An independent think tank at the Riigikogu People in Estonia are living longer than ever but they are living with health problems, and while the life expectancy of Estonians has risen the most in Europe, the same cannot be said of the number of healthy life years.
Prevention must play a larger role in the future, as half of deaths result from people’s own unhealthy behaviour. The potential long-term revenues from preventing health problems are many times larger than the amount of additional funding needed by the Health Insurance Fund to transition to universal health insurance, or to expand the range of services financed by the state.
Universal healthcare at current cost levels would need an additional 79 million euros or so a year, but reducing the number of years of life lost to alcohol by 20% for example would both improve public welfare and earn the state more than 10 times as much each year.
People must be encouraged more and more to take responsibility for their own personal health. They need to be empowered to do this by improving health literacy and the use of digital healthcare solutions, and by allowing secure data sharing and developing databased preventative systems.
Underfunding will become increasingly evident in healthcare because of the gradual long-term trends of an ageing population and falling tax revenues as capacity for work changes.
This will mean costs grow faster than revenues. Further problems are that there are a large number of uninsured people in Estonia, long queues for treatment, large payments required from patients, and a shortage of nurses.’
The state has an important role in ensuring that data exchange between medical staff and patients, the private and public sectors, and the healthcare and social care sectors and ohter parties is secure and meets data protection requirements, and in assessing the impact of new technologies and preventing problems arising. Bold steps need to be taken to move from financing individual treatment services towards funding total treatment outcomes.
The best scenario for the future of healthcare is that people are able and willing to act healthily, which can be supported by:
• universal health insurance;
• a broader range of services funded by the state;
• new technological and data-based solutions for prevention and treatment;
• increased motivation for people to take care of their own health;
• funding for treatment outcomes based on diagnoses instead of funding for individual services.
Keep carrying on
Scenario is the baseline scenario in which no changes are made to the health insurance system and no additional revenues are found for the Health Insurance Fund. In this case the budget of the Health Insurance Fund will fall into deficit of 900 million euros by 2035. Public health insurance coverage will not be expanded and no other services covered by state spending will be added. Public health will deteriorate and the average amount that people have to pay themselves will double.
The Pragmatic world and Half of the work
Scenarios offer cost-effective ways of expanding insurance coverage and funding a broader range of services, but they do this through higher public spending than in the baseline scenario. Public health improves on average, but inequalities in healthcare may widen. The Pragmatic world introduces private insurance to cover higher personal contributions to the cost of care, which will encourage people to take more care of their own health, as insurance payments depend on this.
A dream of healthcare
The best results for public health are in this scenario, which introduces universal public health insurance and expands the range of publicly-funded services substantially. In this case the healthcare system would need an additional 200 million euros a year more than in the baseline scenario.
Where can additional funding be found?
The main ways of increasing revenues for the healthcare system are:
• larger out-of-pocket payments by patients;
• private insurance;
• higher social tax or a broader tax base;
• additional allocations from the state budget from other tax revenues.
Funding healthcare from taxes on income means that the system is funded mainly by wealthier people. Funding healthcare from taxes on consumption or from the contributions of patients means that the system is funded mainly by people on lower incomes.