Estonia plans to merge health and social care systems for better coordination, but interest groups fear rushed reforms could disrupt services, especially for vulnerable groups. Critics warn unclear funding and added bureaucracy may reduce access and strain providers.
The Estonian Ministry of Social Affairs has proposed a significant reform that would merge the country’s health and social care systems, aiming to tackle the persistent lack of coordination and service duplication between these two spheres. Traditionally, Estonia has kept health and social services, such as rehabilitation support, separate, with distinct funding and management: the Health Insurance Fund is responsible for healthcare, while the Social Insurance Board manages social services. This separation has created inefficiencies and often forces individuals—and their families—to carry medical information themselves between different institutions, sometimes resulting in incomplete or inaccurate records and preventing service providers from having a comprehensive overview of each person’s treatment history.
Last year, about 11,000 individuals received social rehabilitation services, encompassing support from various professionals like social workers, psychologists, physiotherapists, speech therapists, and creative therapists, delivered to children, adults with disabilities or chronic illnesses, and the elderly. However, navigating between Estonia’s current dual systems has proven problematic for many, causing agreement among stakeholders that reform is urgently needed. To address these issues, the Ministry completed a development document in July outlining its reform plan, featuring key proposals such as the integration of health and social services, the establishment of new regional coordination bodies (TERVIK-s), and the introduction of health coordinators (“tervisejuht”) who would work in family doctor teams or health centers. These specialists would oversee individual care paths, coordinate support between health and social services, access comprehensive service data, and facilitate collaboration between various service providers.
Despite the promise of better coordination, interest groups have voiced serious concerns that the pace and approach to reform may result in disruptions of service access, especially for vulnerable groups. Both the Chamber of People with Disabilities and the Estonian Association of Rehabilitation Institutions fear that transitioning too quickly to a new social rehabilitation system could leave some people without essential support. Service providers worry that the lack of a planned transition period and unclear funding structures could mean temporary loss of access to care, especially in rural regions if local providers are unable to meet new licensing and regulatory demands. The Ministry acknowledges these risks in its plan, noting that any delay in establishing the new TERVIK bodies may cause interruptions in service provision, and admits that smaller providers could struggle to secure necessary licenses to continue offering healthcare services.
Moreover, criticism has come from the head of the Health Insurance Fund, Rain Laane, who has stated that without additional funding to match the transfer of responsibilities from the Social Insurance Board, the Health Insurance Fund cannot support the proposal. Laane emphasized that previous budget shifts to the Fund—such as those covering ambulance services and treatments for uninsured patients—have resulted in substantial deficits, a trend that could worsen if more responsibilities are transferred without sufficient resources. Family doctors have also raised alarms, fearing that the reform will increase their workload and reduce acute care access. While they recognize the value of integrated services and health coordinators, they question whether existing staff can reasonably take on expanded roles and whether the entire overhaul of the social rehabilitation system is justified or necessary at this time.
In city government, Tallinn’s Deputy Mayor Karl Sander Kase argued that the creation of new regional bodies adds unnecessary management layers instead of achieving real integration and makes the system more confusing, with functions that could be handled by existing national agencies. Ultimately, while Estonia’s proposed reform promises greater efficiency and better coordination between health and social services, a chorus of sector experts warns that if rushed and underfunded, it risks service continuity and may inadvertently create new barriers to care for those most in need.
