In 2017, the Estonian government addressed the longstanding challenge of financial sustainability of the health system by expanding its revenue base. As a relatively low-spending country on health, Estonia relies predominantly on payroll contributions from the working population, which exposes the system to economic shocks and population ageing. In an effort to reduce these vulnerabilities, Estonia will gradually introduce a government transfer on behalf of pensioners, although long-term sustainability of the health system could still prove challenging as the overall health spending as a percentage of GDP is not expected to substantially increase.
Highlights from this paper on national health insurance in Estonia published in May 2019:
- • Estonia expanded its health insurance revenue base to increase financial sustainability.
- • Health insurance funding now includes a transfer on behalf of pensioners.
- • Advocacy from national and international sources, including doctors, prompted reform.
- • Other countries could apply lessons learned from Estonia’s reform.
