Overview

The Health Systems in Transition (‎‎‎HiT)‎‎‎ reviews are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis.

Estonia has vigorously and quite successfully reformed its health system over the last decades. Whereas incremental changes are observed in the last five years, larger scale legislative reforms had been implemented since the early 1990s and at the beginning of this century. The current system is built on solidarity based health financing; a modern provider network based on family-medicine centred primary health care (‎‎‎PHC)‎‎‎; modern hospital services and more attention for public health. This has resulted in a steadily increasing life expectancy and continuously high population satisfaction rates with access and quality.

However, as in any health system, a number of challenges remain. They include reducing inequities in health status and health behaviour; improving control of and responding to the consequences of the high rates of HIV and related conditions; improving regulation of providers to ensure better public accountability; and sustaining health expenditures and human resources on a level that ensures timely access and high quality of care. The last challenge is particularly important in the face of rising patient expectations and increased costs and volume of health care services. If solidarity and equity are to be maintained and guaranteed for the future, additional resources need to be found from public sources of revenue.