Health Care System in Estonia

Healthcare DepartmentMinistry of Social Affairs of Estonia

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ESTONIA

Population – 1, 340 415 million Area 45 285 km² , density 31 /per km2

15 counties, over 200 municipalitiesUrban concentration ~ 67% (EU-15 average: 80%)

POPULATION PROFILE

Age structure 0–14 years 14% (EU-15 average: 18)Population 65+ years 14,5% (2000),15,9%(2003), 17,1% (2009) EU-15 average: 17%

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Mortality and health indicators, 1980-2008

Indicator 1980 1990 2000 2002 2003 2008Life expect. 69,1 69,7 70,6 71,0 71,6 74,0Life expect.F 74,2 74,7 76,0 77,0 76,9 79,2Life expect.M 64,2 64,5 65,1 65,1 66,0 68,6Infant mortality 17,1 12,3 8,4 5,7 7,0 5,0

Infant mortality has fallen steadily in recent years. Figures show a decline from 12,3 in 1990 to 5,0 in 2008

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Causes of death in 2006-2007

  Coef/ per 100 000

Cardiovascular diseases 429.49

Cancer 198.86

External causes 107.88

Digestive diseases 46.76

Respiratory diseases 24.02

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Organizational structure

of the health care system

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Main actors in the system

Ministry of Social Affairs (health, social welfare, labour)National health care agencies which come under the Ministry of Social Affairs:

Health Care BoardState Agency of MedicinesNational Health Protection InspectorateHealth Development Institute

Estonian Health Insurance FundCounty governmentsProviders of careResearch institutesAssociations

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Organisational form Legal form

Primary care sole proprietors or companies

Specialist care (outpatient) companies, foundations or sole proprietors

Specialist care (inpatient) joint stock company or foundation

Emergency Care company, sole proprietor, foundation or a state or local government rescue service agency

Independent provision of nursing

companies, foundations or sole proprietors

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Health Care Reforms since 1991

Basic changes in HC system:from centralised and state-controlled health care delivery

system towards a decentralised one; from a general state funded system to one based on health

insurance.

Main issues of reforms:restructuring and reorganising of health care system

(emphasis on primary care: launching FPS, optimizing hospital sector)growing emphasis on public health

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Changes in number of hospitals and outpatient clinics during reforms (1992 – 2002)

5067687878797983107115118

625587

540525485

370342

300

246152147

0

100

200

300

400

500

600

700

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Hospital Outpatient health care

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List of acute care hospitals approved by the Government (19 hospitals)

2+1 regional hospitals (all specialities)

4 central hospitals (limited scale of specialities and services)

11 general hospitals (more limited scale of specialities and services)

1 local hospitals (more limited scale of specialities and services)

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Estonian Hospital Masterplan 2015

Aimed to

reduce the share of inpatient care

increase the share of outpatient care, daycare and nursing care

concentrate the more sophisticated and expensive specialist care to fewer hospitals

  2001 2007 2015

Acute care hospital beds*

6500 5100 3200

Average length of stay

6,7 5,9 4,6

Bed occupancy rate

67% 76% 83%

* Psychiatry, tuberculosis, rehabilitation and nursing not included

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Changes in hospital sector

400

500

600

700

800

900

1000

1980 1985 1990 1995 2000 2005 2010

EstoniaEU members before May 2004 EU members since May 2004

Acute care hospital beds per 100000

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Changes in hospital sector

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7

8

9

10

11

12

13

14

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1980 1985 1990 1995 2000 2005 2010

EstoniaEU members before May 2004 EU members since May 2004

Average length of stay, acute care hospitals only

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Primary Care

organized around family practices

organized on the county level

free choice of a FP

every FP has a list of patients (up to 2000 persons, arverage size ~1700)

FP as a “gatekeeper” for HC system

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Challenges in Primary Care in 2008

Strengthening the role of FP as an activ “gate-keeper” in the HC system

Widening the scale of services in Primary Care level (MW services, home nursing, physiotherapist services, mental health nursing ect)

More emphasis on disease prevention and health promotion activities on PC level

Better cooperation with specialist care, social system,education ect.

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Long-term care and nursing care

Services for elderly In health sector (inpatient/outpatient nursing care services) In social sector (institutional care, home care)

General objectives (LTC DP 2004-2015)

Availability and quality of both ambulatory and in-patient nursing care services.

A possibility of providing more diverse services through integrating health and social care services to meet the needs of ageing population.

When providing services, thoroughly evaluated need has to be taken into consideration.

17 0 500 1000 1500 2000 2500

2004Belgium2003Switzerland2002Netherlands2004Norway2003Germany2003Iceland2004Malta2004Ireland2004Estonia1999United Kingdom1997Luxembourg2004Denmark2003Lithuania2003France2003Austria2004Czech Republic2004Hungary2002Spain1989Greece2004Sweden

Nursing and elderly home beds per 100000, Last available

Financing Health Care

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Health insurance system in Estonia

Social health insurance MandatoryBased on solidarity

Tax paid by employersproportional as a flat 13% surcharge on salaries

Coverage 94,7% of the populationwider than actual contributors

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Health insurance budget

Specialist care servicesPrimary care servicesDrug reimbursementBenefits for temporary incapacity for workPreventionLong term careAdministrative costs

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State budget

Emergency ambulance services

Emergency care provided to persons not covered by health insurance

Public Health programmes

Capital investments of providers

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Thank you for your attention!