poo . (Koppel 2008)
A numbe o uni e si ies and o he R&D ins i u ions a e in ol ed in heal h ca e R&D.
The e a e ou compe ence cen es in Es onia consis ing o high-le el esea ch g oups ha
ocus on heal h ca e. Funding comes om he EU’s s uc u al unds. The la ges hospi als also
do R&D. In 2001 he go e nmen ounded he Es onian Genome Cen e o os e gene
esea ch, ga he da a on heal h and he edi a y ac o s o he popula ion and apply he esul s
o gene esea ch o imp o e public heal h. In 2007 he Es onian Genome Cen e was joined
wi h he Uni e si y o Ta u. Cu en ly he Genome Cen e s o es a ound 51,500 human gene
samples ha a e used in in e na ional esea ch p ojec s (Ees i Geeni a amu 2011).
Es onia has made ema kable p og ess in e-heal h. Acco ding o he concep o e-heal h,
all and any in o ma ion on a pa ien needs o be cen ally adminis a ed and a ailable o he
pa ien o o medical s a upon a ele an eques . IT-de elopmen s a ed al eady in he
beginning o he 1990s. In 2009 he Es onian Heal h In o ma ion Sys em (EHES) was
launched wi h a suppo i e legal amewo k. EHES s ands on ou pilla s – elec onic medical
his o y, elec onic egis a ion, elec onic image deposi o y and elec onic p esc ip ions. Wi h
i s se ice-based s uc u e and s anda dised da abase he sys em is unique in he whole wo ld.
I enables o p o ide new digi al heal h ca e se ices o bo h ci izens and se ice p o ide s.
(Ees i Haigekassa 2011)
Human esou ces a e a weak poin o Es onia. Compa ed o he EU’s a e age, Es onia
has a ela i ely small numbe o heal h ca e p o essionals, bo h in absolu e and ela i e e ms.
In 2009 he e we e 4,274 medical doc o s in Es onia, i.e. 319 doc o s pe 100,000 ci izens.
The e we e almos wice as many nu ses – 645 nu ses pe 100,000 ci izens. (Aa iksoo 2010)
I is impo an o ake a look a age aspec . In he 1990s, uni e si ies lowe ed admission
quo as o doc o and nu se s uden s. This oge he wi h he ou low o medical s a om
Es onia has c ea ed a si ua ion whe e he e is a conside able disp opo ion be ween e i ing
medical wo ke s and hose needed o eplace hem. Ve y many nu ses change ca ee s (e.g.
5
s a wo king in he wel a e se ices). Also, nu sing is no e y popula and he e has been a
sha p all in he numbe o nu se s uden s. Despi e all e o s made (including mo e unding)
he amoun o new nu ses is no su icien . (Aa iksoo 2010)
In Es onia, he e m heal h ca e p o essional mos ly e e s o he heal h ca e p o essionals
lis ed he Heal h Ca e Se ices O ganisa ion Ac , i.e. medical doc o s, den is s, nu ses and
midwi es egis e ed in he Es onian Heal h Boa d (Te ishoiu eenus e ko aldamise seadus
2001). Public heal h specialis s a e o en disca ded. The same applies o ela i ely new
in e disciplina y heal h ca e p o essions ha ha e eme ged hanks o he apid scien i ic and
echnological de elopmen in he ield o biomedicine, gene echnology and e-heal h. The
heal h ca e sys em should be iewed mo e in eg ally. Di e en ields such as clinical
medicine, public heal h, biomedicine and e-heal h should be iewed oge he as hey a e
igh ly in e linked (Ta u Ülikool 2010). Un o una ely Es onia is lacking a ho ough analysis
on which and how many heal h ca e specialis s a e needed.
Sca ci y o quali ied heal h ca e p o essionals may se iously hinde Es onia’s de elopmen
in mid- e m. Ano he p oblem is how o ensu e sus ainable unding o he heal h ca e sys em
in he ligh o he ageing popula ion. The heal h ca e sys em needs mo e human and inancial
esou ces. One solu ion would be o acili a e en e p ise in he heal h ca e sec o and he eby
inc ease bo h human and inancial esou ces.
