Estonia Health Profile 2012

HEALTH AND DEVELOPMENT
Disease pattern changed, with new challenges ahead. The infant mortality rate has decreased substantially (from 15.7 in 1992 to 5.0 in 2007) and has remained very low in recent years. The main disease burden challenge is premature mortality caused by external causes and lifestyle-related risk factors. The working-age population bears more than half of the disease burden (60% among men). Similar to other industrialized countries, the main causes of mortality are diseases of the circulatory system (50%), cancer (20%) and external causes of death (10%). Mortality differs between men and women due to differences in mortality from external causes. Mortality from circulatory diseases is higher amongmen than among women. The lifestyle risk factors causing the disease burden are alcohol consumption, use of tobacco, low physical activity and low intake of fruits and vegetables. A growing challenge is the increasing prevalence of obesity.
In the past decade, a new challenge of tackling communicable diseases such as HIV and multidrug-resistant tuberculosis has emerged. Estonia has one of the highest HIV incidence rates in the WHO European Region. Estonia has kept other communicable diseases under control with broad vaccination programmes implemented with high coverage. Estonia has rapidly and successfully reformed the health system during the past 18 years. The reforms started with health system financing, followed by organizational changes in service delivery and overall governance. During the transition, Estonia’s economy developed rapidly and sequential health system reforms were implemented.
Health system financing. In 1991, Estonia established a mandatory social health insurance system financed by income-related contributions and covering almost the entire population. The health insurance system went through various changes from decentralization to recentralization. Currently, a single health insurance fund is responsible for collecting contributions, pooling and purchasing health care services. Discussions are ongoing as to whether a similar
active purchasing function should be established for public health services. System-wide cost containment and
improving the efficiency of the health system have always been driving forces of the reforms of health care financing. The financial protection of the population has remained an important objective, but private funding from households has increased over the years and is currently at the level of the western European countries.
Health care services. Health care was reshaped around family physicians at primary care, who have a partial gatekeeping with direct access for few selected specialists and coordinating role. Currently, the whole population is covered by a network of family physicians and enrolled with individual family doctors. In parallelto primary care reforms access to essential and modern medicines has been improved over last decades. Restructuring of the hospital sector has complemented reform of primary health care. Estonia has succeeded in significantly reducing the excess capacity of acute care hospitals to the average level of the EU. The ongoing challenge is developing a network of longterm care providers and improving collaboration between the levels of care. The public health system has been decentralized, and several networks have been created to empower citizens. Standardizing public health services and strengthening coordination are ongoing. Several organizational models have been applied to improve risk management in health protection. On disease prevention and health promotion, links have been applied to primary care and empowerment of the third sector (nongovernmental organizations) to increase the possible service delivery networks.
Stewardship. The Ministry of Social Affairs has exercised stewardship through various policy documents, strategies and regulations. An institutional framework includes various agencies and institutions under both public and private regulation. The EU accession has increased the need to improve coordination at country and international level. Further the need for health sector leadership has increased to exert influence on other sectors influencing health. For this, new leadership and management practices need to be developed and clear performance measurement applied to achieve the health system goals. In 2008 the Government approved the National Health Plan 2009-2020, which aims to increase the health status and quality of life of entire population through various activities.
Human resources. Human resources have been developed over the years. Training institutions have been upgraded using quality criteria, and new curricula have been implemented for nurses and doctors. However, the ratio of doctors and nurses is still unfavourable for shifting tasks and responsibilities and exercising new models of care. The continuing education activities for health professionals and quality management mechanisms have not yet been implemented fully. The new challenges have emerged after EU membership and motivating the workforce to remain in Estonia.

OPPORTUNITIES

• A comprehensive set of strategic documents in the health sector
• Well-developed family medicine centred primary health care already accepted by the stakeholders
• Rationalized hospital system
• Transparent public health and health care service purchasing
• Strong technological and information technology development
• Societal change and strong economic growth until 2008