There are several contradictions regarding occupational health care in Estonia. Companies are increasing spending on improving the work environment to increase employee satisfaction and enhance employer reputation. On the other hand, medical examinations are considered low-value legal obligations. (1) Employers are willing to spend on office furnishings, because in return they receive something nice and tangible, for example, a soft armchair or a comfy bean bag. Spending on medical examinations often returns just some papers with a stamp and signature topped with a recommendation to visit the family physician, eat healthily, get a shoulder rub or take a few laps in the pool. Not exactly what’s expected in return for tens or hundreds of euros spent on every employee?!

Occupational medicine is in the process of evolving

First, we must understand what has caused such a difference in attitude towards medical examinations and work environment improvements. Such differences can be explained by the fact that in Estonia, occupational medicine is currently in the process of evolving. In the year 2004, the activities of the Estonian Center of Occupational Health were terminated. This meant that an institution responsible for coordinating and advising practical occupational health, suddenly lacked existence. As an outcome of this change, there was no more central institution to keep the practitioners of occupational health on an evidence-based track. In such a small country and sphere, a free market is not an appropriate solution, since occupational health is viewed as an additional obligation and spending money on stamped papers only seems excessive. The supervision of healthcare services is in the hands of the Health Board of the Republic of Estonia however, this is a difficult task in the context of lacking guidelines regarding occupational health care.

What has caused the medical examinations to become non-individualized?

Occupational health examinations are often practiced as a routine, assembly-line type of work. The main reason behind this is that employers wish to save money. In most cases, the occupational health physician did not visit the work environment since it costs extra. For some time, the occupational health physicians managed the risk assessments and employee interviews, but time after time they became more distant from the real work environment. If the occupational health physician is not familiar with the work environment, proper advice on necessary improvements cannot be given. This is one of the reasons why the outcome of health examinations is often some kind of banal recommendation, such as to visit the family physician or to continue monitoring the health. It is difficult to give proper recommendations without visiting the work environment.

Why have the contents of health examinations drifted away from evidence-based medicine?

Again, one of the main reasons is that employers wish to save money by picking the occupational health service provider with the lowest prices. Another reason is the public procurement procedure, where one of the evaluation criteria is the lowest price. Since occupational health in Estonia is solely based on private capital, occupational health clinics are forced to cope with the price pressure. Such pressure leads to less necessary tests and analyses, which are also often replaced with cheaper blood tests, that only create apparent value and are not relevant in the context of occupational medicine.

Why does being evidence-based matter in occupational health?

This is a question that should not be asked, since medicine that is not based on evidence, belongs to alternative medicine. Nobody wants a surgeon who is operating below contemporary standards. However, in occupational health, certain package deals have been developed, which do not take individual needs or workplace risks into account. Such tests and analyses are not scientifically justified since international research has found years ago that designating the same tests and analyses for everybody does not prevent sickness or death. Hence, most of the guidelines in occupational health are based on needs. Practicing evidence-based occupational medicine must include considering the patient’s individual risks and symptoms.

Evidence-based occupational health is cost-effective

The most important thing about a service, especially in healthcare, is that it should provide real value. Ineffective services are a useless waste of resources. Some services provided in healthcare are convenience or wellness services and their effectiveness is difficult to evaluate. For example, nail care can provide a visible result, but in the case of crystal therapy, the effect is in the mind. Evidence-based medicine uses tests and analyses, which have a scientifically proven dose and effectiveness. Choosing evidence-based occupational health means that the service provides maximal value and is always cost-effective.

How to measure the effectiveness of occupational health care?

Both quantitative and qualitative methods are used to evaluate the effectiveness of occupational health. (2) The most common quantitative methods used in healthcare are the DEA method and stochastic frontier analysis (SFA). (3) Usually, they are used to analyze big data. To evaluate the effectiveness of occupational health in one company, simpler methods can be used. A common question is where this company positions itself in its sector. Another common question is does the implemented changes and interventions affect the health and wellbeing of the employees. Different validated questionnaires can be used to compare the company with the population or sector average. Temporal trends can be assessed by measuring the parameters several times after certain periods.

Qualitative measurement of the effectiveness of occupational health over time

An option for qualitative measurement of effectiveness in occupational health is evaluating the achievement of agreed goals. For example, the employer and occupational health service provider agree on a goal of reducing the workers’ sick days one year after the health examinations. It is based on a presumption, that the number of sick days before the health examination is known, and the number of employees stays the same. Other factors that might influence the health and work ability of the employees, must also be considered. After one year, the results are analyzed together, new goals are set or health examinations enhanced.

Measuring the effectiveness of occupational health care can provide better results with the same resources

Measuring the effectiveness can help in directing the resources to activities, which maximize the effectiveness of occupational health and increase the value for both employers and employees. Not measuring the effectiveness of the service is like buying a pig in a poke. The company can spend more on improving the work environment, but it might not have a measurable effect. Medihub has been using several methods to measure the effectiveness of occupational health services and workplace interventions. For workplace assessment and measuring the effectiveness of occupational health interventions, ask for an offer here.


[1] Work Health Service research for the Estonian Ministry of Social Affairs.

Final report. 2020. (only in Estonian)

[2] Qualitative, Quantitative or Mixed: Which Is the Most Preferred for Healthcare Studies. July 2018. Advances in Intelligent Systems and Computing.

[3] A Systematic Review of Health Care Efficiency Measures. Health Serv Res. 2009 Jun; 44(3): 784–805.