Oppo uni ies o En e p ise in Es onia’s heal h ca e sec o
Acco ding o S a is ics Es onia, 1,014 companies ope a ed in he heal h ca e sec o in
2008, which is 1.9% o he o al numbe o en e p ises in Es onia. In 2003-2007 he numbe
o en e p ises in he heal h ca e sec o inc eased ca 40%, wi h an a e age g ow h a e o 8.8%
a yea . This means ha new companies keep eme ging. In 2008 he heal h ca e and social
wel a e sec o s p oduced 3.3% o he GDP and employed 4.7% o he wo k o ce. The sec o s’
con ibu ion o he sales e enue and p o i o Es onian en e p ises was a he ma ginal,
espec i ely 0.8% and 0.6%. (Aa iksoo 2010)
Conside ing he ongoing social p ocesses, Es onia’s small size and sca ci y o human and
ma e ial esou ces, i is impo an o inc ease he ole o knowledge based economy in Es onia
o ensu e sus ainable economic de elopmen (EC 2007). Heal h ca e is clea ly a science and
echnology in ensi e ield o economy, and i is he e o e c ucial ha esea ch and
de elopmen esul s on heal h ca e be ans e ed o en e p ise as quickly as possible. The
impo ance o R&D in he heal h ca e sec o is emphasised also in he Es onian R&D and
inno a ion s a egy o 2007-2013 “Knowledge based Es onia”. (Ha idus- ja
Teadusminis ee ium 2007).
Because he domes ic ma ke is small, Es onia needs o de elop new indus ial and se ice
sec o s wi h s ong expo based g ow h po en ial and added alue o boos i s economy.
Looking a he o e all s uc u e o Es onia’s heal h ca e sys em, he sec o ’s ad anced
echnological esou ces, skilled wo k o ce and p ice ad an ages ha will no disappea any
ime soon, Es onia has qui e a po en ial o expo heal h ca e se ices.
Acco ding o a su ey on he expo oppo uni ies o heal h and wellness se ices in
Es onia conduc ed by he Es onian De elopmen Fund, he ollowing ields ha e s ong
expo po en ial: labo a o y diagnos ics, medical examina ions, den al ca e, acial and jaw
6
su ge y, sana o iums, plas ic su ge y, o hopaedics, adiology, in e ili y ea men and eye
su ge y (Aa iksoo 2010).
Expo po en ial also lies in such in e disciplina y ields as biomedicine and e-heal h.
When looking a he in es men s made in o and e sa ile uses o bio echnology
wo ldwide, we can p edic ha in a couple o decades, bio echnology will be he base
echnology implemen ed in i ually all ields o economy and li e, including medicine. The
bigges bene icia y o bio echnology has, o decades, been he pha maceu ical indus y
whose de elopmen is now mainly a ec ed by inc eased heal h ca e cos s, eme gence o
pe sonal medicine and inc eased cos s in de eloping new medicines. (Kukk, T u e 2008)
Al hough Es onia lacks a pha maceu ical indus y, mos domes ic bio echnology
companies s ill ocus on biomedicine and wo k on diagnos ics and d ug de elopmen , usually
as subcon ac o s o ex e nal cus ome s. Usually hese companies a e small, wi h less han 50
employees. Howe e , hese small en e p ises ha e e y high R&D po en ial. As Es onian
biomedicine companies a e s ill aking baby s eps, he numbe o pa en applica ions is small
and business models usually ely on he p o ision o se ices.
Acco ding o he Es onian R&D and inno a ion s a egy o 2007-2013, bio echnology is
one o he h ee p io i y echnologies suppo ed by he s a e, which also means ha mos o
he means ob ained om he EU s uc u al unds a e di ec ed in o bio echnology. Fo
example, ou ou o Es onia’s eigh echnology de elopmen cen es (TDC) – hese a e
esea ch ins i u ions de o ed o long e m coope a ion wi h uni e si ies and en e p ises and
unded by he Eu opean Regional De elopmen Fund – a e ela ed o bio echnology. The aim
o TDC-s is o boos Es onia’s economy ia immedia e implemen a ion o scien i ic esea ch
esul s in en e p ise.
