HHE HOPE 2019 - Page 16

At the moment, the Danish Region is looking at a national wish to reform the outpatient system and to make patients paths easier and more flexible while ensuring a better coordination of care patients a better service by increasing the possibility to diagnose and treat them at home or in primary settings, while, at the same time, reducing the burden to the hospitals. Could you present two/three elements on the impact of such reforms on hospital and/ or healthcare sectors that your organisation/ country has identified? Adjusting the incentives of the system is an ongoing process, especially when it comes of adapting to a reform. The focus is now on changing a silo-based approach to treatment, adopting a more holistic view empowering patients; improving patient pathways; creating a strategy for digital development; investing in personalised medicine; providing transparency to patients for what concerns their health data; and encouraging initiatives on cybersecurity and the use of new technology. Health workforce needs to be supported and trained on how to face these changes and challenges. ESTONIA Mr Urmas Sule HOPE Vice-President, Estonian Hospitals Association Could you describe the last hospital and/ or healthcare reforms implemented in your country in the past 5 years? In 2017, the Estonian government made a historic and long-awaited decision about healthcare system financing. The Estonian healthcare system is mainly publicly funded through solidarity- based mandatory health insurance contributions in the form of an earmarked social payroll tax (13% of wages). The health insurance system covers about 94% of the population. Contributions are related to employment, but the share of non-contributing individuals covered by the Health Insurance Fund (for example, children and pensioners) represents more than half of the insured. Health Insurance Fund revenue base has been dependant on the amount of working people paying social tax, but not unlike other countries, Estonia is also facing the challenges of an ageing population. So finally, in 2017, in close cooperation with the healthcare social partners, the Estonian government promoted the initiative of expanding the revenue base of the health system, which has been a longstanding challenge. The government decided to broaden the Health Insurance Funds revenue base by gradually increasing a state contribution into the Health Insurance Fund on behalf of pensioners, starting from 2018. By 2022, this contribution should reach 13% of average pensions, which is the same rate as the current earmarked social health insurance contribution from payroll tax. This will not solve all problems, but it is definitely a step in the right direction. Thanks to this decision it was possible to renew the nationwide collective agreement in the health sector. This decision impacts also on other services previously covered by the state budget. For example, emergency care (including for non- insured people), ambulance care and IVF are, or will, be under the responsibility of the Health Insurance Fund. The aim of the change was to make the healthcare system more efficient by strengthening the purchasing role of the Health Insurance Fund and making it responsible for financing health services for the whole population and not only for the insured. Estonia is continuously focusing on developing e-health solutions to improve the quality and availability of healthcare services. In 2019, Estonia will launch a statewide digital project to increase health service provision transparency and availability. Could you present two/three elements on the impact of such reforms on hospital and/ or healthcare sectors that your organisation/ country has identified? The previously mentioned reform will not lead to a significant increase in total public health expenditure, but it will consolidate previously fragmented service funding under the Health Insurance Fund. Consequently, the Health Insurance Fund budget will increase significantly in the following years, but at the same time it will also have more responsibilities. However, the funding of the health system will be more logic. In summary, this reform is a good example of Estonia adapting to new situations and challenges, finding innovative solutions, but there is still work to be done in achieving a more sustainable financing system of healthcare. ESTONIA Total current health expenditure as % of Gross Domestic Product (GDP) General government/compulsory current health expenditure as % of total current health expenditure Hospital current health expenditure, as % of total current health expenditure Household out-of-pocket health expenditure as % of total current health expenditure All hospital beds per 100,000 inhabitants Acute care hospital beds per 100,000 inhabitants Acute care admissions/discharges per 100 inhabitants Average length of stay for acute care hospitals (bed-days) Practising physicians per 100,000 inhabitants Practising nurses per 100,000 inhabitants 16 HHE 2019 | hospitalhealthcare.com 2002 4.7% 76.6% 31.6% 20.6% 598.0 480.0 17.0 6.9 309.0 601.0 2008 2016 5.6% 6.7% 77.0% 75.7% 47.9% 46.7% 20.7% 22.7% 563.0 476.0 412.0 350.0 16.7 15.0 5.7 6.1 334.0 346.0 641.0 610.0