Overview

Estonia has a social health insurance (SHI) system that covers approximately 96% 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 funds for healthcare and organises the purchasing of health services. SHI contributions account for about two-thirds of public funding, while direct transfers from the state budget to the EHIF represent a growing share. Health spending in Estonia is relatively low compared to the EU average, both in terms of per capita expenditure (US$ 3202 per person in 2021) and as a share of GDP (7.5%). The EHIF covers a broad basket of benefits, but out-of-pocket (OOP) payments are high at almost 22% of overall health expenditure. Most OOP spending goes towards dental care and outpatient pharmaceuticals.

Recent reforms have focused mainly on broadening the health insurance revenue base through the introduction of increased transfers from the state budget; expanding the functions of the EHIF and consolidating purchasing under the agency; strengthening primary care, in particular by encouraging the establishment of primary health care centres with a broader scope of services, increasing infrastructure investments and promoting multidisciplinary practices; increasing the coverage of dental care; and improving the provision of mental health care. Future reforms will need to focus on improving population coverage, health workforce planning and retention, and, above all, the long-term sustainability of health system financing.