The p oblem is ha mos s a e unding goes o undamen al and applied esea ch whe eas
p oduc de elopmen , ma ke ing and sales p omo ion ge only limi ed esou ces. A su ey
conduc ed among he CEO-s o bio echnology companies showed ha a c ucial bo leneck is
weak comme cialisa ion o new echnologies and lack o compe ence o in e na ional
ma ke ing, sales and echnology managemen . CEO-s hink ha uni e si y-b ed
bio echnologis s should acqui e addi ional skills such as bookkeeping, ma ke ing, p ojec
managemen , in ellec ual p ope y igh s, quali y managemen , e c. Company leade s also
need addi ional aining on business managemen . (Kukk, T u e 2008)
The o he ield men ioned abo e, e-heal h, uni es wo p io i y de elopmen a eas in
Es onia – R&D on heal h ca e and ITC. E-heal h has g ea de elopmen po en ial bo h on he
domes ic and ex e nal ma ke : digi al heal h ca e se ices a e seen in Eu ope as one o he key
solu ions o cu bing he g owing heal h ca e cos s ela ed o ageing popula ion and inc easing
numbe s o people wi h ch onic diseases. Acco ding o he EC’s guideline documen “Digi al
Agenda o Eu ope 2020“, digi al heal h ca e se ices help o gi e ci izens mo e say in
decisions ela ed o hei heal h, imp o e ea men quali y, educe ea men e o s and make
he heal h ca e sys em mo e e icien and sa e (EC 2010b). In i s communica ion
“Telemedicine o he bene i o pa ien , heal hca e sys ems and socie y” (EC 2008a), he
Eu opean Commission encou ages he membe s a es o make ex ensi e use o elemedicine.
The Es onian Heal h In o ma ion Sys em launched in 2009 wi h a suppo i e legal
amewo k is an excellen basis o de eloping and implemen ing new digi al heal h ca e
se ices o he bene i o public heal h. Some Es onian en e p ises ha e al eady managed o
7
success ully expo hei e-se ices. One example is Rain ee Es onia OÜ ha de elops
managemen so wa e o medical ins i u ions co e ing di e en b anches (physio he apy,
ba ia ics, paedia ics, adiology and oncology). The company has o e 2,000 cus ome s in he
USA and Canada (Rain ee Es onia 2011).
Di ec ions o en ep eneu ship educa ion in Es onia
Du ing he las decades, en ep eneu ship educa ion has ecei ed mo e and mo e a en ion
wo ldwide. I is pa ly so because o he disco e y ha he e is a posi i e co ela ion be ween
en ep eneu ship and economic g ow h (EC 2006). Mo eo e , social changes ha e al e ed he
na u e o wo king. Employees ha e mo e independence and eedom o decision in
pe o ming hei asks and hanks o p ojec based and ele-wo k he daily ac i i ies o many
wo ke s esemble hose o en ep eneu s. Unde s anding ole o en ep eneu ship educa ion
has also changed. When in he middle o he las cen u y emphasis lied wi h heo e ical
managemen ela ed knowledge, hen by oday he ocus has shi ed mo e owa ds he
de elopmen o pe sonal quali ies (Gibb 2005).
The co e o en e p ise is an en ep eneu ial pe son and hus eaching en ep eneu ship is
closely linked wi h de eloping en ep eneu ial spi i . En ep eneu ship, cha ac e ised by he
abili y o ini ia e, ac i eness, independence and inno a i eness in pe sonal, p o essional and
social li e, mo i a ion and pe sis ence in pu suing bo h pe sonal and p o essional goals, is –
acco ding o he Eu opean Pa liamen – one o he eigh key compe ences o li e-long lea ning
needed in knowledge based socie y (EC 2005).
An impo an goal o en ep eneu ship educa ion is o inc ease employmen . I is
especially opical oday wi h ala ming unemploymen a es in Es onia and he en i e EU. The
global economic c isis clea ly demons a ed he bene i s o good business managemen skills,
en ep eneu ial spi i and cou age, he abili y o see and make good use o he exis ing
oppo uni ies. The Eu opean Commission knows i oo: i op ed o a wise, sus ainable and
inclusi e s a egy o economic g ow h o su i e he economic ecession. Eu ope needs o
ake ull ad an age o i s wo k o ce po en ial o cope wi h ageing popula ion and inc easing
global compe i ion. People need o be able o acqui e new skills o swi ly adap o new
condi ions and possible ca ee changes. The EU’s s a egic documen s epea edly emphasise
he impo ance o eaching business managemen skills and en ep eneu ship. And i needs o
s a a an ea ly age. When pupils acqui e a posi i e a i ude owa ds en e p ise, business
managemen skills and en ep eneu ial spi i in school, hey a e mo e likely o become
en ep eneu s a e hei s udies. Howe e , new en e p ises and jobs a e no he only bene i s
o en ep eneu ship educa ion. En ep eneu ship is a c ucial quali y o anyone as i makes
people mo e c ea i e and con iden in hei pu sui s and helps hem o be mo e success ul in
he labou ma ke (EC 2010a).
