In December 2024, the Estonian government approved the Hospital Network Development Directions 2040, which were developed over the period of 2020–2022. The plan outlines the future structure of the hospital system, defining the network organization, hospital responsibilities, principles for cooperation and consolidation, and an investment roadmap.
The main aim of the plan is to ensure high-quality, accessible specialized medical services that take into account changing demographics and future trends in both the health sector and society at large. Each county will retain at least one hospital providing 24/7 emergency and specialized care, although the overall hospital network will be reduced from 20 to 17 facilities. This reduction will be achieved by merging four hospitals in Tallinn into a single unified institution, Tallinn Haigla.
A core principle of the plan is to centralize high-tech, resource-intensive services, while decentralizing frequently needed services such as mental health, nursing and palliative care across all counties. The plan also aims to integrate health and social care services to provide more comprehensive care, particularly for older people and those with chronic conditions. To achieve that, it emphasizes the establishment of local service networks that bridge hospital-based specialist care with primary care, ambulance services and social services, aiming to reduce fragmentation of services and improve continuity of care.
Based on the plan, hospitals will also be required to adopt sustainable practices to minimize their impact on the environment and climate by using renewable energy, improving waste management and promoting circular economy principles. The plan also envisions strengthening the role of the state in governing the hospital network, although it does not specify how this should be achieved.
Another critical aspect of the plan is crisis preparedness. Hospitals must ensure continuity of operations during both civil and military crises by establishing formal frameworks for cooperation with military organizations and regional partners involved. This includes defining clear chains of command, partner roles, crisis management procedures, and flexible patient transfer mechanisms to maintain essential care during emergencies.
The overall investment needs for hospital infrastructure are estimated at EUR 1.8 billion by 2040. However, no direct funding has been allocated in the current state budget. If investment funds become available, priority will be given to enhancing psychiatric services and developing Tallinn Haigla.