Estonia operates a social health insurance (SHI) system that covers approximately 95% of the population of 1.3 million, with those in temporary or unstable employment among the uninsured. The Estonian Health Insurance Fund (EHIF) pools most of the public funding for health and organises the purchasing of health care. SHI contributions make up about two thirds of this public funding while direct state budget transfers to EHIF constitute a growing share. Health spending in Estonia is relatively low compared to the average across EU countries, both in terms of per-person spending (€1733 per person in 2019) and as a share of GDP (6.7%). EHIF covers a broad basket of benefits but out-of-pocket payments are high at nearly 24% of overall health expenditure. Most OOP spending goes towards outpatient pharmaceuticals and dental care. 

Recent reforms have focussed mainly on broadening the health insurance revenue base through the introduction of increased state budget transfers; consolidating purchasing under the EHIF; strengthening primary care, in particular to incentivize the establishment of primary health care centres with a broader scope of services, increase infrastructure investments and encourage multidisciplinary practices; increasing the coverage of dental health care; and  financing remote consultations for specialist care. Future reforms will need to address (among other things) the population health coverage gap to ensure all individuals have insurance, growing health workforce shortages and the long-term sustainability of health system financing.