Relying on he ecommenda ions o he Eu opean Pa liamen and Council o he EU o he
membe s a es acco ding o which he s a egy o li e-long lea ning should include access o
key compe ences o all ci izens, he Es onian Minis e o Educa ion and Resea ch (MER) and
Minis e o Economic A ai s and Communica ion (MEAC) signed a join decla a ion i led
“On he de elopmen o en ep eneu ial spi i and en ep eneu ship educa ion in he Es onian
educa ion sys em” in Oc obe 2007, ag eeing ha bo h minis ies will be in ol ed in
8
de eloping he espec i e plan. In Oc obe 2008 he En ep eneu ship Educa ion Think Tank
was c ea ed o he Es onian Chambe o Comme ce and Indus y ha s a ed wo king on a
p og amme o eaching en e p ise and en ep eneu ship in gene al educa ion schools in
Es onia. De eloping en ep eneu ship educa ion in Es onian highe educa ion ins i u ions
(non-economics p og ammes) is he esponsibili y o he en ep eneu ship educa ion wo king
g oup c ea ed by he MEAC in sp ing 2009. In addi ion o compiling p og ammes o
en ep eneu ship educa ion, he wide goal o bo h wo king g oups is o os e en ep eneu ial
a i ude on s a e, egional and indi idual le el.
Since 2006 he na ional cu icula o all speciali ies in Es onian oca ional schools need o
con ain an obliga o y module o en ep eneu ship educa ion (40 s udy hou s).
En ep eneu ship educa ion was also in oduced as an elec i e in he na ional cu iculum o
seconda y school ha en e ed in o o ce in Sep embe 2010. Mo eo e , en ep eneu ship is
one o he ecu ing hemes al eady in he basic school.
Se e al na ional and EU inanced p og ammes o p o iding en ep eneu ship educa ion
o adul s ha e been launched. Fo example, egional de elopmen cen es o e basic aining
o s a -ups and ee counselling o new en ep eneu s. Founda ion En e p ise Es onia unde
MEAC o e s unding o he con inuing educa ion o en ep eneu s, manage s and
employees. Founda ions Inno e and A chimedes unde MER o e unding o he aining
and con inuing educa ion o en ep eneu ship educa ion eache s, compila ion o s udy
ma e ials and pa icipa ion in in e na ional collabo a ion ne wo ks. Se e al Es onian highe
educa ion ins i u ions and oca ional educa ion cen es, he Es onian Chambe o Comme ce
and Indus y, he Es onian Unemploymen Fund, aining companies and many o he
o ganisa ions o e aining cou ses on en ep eneu ship educa ion.
In he ligh o wha has been said so a , we can say ha eaching en ep eneu ship and
en e p ise in Es onia has had qui e a ake-o . Howe e , a na ional concep o
en ep eneu ship educa ion ha would encompass all educa ion le els and economic sec o s is
s ill missing. En ep eneu ship educa ion is o en hough o as some hing gene al. I is
o go en ha di e en a ge g oups need di e en app oaches. I is ue ha e e ybody needs
gene al economic and business ela ed knowledge, bu di e en a eas o specialisa ion ha e
di e en needs. Speci ic, ield- ela ed en ep eneu ial knowledge is wha is o en lacking.
Di e ences can be qui e big e en wi hin one sec o . Fo example, he heal h ca e sec o
co e s a ange o p o essions: gene al p ac i ione s and specialised doc o s, nu ses, midwi es,
den is s and o hodon is , chemis s and pha maceu is s, leade s o heal h ca e o ganisa ions,
adminis a i e and suppo pe sonnel, educa o s o heal h ca e p o essionals, medical s a is s,
e-heal h specialis s, p o ide s o addi ional and al e na i e heal h ca e se ices, e c. A g ea
pa o p o essionals, e.g. doc o s and nu ses in hospi als, a e employees and we end o hink
ha en ep eneu ship skills a e i ele an o hem. This, howe e , is a miscalcula ion,
conside ing ha he aim o en ep eneu ship educa ion is no only c ea e new en ep eneu s
bu also inc ease people’s en ep eneu ial spi i and c ea e a clea unde s anding o how
economic p ocesses ake place in oday’s wo ld. Ini ia i e, independence and inno a ion
oge he wi h adequa e knowhow on he unc ioning o he su ounding en i onmen help o
succeed ei he as an en ep eneu o an employee.
