Overview

Estonia has a social health insurance (SHI) system that covers about 94% of the population of 1.3 million, leaving those with temporary or unstable employment among the uninsured. The health system is highly centralised, with municipalities playing a minimal role in the organisation of health care. The Estonian Health Insurance Fund (EHIF) pools the majority of public funds and organises the purchasing of health services through contracts.

SHI contributions account for about two thirds of public funding, while direct transfers from the state budget to the EHIF are becoming increasingly important. Health spending in Estonia remains relatively low compared to the EU average, both in terms of per capita expenditure (US$ 3313 per person in 2022) and as a share of GDP (6.9%). Although the EHIF provides a broad basket of benefits, out-of-pocket (OOP) payments are significant, accounting for 23% of total health expenditure, with most OOP spending driven by dental care and outpatient medicines.

Recent reforms in Estonia have focused on broadening the revenue base of the health insurance system by increasing transfers from the state budget.  At the same time, measures have been introduced to strengthen the financial protection of the insured population, such as modulating pharmaceutical user fees and improving dental benefits for low-income individuals. Looking ahead, future reforms will aim to prioritise improving population coverage, strengthening health workforce planning and retention, and continue to explore ways to ensure the long-term financial sustainability of the health system.