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28 July 2025 | Country Update
A new Estonian Emergency Medical Services Development Plan 2035 -
28 July 2025 | Country Update
Estonia’s plan to integrate health and social care systems -
23 June 2025 | Country Update
New government sets health reform priorities for 2025–2027
6.2. Future developments
There are some important challenges that have long been debated and require policy attention. First, the level and stability of insurance coverage have been widely recognized as weaknesses of the contribution-based system in Estonia. However, there is still no consensus on feasible mechanisms to address them (see section 7.3 Financial protection). Additionally, as the EHIF’s role in health service financing and organization has increased, there is a need to review its governance and accountability framework to guarantee effective checks and balances.
Second, the relatively high level of OOP payments and the lack of significant improvement in financial protection, despite the changes introduced in the coverage of outpatient prescription medicines and dental care, have resulted in an ongoing policy dialogue on necessary additional measures (see section 7.3 Financial protection). New measures could include the incorporation of caps on cumulative annual co-payments, as well as increasing overall public spending on health (see section 3.3.1 Coverage). Additionally, greater emphasis should be placed on redesigning coverage and purchasing policy to tackle significant social and regional inequalities.
Third, the future of the hospital network is still unclear. A new proposal for the HNDP has been prepared, but the roles, governance structure, and relationship of small county-level hospitals to PHC and to larger hospitals remain to be determined. However, there is an understanding that hospital network development should be undertaken together with the development of PHC and ambulance networks (see sections 2.1 Historical background, 2.4 Planning, 3.6.2 External sources of funds and 4.1.1 Infrastructure, capital stock and investments).
Fourth, the adoption of a new Public Health Act, which would clarify the roles and responsibilities of public health actors, has been delayed, with the main obstacle being the gender correction provisions (see section 5.1.1 Public health governance).
Lastly, there are other important challenges that will require policy attention in the coming years. The most urgent ones are the shortage of health professionals, especially in PHC and mental health, and the need to strengthen prevention and early detection of mental health issues, together with timely access to quality care.
The Ministry of Social Affairs has developed the Emergency Medical Services Development Plan 2035 (EMS 2035). EMS 2035 is one of three strategic pillars shaping Estonia’s broader health system reform, which also includes the country’s hospital and primary care development plans.
Under EMS 2035, the emergency medical services system will be organized into four regions to strengthen coordination, ensure consistent service quality, and enhance preparedness for crises and mass casualty events, including chemical incidents. A key priority is to expand EMS crisis reserves and deploy mobile stocks, particularly in remote areas and on islands.
Each region will implement unified quality management, giving all ambulance teams access to tools such as telemedicine consultations, automated decision support systems and structured training. EMS will also be better integrated into patient care pathways, with clearer criteria for medical transport and improved coordination with hospitals, social services, and local authorities. Plans also include improved data exchange and stronger alignment between EMS and broader health and social care planning.
The strategy was co-developed with ambulance providers, including hospitals and private operators. The Estonian Ambulance Association has endorsed the strategy as forward-looking and realistic. Implementation will be overseen by a national steering group and an expert advisory council.
Authors
In July 2025, the Ministry of Social Affairs (MoSA) submitted a concept paper for draft legislation for public consultation, aiming to support the integration of health and social services and improve continuity of care for people with complex needs, especially in the context of population ageing and increasing multimorbidity. The concept paper highlights persistent fragmentation between Estonia’s health and social systems, characterized by separate planning, funding and decision-making, that results in poor coordination, reactive service provision, and inefficiencies such as service duplication and lack of interoperable data systems. This fragmentation leads to delayed support, avoidable hospitalizations and higher long-term societal costs.
To address these challenges, the concept paper proposes establishing regional “well-being regions” aligned with existing counties, each with population-based goals tailored to local needs. Regional networks (TERVIKs) will bring together PHC providers, hospitals and municipalities (responsible for delivering social services) to jointly implement shared strategies. “Well-being regions” are expected to adopt risk-based population management to proactively identify and support vulnerable groups. The Estonian Health Insurance Fund will contract TERVIKs to cover base costs and incentivize results, while the MoSA will provide support through development projects. Specially trained health coordinators will ensure cross-sector case management using shared digital tools.
Following public consultation, legal amendments are expected to be submitted to the government in January 2026, with parliamentary proceedings in the first half of 2026.
Authors
Following the departure of the Social Democrats from government, the remaining parties, Reformierakond and Eesti 200, signed a new coalition agreement on 24 March 2025 and confirmed the coalition programme for 2025–2027 on 24 May 2025. The programme outlines a health reform agenda focused on improving care quality, system efficiency and financial sustainability. Key priorities include consolidating quality and patient safety governance under a single agency and adopting a national strategy for health service quality. The plan supports the establishment of the Tallinn Hospital Group and the revision of the hospital governance, and it aims to strengthen primary care while maintaining a hospital in every county. It also plans to introduce integrated planning and funding models for health and social services. The coalition further aims to promote healthy lifestyles and mental well-being through a national alcohol harm reduction plan, stricter tobacco regulation, a digital self-help platform for mental health and updated infectious disease control legislation informed by COVID-19 lessons.
As part of the new government structure, the roles of Minister of Health and Minister of Social Affairs have been merged into a single Minister of Social Affairs, responsible for both sectors.