Conside ing ha he e a e se e al ypes o heal h ca e p o essionals depending on hei
wo k speci ics, each subg oup should be app oached di e en ly when p o iding
en ep eneu ship educa ion. Fi s , we mus ind ou he needs and expec a ions o each a ge
9
g oup and hen de e mine he ex en and me hods o en ep eneu ship educa ion in o de o
each he goals se in he bes possible way.
Heal h ca e p o essionals and en e p ise
Pu suan o he Heal h Ca e Se ices O ganisa ion Ac , amily doc o s p o iding gene al
medical ca e a e p i a e owne s and may ac as sole-p op ie o s o ound a business
associa ion o p o iding gene al medical ca e. Acco ding o he law, amily doc o s may
p o ide he ollowing se ices: gene al medical ca e, independen ly p o ided nu sing aid,
social se ices and heal h ca e educa ion and esea ch. Family doc o s pe o m he ollowing
asks: heal h p omo ion, p e en ion o diseases, medical inspec ion, indi idual heal h
educa ion, medical ad ice, immunisa ion, sc eening, diagnos ics and ea men o illnesses,
e e al o ac i e ea men and ehabili a ion in collabo a ion wi h specialised doc o s, nu ses,
midwi es, social wo ke s and local municipali ies. Family doc o s a e also esponsible o
pape -wo k ela ed o he p o ision o heal h ca e se ices. All amily doc o s need o wo k
wi h a leas one amily nu se. (Koppel 2008)
Family nu ses pe o m he ollowing asks: moni o ing he men al and physical
de elopmen o heal hy in an s and child en and pe o ming egula examina ions; ad ising
pa en s and amilies on child hygiene, ca e, physical ac i i y, p e en ion o diseases and die ;
ad ising pa ien s on amily planning and sexual heal h; moni o ing no mal p egnancy;
ad ising p egnan women on die and physical ac i i y; p epa ing u u e moms and dads o
labou and pa en hood; moni o ing he heal h o he elde ly and ad ising hem on heal h and
age ela ed issues; o de ing and disposing o accines, immunisa ion, keeping ack o
immunisa ion plans; de e mining he needs o nu sing aid and compiling nu sing aid plans;
p o iding ou -pa ien and home nu sing aid; was e disposal. (Koppel 2008)
So amily heal h cen es no mally ha e amily doc o s as en ep eneu s and amily nu ses
as employees. While amily doc o s as en ep eneu s a e in compelling need o business
managemen skills, amily nu ses also need o ha e an unde s anding o how a business
wo ks, as due o limi ed human esou ces amily nu ses some imes need o ul il he asks o
amily doc o s o keep he p ac ice unning smoo hly.
P o ide s o ou -pa ien specialised medical ca e can be ei he business associa ions o
sole-p op ie o s. Specialised medical ca e is p o ided in heal h cen es, hospi als’ ou -pa ien
depa men s and p i a e p ac ices. In-pa ien ca e is p o ided in hospi als ha ope a e
acco ding o p i a e law. Al hough Es onian hospi als a e owned by he public sec o , hei
managemen s yle is ha o he p i a e sec o . This has c ea ed a amewo k whe e hospi als
a e managed like ne wo ks o in eg a ed se ice p o ide s, i.e. hey a e eal economic uni s
whe e manage s mus ensu e adhe ence o good medical p ac ice as well as e icien
economic ac i i y. (Koppel 2008) This makes he wo k o hospi al and heal h cen e manage s
simila o en ep eneu s. The medical s a has con ac s wi h he hospi als, which makes hem
employees.
The numbe o public heal h se ice (e.g. ad ice on cessa ion o smoking, p e- and pos -
p egnancy moni o ing, medical se ices o young a hle es) p o ide s is limi ed. The Na ional
Ins i u e o Heal h De elopmen , esponsible o implemen ing na ional public heal h
se ices, does no pe o m all asks i sel . Ins ead i delega es ce ain asks o non-p o i
16
inima engu a uanne 2008, ed Ees i Koos öö Kogu, 12-13. Ees i Eksp essi Ki jas use AS.
Ees i Geeni a amu. (2011) Homepage. [h p://www.geeni a amu.ee/].
Ees i Haigekassa (2011) Ees i Haigekassa majandusaas a a uanne 2010. Tallinn.
[h p://www.haigekassa.ee/uploads/use iles/HK_majandusaas a_a uanne_2010.pd ].
Ees i S a is ikaame . (2011) [h p://www.s a .ee/pohinai ajad], 10.06.2011.
