Press release by the Estonian Ministry of Health
Kristina Koehler & Kaija Kasekamp (Estonia), Riina Sikkut (Minister of Health, Estonia), Natasha Azzopardi-Muscat (WHO/Europe) and Ewout van Ginneken (European Observatory on Health Systems and Policies) at the Estonian HiT launch during the Tallinn health systems conference
Although the health of the people of Estonia has improved in recent years according to several indicators, the COVID-19 pandemic and health inequalities have damaged people's health. The sustainability of health care financing also needs to be resolved, according to the overview of the Estonian health system published today by the European Observatory on Health Systems and Policies.
The average life expectancy of people in Estonia has increased by 7.5 years, from 71.1 to 78.9, compared to the European Union average over the past five years. However, due to COVID-19, excess mortality increased in 2021, causing average life expectancy to decrease. Cardiovascular diseases are still the main cause of premature mortality. A large proportion of Estonian residents’ poor health is due to behavioral risk factors, including unbalanced nutrition, smoking and alcohol consumption.
According to Ewout van Ginneken, an expert at the European Observatory on Health Systems and Policies who leads the work on health systems reviews, reducing inequalities is essential to increase healthy years of life. “In Estonia, people with a lower income and less education are the ones losing healthy years of life the most,” he said. People with lower income also tend to give up the necessary treatment if the co-payment for the service is high. In the past five years, the share of government sector spending of total healthcare costs has increased. Necessary reforms have been made to reduce people's co-payments for medicines and dental care, but people’s co-payments for healthcare services remain high (22%).
The fact that part of the population still does not have health insurance also needs to be resolved. “It is becoming more and more obvious that people without health insurance have limited access to health services, which is why they get treatment too late,” said Health Minister Riina Sikkut. At the same time, it is more beneficial for society if a person does not drop out of the labour market due to health and does not have to start paying benefits. In order to avoid this, it is necessary to extend insurance coverage to the entire population and provide for exemptions from deductibles according to households’ ability to pay.”
In recent years, the Estonian government has prioritized healthcare funding in the state budget, but the Health Fund's budget will have a deficit of 170 million euros by 2025. “Although extra money was temporarily directed to the Estonian health system during the COVID-19 pandemic, the question of the long-term sustainability of healthcare funding still awaits a solution,” said Health Minister Riina Sikkut.
According to one of the authors of the review, healthcare expert Kaija Kasekamp, important reforms have been made in the healthcare system by increasing the role of primary care and improving the availability of mental health services. “Strengthening primary care is essential in order to cope with more and more patients with chronic diseases in the future," she said. "However, the prerequisite for strengthening the role of the primary level is the availability of personnel and good cooperation between different levels of the system.’
The review singles out the worsening shortage of health workers, particularly nurses, and primary care and mental health professionals as a whole, as one of the biggest challenges. The review also describes challenges in managing the healthcare system. The role of the health insurance fund has changed significantly over time, and obligations have been added to it that require the provision of services to the entire population, not just the insured. “Therefore, it is important to modernize the framework governing the management and responsibility of the Health Fund in order to ensure that it can cope with new tasks and avoid the risks associated with the concentration of tasks,” said Kaija Kasekamp.
The overview of the Estonian health system deals with recent developments in the organization, management, financing, provision of health services and the functioning of the health system. It is a health systems analysis series run by the European Observatory on Health Systems and Policies, which looks at health systems in different countries of the European region.
‘Estonia: health system review 2023’ has been prepared by the European Observatory on Health Systems and Policies in cooperation with Estonian experts. The publication was launched during the Tallinn Charter 15th Anniversary Health Systems Conference on 13 December 2023, co-hosted by WHO/Europe, the Observatory and the Estonian Ministry of Social Affairs.
- Download the Estonian HiT
- View the full Health Systems in Transition (HiT) series