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and other needs of the ageing population; minimizing stark socioeconomic inequalities in health outcomes; renewing the outdated public health framework; and further improving integration and coordination of care and clinical decision-making.

Eesti: tervisesüsteemi ülevaade

Eesti tervisesüsteemi analüüs käsitleb viimast arengut tervisesüsteemi korralduses,juhtimises ja rahastamises, tervishoiuteenuste osutamises, tervisesüsteemireformides ja tulemuslikkuses. Eesti valitsus astus 2017. aastal ajaloolisesammu ja laiendas tervisesüsteemi tulubaasi, mis on pikka aega olnudprobleem. Lisanduv raha on protsendina SKPst siiski väike ning pikaajalisestabiilsuse saavutamine võib endiselt jääda probleemiks. Kui lisaraha investeeritaksetargalt, võib see tervisesüsteemi täiustamisele positiivselt mõjuda.Ehkki Eestis on paljud tervisenäitajad oluliselt paranenud (nt oodatava elueasuurim pikenemine kõigist ELi riikidest, välditava suremuse oluline vähenemine),on nii mõndagi veel saavutada. Näiteks tuleks ületada suured erinevusedsotsiaal-majanduslike rühmade tervises, parandada elanikkonna kindlustuskatet,koostada põhjalik kava tööjõupuuduse lahendamiseks, pareminitegeleda kasvava hulga inimestega, kes põevad (mitut) mittenakkushaigust,ning paremini ära kasutada e-tervise süsteemi, eriti arstiabi integreerimiseksja kliiniliste otsuste tegemiseks. Kvaliteedi osas on tehtud suuri edusamme,kuid üldpilt on jätkuvalt ebaühtlane. Välditavate hospitaliseerimiste arv onüks Euroopa madalamaid astma ja kroonilise obstruktiivse kopsuhaigusepuhul, keskmine südamepuudulikkuse ja diabeedi puhul, kuid üks suuremaidkõrgvererõhktõve puhul. Lisaks on südameinfarkti ja insuldi 30-päevasesuremuse näitaja Eestis üks Euroopa halvimaid. Need tulemid viitavad sellele,et teenuste kvaliteedi ja ravi koordineerimise parandamiseks on veel paljuteha. Uuel rahvastiku tervise arengukaval, mis on praegu läbivaatamisel, ontulevaste reformide edukuses otsustav roll.

Estonia: health system review

This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In 2017, the Estonian government took the historic step of expanding the revenue base of the health system,which has been a longstanding challenge. However, in terms of percentage of GDP it remains a small increase and long-term financial sustainability could still pose a problem. That said, if these additional funds are invested wisely, they could play a positive role in further improving the health system. Indeed, although Estonia has made remarkable progress on many health indicators (e.g. the strongest gains in life expectancy of all EU countries, strongly falling amenable mortality rates), there are opportunities for improvements. They include overcoming the large health disparities between socioeconomicgroups, improving population coverage, developing a comprehensive plan to tackle workforce shortages, better managing the growing number of people with (multiple) noncommunicable diseases and further reaping the benefits of the e-health system, especially for care integration and clinical decision-making. Also in terms of quality, large strides have been made but the picture is mixed. Avoidable hospital admissions are among the lowest in Europe for asthma and chronic obstructive pulmonary disease (COPD), about average for congestive heart failure and diabetes, but among the worst for hypertension. Moreover, the 30-day fatality rates for acute myocardial infarction and stroke are among the worst in the EU. These outcomes suggest substantial room to further improve service quality and care coordination. The new NHP, which is currently being revised, will play a crucial role in the success of future reform efforts.