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