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Estonia Medical Insurance
The Republic of Estonia is a state located in the Baltic Region of Northern Europe. Bordered by the Russian Federation to the east and Latvia to the south, Estonia covers an area of approximately 45,215 km² and features a temperate seasonal climate. It is a heavily forested country and the smallest of the Baltic states with a population of just 1.34 million people. Estonia is a democratic parliamentary republic, divided into 15 different counties, which elects a national president every 5 years. The capital and largest city is Tallinn. Since regaining independence from the Soviet Union in 1991, Estonia’s political infrastructure has proved stable enough to implement various progressive economic and social sector reforms that aim to further ensure stability. Estonia has the largest GDP per person of any country that were formerly part of the USSR. Estonia had enjoyed an investment boom following admittance into the EU, but in 2008 its economy was badly hit by the global financial crisis. The republic adopted the Euro on January 1st 2010. Despite its size, Estonia offers an impressive variety of environments and tourism opportunities and has maintained a distinctive language and culture.
After regaining independence from the Soviet Union in 1991, health sector financing and planning in Estonia underwent a myriad of reforms to move from a centralized, over-capacitated hospital system into a more efficient model that emphasizes previously ignored prevention and health promotion services. These new national health programs and projects initiated in Estonia have had a positive impact on the health of the population with several key health indicators showing marked improvement. Average life expectancy at birth increased from 67.9 years in 1995 to 73 years in 2007. Despite these upward trends, population health outcomes in Estonia still are behind EU averages. Cardiovascular diseases are the main cause of death in Estonia, followed by cancer. A moderately high prevalence of HIV and TB also remain a concern for public health.
Today the Estonian health care system incorporates a compulsory insurance system and universal access to medical services that are made available through private health providers. The Ministry of Social Affairs oversees the administration of the system with numerous agencies, public independent bodies, private health care units, hospitals, NGOs and professional associations all coordinating beneath them. Local governments have a minor, voluntary role in organizing and financing medical services. Estonia’s integrated system has received international commendation for its ability to act efficiently on health care reform, but considerable challenges still persist regarding accessibility and quality of health care. The National Health Plan for 2009–2020 covering the whole health system was announced and approved by the government in June 2008, laying out long term goals and strategies for continued improvements to the healthcare system.
The Estonian health care system is primarily public funded through mandatory health insurance contributions made through an earmarked social payroll tax, which accounts for almost two thirds of all health care expenditure in the country. This earmarked payroll tax is then pooled by the Estonian Health Insurance Fund (EHIF), an independent public body that acts as the sole purchaser of medical care. The EHIF operates through four regional branches, each covering two to six counties, and its main responsibilities include collecting funds, contracting service providers, reimbursement for health services, pharmaceuticals and other temporary benefit programs. The health insurance system is mandatory, covering about 95% of the population. Contributions are proportional to employment and salaries, but non-contributing dependants (children and elderly) represent almost half of the insured people, a considerable financial burden moving forward. The Ministry of Social affairs covers emergency care for uninsured persons and ambulance services. Private health care expenditure has risen to over a quarter of all medical spending, comprised mostly of direct out-of-pocket payments in the form of co-payments for pharmaceuticals and certain specialist care. To receive health insurance from the EHIF, taxes must be paid in Estonia and an Estonian ID number is required. Foreign nationals should receive an ID number together with a residence permit for employment. An Estonia-based employer will forward the information concerning your employment status to the EHIF.
Estonia inherited a large, cumbersome hospital network with poor facilities from the Soviet era. Numerous structural reforms have since reduced the number of hospitals and modernized the medical network, granting more autonomy to both purchasers and providers. In 1990 there were around 120 hospitals in Estonia. That number had reached 54 by 2005 with further downsizing planned. Estonia has developed a medical facility infrastructure system built upon countrywide primary care, which is centered on family medicine with well-trained physicians and nurses. These family practitioners are usually the first point of contact within the health system and will refer individuals for further specialist treatment if additional consultation is required. Specialized care is often provided in outpatient settings, and care involving advanced technology has been increasingly centralized to major hospitals. There are four central hospitals which provide secondary and tertiary care. Two of them are located in Tallinn: West Tallinn Central Hospital and East Tallinn Central Hospital. They provide specialist services mostly to the residents of Tallinn and Harju County. The area covered by the Pärnu Hospital is Pärnu County, and the service area of the Ida-Viru Central Hospital is Ida-Viru County. People living in south Estonia obtain specialist medical care at central hospital level, in the Tartu University Hospital, which also provides regional hospital services to the residents of this region.
Estonia’s health care system faces similar problems to that of the rest of Western Europe. The continued evolution of hi-tech medical technology and pharmaceutical innovations coupled with increasing expectations from the population for new treatments and an ageing population put serious strain on the financial and human resources of the state’s health care sector. There is a lack of physicians and qualified nurses in Estonia, which has affected the quality of service in the healthcare system. This has resulted in long waiting periods to see a local doctor and for the undertaking of non-emergency surgical and dental procedures. Private options are also available for those who cannot wait.
Estonia’s quality of medical service is generally good, especially in Tallinn, and in other major cities such as Tartu and Pärnu. The country has highly-trained medical professionals, but some hospitals and clinics still suffer from a lack of equipment and resources, especially in rural areas. You may find that some hospital staff and nurses, including those who work in emergency rooms, speak only limited English. Estonia is a member of the European Union and thus European citizens are entitled to have the same health benefits as an Estonian citizen under reciprocal healthcare agreements, provided they hold a European Health Insurance Card (EHIC). Comprehensive insurance is advised for all other nationals. Check with your country's health department to see if a reciprocal healthcare agreement is in place with Estonia. Expatriates should take note that although the quality standard of healthcare is good in Estonia, it is strongly recommended that a visitor to the country takes out comprehensive international medical insurance, which should include cover for medical evacuation and medical repatriation in case of an extreme medical circumstance.
Pacific Prime offers a wide variety of health care plans with possible benefit packages including dental, maternity, inpatient, outpatient, specialist consultations, and many more. Please contact our professional advisors today for a free quote and enjoy the security that our extensive Health Insurance Plans can provide.
