Estonia: Health System Review.

This analysis of the Estonian health system illustrates recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In general, Estonia spends less per capita on health than the European Union average, although public expenditure has been growing steadily, with an increasing role of government budget transfers towards the social health insurance model. Despite these efforts, more than a fifth of current health expenditure comes from out-of-pocket payments, creating pressure to develop new and strengthen existing financial protection instruments. Life expectancy in Estonia has increased rapidly over the past decade, but not fast enough to meet the targets set in strategic documents. The first years of the COVID-19 pandemic were marked by a decline in life expectancy and high excess mortality, which set back progress. Despite this, Estonia's gains in population health were more pronounced in 2022. Overall, health inequalities between socioeconomic groups remain high, prompting policymakers to take steps to increase equity in access to care. The outstanding challenges for the Estonian health system include: addressing the shortage of primary and mental health experts, especially given the growing burden of chronic conditions and other needs of the ageing population; minimizing stark socioeconomic inequalities in health outcomes; renewing the outdated public health framework; and further improving integration and coordination of care and clinical decision-making.

Estonia: health system review

This analysis of the Estonian health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance.Without doubt, the main issue has been the 2008 financial crisis. AlthoughEstonia has managed the downturn quite successfully and overall satisfactionwith the system remains high, it is hard to predict the longer-term effects of theausterity package. The latter included some cuts in benefits and prices, increasedcost sharing for certain services, extended waiting times, and a reduction inspecialized care. In terms of health outcomes, important progress was made inlife expectancy, which is nearing the European Union (EU) average, and infantmortality. Improvements are necessary in smoking and alcohol consumption,which are linked to the majority of avoidable diseases. Although the healthbehaviour of the population is improving, large disparities between groupsexist and obesity rates, particularly among young people, are increasing. Inhealth care, the burden of out-of-pocket payments is still distributed towardsvulnerable groups. Furthermore, the number of hospitals, hospital beds andaverage length of stay has decreased to the EU average level, yet bed occupancyrates are still below EU averages and efficiency advances could be made. Goingforwards, a number of pre-crisis challenges remain. These include ensuringsustainability of health care financing, guaranteeing a sufficient level of humanresources, prioritizing patient-centred health care, integrating health and socialcare services, implementing intersectoral action to promote healthy behaviour,safeguarding access to health care for lower socioeconomic groups, and, lastly,improving evaluation and monitoring tools across the health system.

Estonia: health system review

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Estonia has vigorously and quite successfully reformed its health system over the last decades. Whereas incremental changes are observed in the last five years,larger scale legislative reforms had been implemented since the early 1990s and at the beginning of this century. The current system is built on solidarity based health financing; a modern provider network based on family-medicine centred primary health care (PHC); modern hospital services and more attention for public health. This has resulted in a steadily increasing life expectancy and continuously high population satisfaction rates with access and quality. However, as in any health system, a number of challenges remain. They include reducing inequities in health status and health behaviour; improving control of and responding to the consequences of the high rates of HIV andrelated conditions; improving regulation of providers to ensure better public accountability; and sustaining health expenditures and human resources on a level that ensures timely access and high quality of care. The last challenge isparticularly important in the face of rising patient expectations and increased costs and volume of health care services. If solidarity and equity are to be maintained and guaranteed for the future, additional resources need to be found from public sources of revenue.