Eu opean Commission. (2010a) Eu oopa 2020. aas al. A uka, jä kusuu liku ja kaasa a
majanduskas u s a eegia. COM (2010) 2020. B üssel. [h p://ec.eu opa.eu/eu2020/
pd /1_ET_ACT_pa 1_ 1.pd ].
Eu opean Commission. (2010b) Digi al Agenda o Eu ope 2020. COM (2010) 245.
[www.ec.eu opa.eu/in o ma ion_socie y/digi al-agenda].
Eu opean Commission. (2009) Te is-EL. Eu oopa Liidu ah a e ise po aal.
[h p://ec.eu opa.eu/heal h-eu/my_heal h/elde ly/index_e .h m].
Eu opean Commission. (2008a) Communica ion om he Commission o he Eu opean
Pa liamen , he Council, he Eu opean Economic and Social Commi ee and he
Commi ee o he Regions on elemedicine o he bene i o pa ien s, heal hca e sys ems
and socie y. COM (2008) 689). [h p://www.ep ac ice.eu/ iles/media/media2333.pd ].
Eu opean Commission. (2008b) G een Pape On he Eu opean Wo k o ce o Heal h.
COM (2008) 725. [h p://ec.eu opa.eu/heal h/ph_sys ems/docs/wo k o ce_gp_en.pd ].
Eu opean Commission. (2007) Majanduskeskkonna a endamise akenduska a. COM
(2007) 4694.
[h p://www.s uk uu i ondid.ee/public/suunised/majanduskeskkonna_OP_o sus.pd ].
Eu opean Commission. (2006) Implemen ing he Communi y Lisbon P og amme: Fos e ing
en ep eneu ial mindse s h ough educa ion and lea ning. COM (2006) 33. [h p://eu -
lex.eu opa.eu/LexU iSe /si e/en/com/2006/com2006_0033en01.pd ].
Eu opean Commission. (2005) P oposal o a ecommenda ion o he Eu opean Pa liamen
and o he Council on key compe ences o li elong lea ning. COM (2005) 548. B ussels.
h p://ec.eu opa.eu/educa ion/policies/2010/doc/key ec_en.pd
Eu os a . (2011)
[h p://epp.eu os a .ec.eu opa.eu/ gm/ able.do? ab= able&language=en&pcode= eilm020
& ableSelec ion=1&plugin=1]
Eu os a . (2008)
[h p://epp.eu os a .ec.eu opa.eu/po al/page?_pageid=1090,30070682,1090_33076576&_
dad=po al&_schema=PORTAL].
Gibb, A. (2005) “The u u e o en ep eneu ship educa ion – De e ming he basis o cohe en
policy and p ac ice? The Dynamics o Lea ning En ep eneu ship in a C oss-Cul u al
Uni e si y Con ex ”. Edi . by Ky ö, P. and Ca ie , C. En ep eneu ship Educa ion Se ies
17
2/2005: 44–67.
Ha idus- ja Teadusminis ee ium. (2007) Teadmis epõhine Ees i. Ees i eadus- ja
a endus ege use ning inno a siooni s a eegia 2007-2013. Ta u.
Kukk, P., T u e, E. (2008) Ees i bio ehnoloogia s a eegia 2008-2013. Tallinn: Ees i
Bio ehnoloogia Lii
Koppel, A., Kahu , K., Habich , T., Saa , P., Habich , J., an Ginneken, E. (2008) “Ees i
e isesüs eemi üle aade”. Te isesüs eemid muu us es 10(1).
[h p://ee.eu o.who.in /HIT_ aama _2008.pd ].
Majandus- ja Kommunika siooniminis ee ium. (2009) E e õ lusõpe Ees i kõ gkoolides.
Majandus- ja Kommunika siooniminis ee iumi e e õ lusõppe öö ühma koos a ud apo
ja ege uska a aas a eks 2010-2013. [h p://www.mkm.ee/public/E e o lusoppe_
apo _ ege uska a.pd ].
Rain ee Es onia. (2011) Homepage.
[h p://www. ain ee.ee/index.php?op ion=com_ on page&I emid=1]
Ta u Ülikool. So siaal eaduslike akendusuu ingu e keskus. (2010) Riikliku e ishoiu
eadus- ja a endus ege use p og ammi oe a uu ing. Ta u.
[h p://a chimedes.ee/ eadus/File/HTM_ e ishoid_ apo .pd ].
Te ishoiu eenus e ko aldamise seadus. (2001), Riigi Tea aja,
[h ps://www. iigi ea aja.ee/ak /965572?leiaKeh i ].
