1. Health Care System in Estonia Healthcare Department Ministry of Social Affairs of Estonia

2. 2 ESTONIA Population – 1, 340 415 million Area 45 285 km², density 31 /per km 2 15 counties, over 200 municipalities Urban concentration ~ 67% (EU-15 average: 80%) POPULATION PROFILE Age structure 0–14 years 14% (EU-15 average: 18) Population 65+ years 14,5% (2000),15,9%(2003), 17,1% (2009) EU-15 average: 17%

3. 3 Mortality and health indicators, 1980-2008  Indicator 1980 1990 2000 20022003 2008  Life expect. 69,1 69,7 70,6 71,071,6 74,0  Life expect.F 74,2 74,7 76,0 77,076,9 79,2  Life expect.M 64,2 64,5 65,1 65,166,0 68,6  Infant mortality 17,1 12,3 8,4 5,7 7,0 5,0 Infant mortality has fallen steadily in recent years. Figures show a decline from 12,3 in 1990 to 5,0 in 2008

4. 4 Causes of death in 2006-2007 Coef/ per 100 000 Cardiovascular diseases429.49 Cancer198.86 External causes107.88 Digestive diseases46.76 Respiratory diseases24.02

5. 5 Organizational structure of the health care system

6. 6 Main actors in the system Ministry of Social Affairs (health, social welfare, labour) National health care agencies which come under the Ministry of Social Affairs : Health Care Board State Agency of Medicines National Health Protection Inspectorate Health Development Institute Estonian Health Insurance Fund County governments Providers of care Research institutes Associations

7. 7 Organisational formLegal form Primary caresole proprietors or companies Specialist care (outpatient)companies, foundations or sole proprietors Specialist care (inpatient)joint stock company or foundation Emergency Carecompany, sole proprietor, foundation or a state or local government rescue service agency Independent provision of nursing companies, foundations or sole proprietors

8. 8 Health Care Reforms since 1991 Basic changes in HC system: from centralised and state-controlled health care delivery system towards a decentralised one; from a general state funded system to one based on health insurance. Main issues of reforms: restructuring and reorganising of health care system (emphasis on primary care: launching FPS, optimizing hospital sector) growing emphasis on public health

9. 9 Changes in number of hospitals and outpatient clinics during reforms (1992 – 2002)

10. 10 List of acute care hospitals approved by the Government (19 hospitals) 2+1 regional hospitals (all specialities) 4 central hospitals (limited scale of specialities and services) 11 general hospitals (more limited scale of specialities and services) 1 local hospitals (more limited scale of specialities and services)

11. 11 Estonian Hospital Masterplan 2015 Aimed to reduce the share of inpatient care increase the share of outpatient care, daycare and nursing care concentrate the more sophisticated and expensive specialist care to fewer hospitals 200120072015 Acute care hospital beds* 650051003200 Average length of stay 6,75,94,6 Bed occupancy rate 67%76%83% * Psychiatry, tuberculosis, rehabilitation and nursing not included

12. 12 Changes in hospital sector

13. 13 Changes in hospital sector

14. 14 Primary Care organized around family practices organized on the county level free choice of a FP every FP has a list of patients (up to 2000 persons, arverage size ~1700) FP as a “gatekeeper” for HC system

15. 15 Challenges in Primary Care in 2008 Strengthening the role of FP as an activ “gate- keeper” in the HC system Widening the scale of services in Primary Care level (MW services, home nursing, physiotherapist services, mental health nursing ect) More emphasis on disease prevention and health promotion activities on PC level Better cooperation with specialist care, social system,education ect.

16. 16 Long-term care and nursing care Services for elderly  In health sector (inpatient/outpatient nursing care services)  In social sector (institutional care, home care) General objectives (LTC DP 2004-2015) Availability and quality of both ambulatory and in-patient nursing care services. A possibility of providing more diverse services through integrating health and social care services to meet the needs of ageing population. When providing services, thoroughly evaluated need has to be taken into consideration.

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18. Financing Health Care

19. 19 Health insurance system in Estonia Social health insurance Mandatory Based on solidarity Tax paid by employers proportional as a flat 13% surcharge on salaries Coverage 94,7% of the population wider than actual contributors

20. 20 Health insurance budget Specialist care services Primary care services Drug reimbursement Benefits for temporary incapacity for work Prevention Long term care Administrative costs

21. 21 State budget Emergency ambulance services Emergency care provided to persons not covered by health insurance Public Health programmes Capital investments of providers

22. 22 Thank you for your attention!