Good progress report on Estonia’s healthcare

A new report highlights the remarkable progress Estonia has made over recent years. The amount spent by the state health agency to send patients abroad is increasing, with the majority of these being treated in Finland and Sweden. Most inbound medical tourists come from neighbouring countries, such as Finland and Sweden, but increasingly also from the Russian Federation and Latvia.

The European Observatory on Health Systems and Policies has released a new health system review on Estonia, highlighting the remarkable progress Estonia has made over the years, as well as identifying several opportunities for improvement.

The Estonian health system is based on compulsory insurance for all citizens but is very limited on dental care and does not pay for any cosmetic surgery.

The State health agency Estonian Health Insurance Fund (EHIF) is responsible for all cross-border patient mobility issues. Insured individuals are entitled to receive EHIF covered services in the other EU member states, Iceland, Liechtenstein, Norway and Switzerland for both emergency healthcare and planned treatment.

The EHIF pays for treatment in line with prices and co-payments as covered by the compulsory state health insurance. The reimbursement does not cover travelling costs.

State patients sent abroad

An Estonian insured may ask the EHIF for pre-authorisation when planning to receive treatment abroad. This care cannot be denied if it is covered by the Estonian basic benefit package but cannot be provided in Estonia within a medically justifiable time limit. Other national criteria applied in this decision are whether the service is medically justifiable, and if it is of proven medical efficacy, with a probability of success of at least 50%.

Planned treatment overseas paid for Estonians insured with the EHIF increased from €1.4 million in 2008 to €5.3 million in 2011, and €5.4 million in 2016. The number of prior authorisations has increased from 18 patients in 2002 to 244 patients in 2016.

In 2015, 64 persons were referred for treatment abroad, 141 for examinations, and 39 to search for unrelated bone marrow donors through the Finnish Red Cross. The majority of patients were treated in Finland and Sweden, while the number of examinations was highest in Germany and Finland.

The EHIF only reimburses the services that are included in the state insurance benefits package at the EHIF price list. If the price is higher abroad, the patient must pay the difference. In addition, the patient has to pay for the visit, co-payment fees, and travel expenses.

Inbound flows increasing from Russia, Latvia

As for private patients voluntarily coming from abroad to receive treatment in Estonia, spa hotels are active in attracting foreign customers. Also, dental care, cosmetic surgery, ophthalmology, in vitro fertilization treatment, radiology and diagnostics services are among services provided to cross-border patients. Most are from neighbouring countries, such as Finland and Sweden, but increasingly also from the Russian Federation and Latvia.

Healthcare market state & private

The state dominates the hospital sector but most clinics including all dental and cosmetic surgery clinics, are privately owned.

Of 1,400 health care institutions in Estonia 54 provide inpatient care and are classified as hospitals. The 54 hospitals include 24 nursing and rehabilitation hospitals. There are 20 publicly owned acute care hospitals that provide acute inpatient care, but vary greatly in size and profile. These 20 hospitals take up 99% of the specialised medical care expenditure in Estonia.

There are 10 small for-profit private hospitals, which provide selected specialised services such as gynaecology, orthopaedics and psychiatry. Of 1,350 outpatient care providers, one third are family physician practices, one third are dental clinics, 288 are specialised outpatient medical care providers and 36 are providers of outpatient rehabilitation services. The vast majority of the outpatient institutions are owned and run by the staff providing the services.