The 2017 reform to improve financial sustainability of national health insurance in Estonia: Analysis and first lessons on broadening the revenue base. Issue 8 (August 2019)

• Record Type: Journal Article
• Authors: Habicht, Triin; Reinap, Marge; Kasekamp, Kaija; Habicht, Jarno; van Ginneken, Ewout; Webb, Erin
• Is Part Of: Health policy. Volume 123:Issue 8(2019)
• Page Start: 695
• Page End: 699
• Publication Date: 2019-08
• Subjects: Health financing -- Social health insurance -- Payroll tax -- Earmarking -- Universal health coverage -- Estonia; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2019.05.019
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: 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. Abstract: 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. Estonia has rolled out the reform according to plan, but it has led to debate about the need to achieve universal population coverage (currently at about 95%). Moreover, the Estonian experience also holds important lessons for other countries looking to reform their health system. For example, policymakers should recognize that reforms require extensive preparation using consistent messaging over a long period of time, also to prevent prioritising short term and popular fixes over structural reforms. Additionally, collaboration between the health and financial ministries throughout the reform increases the buy-in for the reform and likelihood of adoption. Furthermore, health professionals play a significant role in advocacy, and seeking support from this group can smooth the path towards health system reform.