No. 42



Choices for Estonia’s Health Insurance System Until 2035

09 December 2020


RiTo No. 42, 2020

Over the last decade, life expectancy in Estonia has grown faster than the EU average. At the same time, the increase in healthy life years has ground to a halt. This means that although people live longer, illnesses and health related causes limit their participation on the labour market and increase the health care costs for the state.

Developments that are out of our hands and yet affect health care include the ageing and decreasing of the population, the rapid development of personalised medicine, gene technology and biotechnology, developments on the labour market and change in the forms of work, lifelong learning, accelerating urbanisation, and global crises. The health care system allows us to influence the health insurance coverage, the level of integration of services, and the access to services and medicines.

The health insurance system is only one of the factors that have an impact on healthy life years. What kind of system should we create against the backdrop of current trends if we hope to support a healthier life? 1) Continue with the existing system and create new forms of insurance. This would provide insurance to new small groups while complicating the overall system. 2) Make the GP service universally accessible and extend it further, while the other services remain accessible to those covered by a health insurance. This would cost us around 11–15 million during the first years. 3) Make the health insurance universal. The cost of this would be ca 80 million a year during the first years. This could turn out to be an excellent long-term solution that benefits the health of the Estonian population and ensures larger tax revenues through improved health as well as a longer and more productive participation on the labour market.

Estonia’s health care expenses are low compared to the other EU countries – 6.4 percent of the GDP in 2017. So far, the health insurance funding has been based on a narrow revenue base, i.e. exclusively on salary based payments, which makes the system sensitive to economic downturns and the ageing of the population. A certain percentage of health care service costs is covered by the beneficiaries themselves by cost-sharing (24.5%). Forecasts predict a EUR 700–900 million deficit for the Health Insurance Fund in 2035, unless the tax system is changed and new allocations made. So regardless of any changes in the health insurance system, we need to tackle health insurance funding problems today because the Fund’s expenses will exceed its revenues in the very near future. Unless we are willing to give up some of the medical treatments currently on offer, provide health insurance for a smaller number of people, or resign ourselves to falling behind in the introduction of smart technology, we need to reorganise or enhance the current funding model.