Situation analysis on evidence-informed health policy-making: Estonia

The aim of the situation analysis is to provide deeper understanding of the major factors that may facilitate or hinder the evidence-informed health policy in Estonia. It was conducted based on the WHO situation analysis manual and it found that in order to ensure research use among policy-makers in a systematic way, a knowledge translation platform could be created. A knowledge translation platform is a national-level entity designed to create and nurture links among researchers, policy-makers and other research users. With the aim of using the available resources in the best possible ways in order to obtain good population health outcomes, the platform would support already existing practices in health policy-making with high-quality evidence and implementation considerations. It would support the work of policy-makers and focus on knowledge translation that will help to make evidence available in the policy-making process without limiting choices among decision-makers.

Eurohealth: health system developments in former Soviet countries

Nearly 25 years after the dissolution of the Soviet Union, all of the countries in the region are actively engaged in the process of reforming their health care systems, with various degrees of success. This issue’s Observer section looks in closer detail at the main challenges andachievements in the former Soviet countries. Eurohealth Observer - Primary care reforms in countries of the former Soviet Union, Challenges in specialized and inpatient services, Access to medicines, Reforming the Ukrainian health system, Challenges to universal coverage in Uzbekistan; Eurohealth International - Luxembourg Presidency health priorities; Eurohealth Systems and Policies - New strategies in care for older people (Denmark and Norway), Out-of-pocket payments (Netherlands), Access to long-term care services (Spain); and Eurohealth Monitor.

Out-of-pocket payments and health care utilization in Estonia, 2000–2012

This paper analyses out-of-pocket payments, their impact on catastrophic expenditures and impoverishment in Estonia from 2000 to 2012. Microdata from the Estonian Household Surveys collected by Statistics Estonia were used, complemented by utilization data from other studies. Statistical and econometric methods were applied. The results show that out-of-pocket expenditures peaked in 2006 and dropped thereafter. The decline is explained by the relative increase of pensions during the crisis years, promotion of generic drugs and reduced utilization of health care, especially dental care. Analysis of income-related inequalities in health care financing and utilization continues to show that for those services that are more dependent on out-of-pocket payments, there were either more inequalities in utilization, clearly demonstrated in adult dental care, or there was more risk of being pushed into poverty, such as in the case of spending on prescription and over-the-counter drugs by pensioners. Compared to previous studies, the impact of drug purchases on catastrophic expenditure has declined, which may be explained by both the changing attitudes towards cheaper drugs and increasing pensions relative to drug prices. Regarding the dental care, however, the picture is similar to earlier studies that high out-of-pocket payments cause low-income households to withdraw from the utilization of dental care services.

Võimalused Eesti tervisesüsteemi rahalise jätkusuutlikkuse tagamiseks: üks aasta hiljem

Käesolevas lühikeses dokumendis käsitletakse peamisi muutusi tervishoiu rahastamises alates 2009. aasta aprillist, mil alustasime algse aruande koostamist. Eesmärk ei ole hinnata 2010. aasta aru ande mõju, vaid vaadata üle areng nendes valdkondades, mille puhul aruandes leiti, et need võivad märkimisväärselt mõjutada tervisesüsteemi rahalist jätkusuutlikkust. Selline läbivaatamine on eriti vaja lik viimas tel aastatel Eestis toimunud majanduslike ja poliitiliste muutuste tõttu: Majanduskoostöö ja Arengu Organisatsiooni (OECD) liikmeks saamine, uue (kuid samas juba tuntud) valitsuse ametisse astumine ning kestvast majanduslangusest, kasvavast töötusest ja euroalaga ühinemisest tingitud eelarvesurve

Responding to the challenge of financial sustainability in Estonia’s health system: one year on

This brief document identifies the main changes to health financing policy since we began preparing the original report in April 2009. Its intention is not to measure the impact of the 2010 report, but to review progress in areas the report highlighted as likely to have a significant effect on the health system’s financial sustainability. Following up would be a useful exercise under most circumstances; in Estonia’s case it is particularly compelling due to the economic and political changes that have occurred in the last few years: joining the Organisation for Economic Cooperation and Development (OECD), the election of a new (but familiar) government and fiscal pressures created by a sustained recession, growing unemployment and entry to the Eurozone.

