Health care has to choose a development path to tackle the funding crisis

“The population of Estonia is ageing and the need for medical care increases, but if the current financing model continues, the possibilities to provide health services decrease. The Estonian Health Insurance Fund will reach funding crisis in the next five years,” Head of the Foresight Centre Tea Danilov said. “If no additional income is found, it will mean longer treatment waiting lists, and by 2035, cost-sharing in paying for medical services would be twice as high as now. Thus, the probability of becoming impoverished due to high health expenses would also increase twice.”

Expert of the Foresight Centre Magnus Piirits said that already now Estonia had the highest unmet demand for medical services in the European Union. “In 2018, more than 16% of the population did not get assistance fast enough according to their own estimation. Also, 6% of the population is not covered by medical insurance, which is one of the highest indicators in the European Union,” Piirits said. “Increasing the patient’s cost-sharing is not possible because it has already reached 24% of the costs of medical treatment.”

Magnus Piirits added that the most dangerous development path for the Estonian health care system would be simply not making fundamental choices for the future during the next five years.

Kaupo Koppel, an analyst at Praxis Centre for Policy Studies, said that more health problems should be solved at the primary level. “For example, in the Netherlands, more than 90% of the health problems that have emerged at the primary level are solved at the same level and the patient is not referred to another medical specialist. This has shortened waiting lists and improved the availability of health care services. On the other hand, the people of Estonia have a strong faith in specialised doctors, which means increased costs and longer waiting lists.”

Koppel emphasised that in the future, improvement of health behaviour should also be the focus of health care. “The impact of health behaviour on the expenditure and revenue of the state is greater than the costs of financing new services,” Koppel explained. “Every year, society loses tens of thousands of life years and hundreds of millions of euro due to alcohol, overweight and obesity and mental health problems.”

The report “The Future of Healthcare in Estonia. Scenarios up to 2035” presents four scenarios on the future of the Estonian health care system, which differ by the range of services provided, sources of funding and the level of innovation implemented in the field.

• Scenario “A dream of healthcare”
  • The health behaviour of the Estonian people will become more responsible, technological progress will take place in prevention and treatment, and general medical insurance will be launched with a wider package of services.
• Scenario “A pragmatic world”
  • The health behaviour of the Estonian people will become more responsible, technological progress primarily in treatment and launching of general medical insurance. The deficit of the Estonian Health Insurance Fund is financed from the increase of patient’s cost-sharing, private insurance is implemented to cover that.
• Scenario “Half of the work”
  • The health behaviour of the Estonian people will become more responsible, technological progress is more limited. Instead of the general health insurance of the population of Estonia, general health insurance is implemented only in primary medicine.
• Scenario “Keep carrying on”
  • The Estonian people will not assume greater responsibility in taking care of their health, technological progress is limited. The current health insurance system will continue.

More information on the topic: https://arenguseire.ee/en/uurimissuunad/future-health-care/.

The Foresight Centre is a think tank at the Chancellery of the Riigikogu that analyses long-term developments in society and the economy. The Centre conducts research projects to analyse the long-term developments in Estonian society and to identify new trends and development directions.