Estonia modernized its health system during the early years of independence following the collapse of the Soviet Union. In 1991, the parliament passed the Health Insurance Act, which set the basis for a new funding source for health care. Reforms in the mid-1990s strengthened the financing system and reorganized the provider network. In 2000, the Estonian Health Insurance Fund (EHIF) was established as the single public purchaser of health services. The EHIF administers Estonia’s health insurance system by contracting with providers, paying for services, reimbursing pharmaceutical expenditures, and paying for temporary sickness and maternity leave. Strategic documents such as the National Health Plan (NHP) 2020–2030 guide and prioritize health system reforms with measurable targets and state budget-funded activities.
Since 2012 Estonia has broadened the health insurance revenue base and increased the share of the state budget for the vulnerable to 13% of the total health budget. The government consolidated vertical health programmes under EHIF by purchasing emergency care for the uninsured, ambulance care, HIV and drug dependency treatment and other services previously financed from the state budget. Primary health care was reformed to incentivize providers, attract infrastructure investments, and encourage multidisciplinary practices. Dental care reform re-introduced dental care benefits for adults and expanded benefits for the vulnerable. In 2021, reimbursement of remote consultations by specialists was introduced. Digitalization allowed advanced e-health solutions and services such as electronic health records, digital images, e-prescriptions, and telemedicine.
A snapshot of the Estonian social health protection system
Estonian health expenditure per capita tripled from under € 500 per person in the 2000s to € 1733 (Int$ 2,617) per person in 2019, with health reaching 6.7% of GDP. Nearly three quarters of health spending is public, while 23.9% comes from out-of-pocket (OOP) payments and 1.6% from voluntary health insurance. The largest source (two- thirds of all health funding) comes from statutory health insurance contributions via an earmarked social payroll tax of 13%.
The health system has become increasingly centralized since the 1990s, and EHIF purchases health services for the entire population of around 1.3 million people in 2022. About 95% of the people are covered by statutory health insurance. The uninsured have access to emergency care, treatment for tuberculosis and for HIV/AIDS, COVID-19 care and vaccinations, and cancer screenings. Over 96% of the population holds an identification card that enables digital authentication for government services, including access to a health portal. EHIF updates the benefit package and prices for over 2,800 health services and diagnosis-related groups, about 2,200 pharmaceuticals and 2,100 medical products, at least annually.