Võimalused Eesti tervisesüsteemi rahalise jätkusuutlikkuse tagamiseks: Kokkuvõte

Tervisesüsteemi rahaline jätkusuutlikkus on Eesti tervisepoliitika keskmes olnud alati, kuid hiljutine ¬nantskriis on tõstnud selle esmatähtsaks poliitiliseks küsimuseks mitte ainult Eestis, vaid kogu maailmas. Aruandes hinnatakse Eesti tervisesüsteemi toimivust ja selle rahalist jätkusuutlikkust. Analüüsitakse, kas praegune rahastamissüsteem on pikas perspektiivis (aastani 2030) elujõuline, ning pakutakse välja võimalusi rahastamispoliitika tõhustamiseks.

Responding to the challenge of financial sustainability in Estonia’s health system: executive summary

Health system financial sustainability has always been a central health policy issue, but the recent financial crisis has forced it to the top of the policy agenda the world over. With the aim of supporting a financially sustainable, high-performing health system, this report assesses health financing policy in Estonia. It looks at how well-placed current financing policy is to enable goal attainment in the medium-to-long term (to 2030) and identifies ways to strengthen financing policy.

Responding to the challenge of financial sustainability in Estonia's health system

Estonia explores how to move from values to action by implementing the Tallinn Charter: Health Systems for Health and Wealth. There are many options for change, but only some will help the health system to achieve its objectives. This report brings together the views and values of stakeholders, recent data on health financing and new revenue and expenditure projections from now to 2030.

National workshop with stakeholders to report back on the assessment results of the Environment and Health Performance Review in Estonia: Tallinn, Estonia, 17–18 February 2009: workshop report

Following the decisions of the Fourth Ministerial Conference on Environment and Health (Budapest, 2004),the WHO Regional Office for Europe has initiated a project to give guidance on strengthening environmentand health policy-making, planning preventive interventions, and ensuring service delivery and surveillancein the field of environment and health. Through detailed environment and health performance reviews theRegional Office is providing country-based analytical descriptions of the environment and health situationin Member States.Based on the review that took place in Estonia in February 2008, a report has been prepared giving anoverview of the current environment and health situation, evaluating the strong and weak points ofenvironmental and health system and services in Estonia and formulating recommendations for furtheractions.As a follow up to the review the World Health Organization convened a workshop with the objective todiscuss how to best use the recommendations formulated in the report at national level. Participants at theworkshop set priorities in the actions needed, discussed possible implementation mechanisms and tookresponsibility for the implementation and monitoring of actions that are under their direct responsibility.

The economic consequences of ill-health in Estonia

The main contribution of the present report is to go beyond a description of the health status per se and to provide a direct quantitative assessment of the economic consequences of ill-health in the specific case of Estonia. In particular, we begin to answer two important questions: 1) What effect has adult ill-health, in particular chronic disease, had on the Estonian economy and the economic outcomes of the people living in the country? 2) If the substantial burden of adult ill-health in Estonia were reduced, what economic benefits could result? The overarching message from our findings is unambiguous: poor adult health negatively affects economic well-being at the individual and household level in Estonia; and, if effective action were taken, improved health could play an important role in sustaining high economic growth rates

10 health questions about the 10

Ten countries joined the previously 15-member European Union (EU15) on 1 May 2004, creating EU25. The health status of the population varies among the new members, and sometimes between them and EU15. Similarly, their health systems show different patterns of development. How does each of the new EU members compare in terms of health to the old members? This book offers a quick and easy way to grasp the essential features of health and health systems in the 10 newcomers. Each chapter provides a concise overview of key health indicators in 1 of the 10, compares these indicators to EU15 averages, summarizes the key aspects of the country’s health system and describes what it has achieved after a decade of health reform. This book is not a comprehensive in-depth study, but an easy guide to the knowledge available. It offers valuable reading for anyone who wants to have a quick, straightforward and accurate entry point to understanding health in the 10 new EU member states.