New WHO report on Estonia identifies policies to make health care more affordable for low-income people

On International Universal Health Coverage Day 2023, a new report on affordable access to healthcare in Estonia shows that 1 in 14 households (7%) experienced catastrophic health spending in 2020 as a result of having to pay from health care pocket. People experiencing catastrophic health spending may not be able to pay for other basic needs such as food, housing and heating. In the same year, out-of-pocket payments pushed 2% of Estonian households into poverty or forced them into poverty.

Although catastrophic health expenditure in Estonia continues to be higher than in many European Union (EU) countries, the situation improved between 2015 and 2020. This reflects positive policy changes in coverage and other factor, according to a new WHO/Europe study launched today at the Health Systems Conference marking the 15th anniversary of the Tallinn Charter.

The report “Can people pay for healthcare? New evidence on financial protection in Estonia 2023” shows that financial hardship is mainly driven by out-of-pocket payments for outpatient medicine and dental care, and it is heavily focused on low-income households.

Gaps in coverage undermine financial protection

The study identifies gaps in all 3 dimensions of health coverage:

  1. Who is covered – linking the right to payment of social health insurance contributions leaves 10% of people of working age without coverage.
  2. Which services are covered – the package of health care benefits provided by the Estonian Health Insurance Fund (EHIF), although quite extensive, offers limited coverage of adult dental care.
  3. The proportion of costs covered – although the Government has tried to improve protection from copayments for outpatient prescription drugs and dental care, more can be done to protect low-income people.

“The Tallinn Charter signed in 2008 emphasized that people in Europe should not be poor because of ill health. Since then, the Government of Estonia has redesigned several aspects of the coverage policy to improve the affordability of outpatient drugs and dental care,” explains Dr Natasha Azzopardi-Muscat, Director of the Division of Health Policies and Systems of Countries in WHO/Europe.

He added, “Based on the analysis in our new report, we call on the Government to continue to reduce out-of-pocket payments for these and other services, and to focus on strengthening protection for low-income households. you.”

Make health care more affordable for low-income people

To improve financial protection, Estonia can:

  • close the population coverage gap by changing the basis for entitlement to EHIF benefits to residence;
  • increase and adjust benefits to better serve those most in need;
  • increase protection from all copayments, especially for low-income households;
  • remove balance billing for primary care services to ensure access is not dependent on ability to pay;
  • reduce out-of-pocket payments on long-term health care; and
  • reduce out-of-pocket payments for outpatient drugs through incentives to prescribe and provide the cheapest alternatives, price regulation, and improvements in how over-the-counter drugs are sold and used that medicine.

About the report

The report draws on data from household budget surveys conducted in 2015, 2016, 2019 and 2020; data from the Estonian System of Health Accounts for 2021; data on unmet need for health care and dental care through 2022; and coverage policy information until 2023. It benefited from financial assistance from the EU through the European Commission’s Directorate-General for Health and Food Safety.

About WHO/Europe’s work on financial protection

Financial protection is central to overall health coverage and a key dimension of health system performance assessment. It is an indicator of the Sustainable Development Goals, part of the European Pillar of Social Rights, and is at the heart of the European Program of Work, the strategic framework of WHO/Europe.

WHO/Europe monitors financial protection through the WHO Barcelona Office for Health Systems Financing, using regional equity-sensitive indicators. The WHO Office in Barcelona provides tailored technical assistance to countries to reduce financial hardship and unmet need by identifying and addressing gaps in health coverage.

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