REVIEW – October 2004

Trends in the financing of health care and in health policy


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Several state structures are involved in the organisation of health care – the Ministry of Social Affairs, the Central Health Insurance Fund and the State Agency of Medicines, as well as the county structures and the local self-governments. Regrettably, the responsibilities of the latter in the organisation of health care are not strictly regulated and their possibilities are limited.

Physicians are educated at the Faculty of Medicine of the University of Tartu. Considering the age structure of the Estonian medical community and the fact that many young doctors prefer to start working abroad, it is necessary to enroll, on the basis of a government-placed order, 150 students in the Faculty of Medicine in the nearest future. In recent time, residency admission has increased and the remunition of residents will rise next year. It is expected that in this way young physicians will have better possibilities for specialisation, while their motivation for further education will be higher as well.

Also, it is essential to render the CME system more effective in the years to come. In accordance with the agreement concluded between the employers, the government and the professional societies of the health workers, the salary of the health workers will increase next year.

The present Estonian system of primary level medicine does not ensure adequate access to medical aid round the clock, as a consequence of which emergency medical service is overburdened. It would be expedient to establish health centres in larger settlements and to set up departments of emergency medicine at hospitals. Maintenance of emergency medical service and its financing by the government is considered necessary in the Estonian conditions .

The execution of the hospital master plan will continue. It is foreseen that there will be two regional hospitals, four central hospitals and nine general type hospitals in Estonia. In addition, there will function three local hospitals. Elaboration of basic hospital regulations, which will identify the functions of different hospitals as well as their reference areas, is under way.

Most of the health related expenses are now covered from the resources of the Central Health Insurance Fund, collected from the social tax, which is paid by the employers. Patients cover almost 20% of all expenses spent for health care.

At present, health expenses account for 5.1% of the GDP in Estonia, which is the lowest figure among the EU member states. Hence it would be indispensable to increase the proportion of the health expenses covered from the state budget. Additional resources from the state budget should be used mostly for covering the operating costs of the health insitutions and their servicing related expenses.