Can people afford to pay for health care? New evidence on financial protection in Estonia 2023

ABSTRACT

This review is part of a series of country-based studies generating new evidence on financial protection – affordable access to health care – in health systems in Europe and central Asia. Financial protection is central to universal health coverage and a core dimension of health system performance assessment. Financial protection improved in Estonia between 2015 and 2020, reflecting positive changes in coverage policy and other factors. However, catastrophic health spending continues to be higher in Estonia than in many European Union countries – mainly driven by out-of-pocket payments for outpatient medicines and dental care – and is heavily concentrated among households with low incomes. Levels of unmet need for health care are also well above average for the WHO European Region, reflecting long waiting times for specialist care. Gaps in all three dimensions of health coverage undermine financial protection in Estonia and systematically affect households with low incomes. Linking entitlement to payment of contributions leaves 10% of working-age people without coverage. The benefits package – while quite broad – provides limited coverage of adult dental care. The Government has tried to protect people from co-payments for outpatient prescribed medicines and dental care but these efforts have not been sufficient for people with lower incomes. To improve financial protection, Estonia can change the basis for entitlement to residence; increase and fine-tune benefits to better target those in most need; reduce out-of-pocket payments in long term health care; and increase protection from all co-payments, especially for households with low incomes.