The issue has come under the spotlight following last week's resignation of Rein Laane as the fund's director, days after media reports revealed the fund held its summer days at a lavish hotel in South Estonia, despite the agency operating at a deficit and at a time of soaring prices and rising taxes.

World Health Organization (WHO) consultant Kaija Kasekamp said that the fact that the Health Insurance Fund's budget is now in deficit had been known about for a decade and a half or more.

"Several analyses on the topic of health financing had been carried out, as early as 2010 or even earlier, which show that this system, where the contributing population is falling, is not sustainable," Kasekamp told "Aktuaalne kaamera."

Tanel Ross, a former head of the Health Insurance Fund, said he too believes that the structure of health financing in Estonia needs to be overhauled.

"Healthcare costs are growing. The main fundamental cause is an aging population and the resulting increased burden from illness, and also new treatment options. These ultimately reflect the growth in healthcare financing," said Ross.

One option is to increase the fund's efficiency, which Kasekamp said should be done in any case, adding this need not mean cutting back the services offered to people.

"The government's recent decision to increase co-payments in order to reduce the Health Insurance Fund deficit means that fewer services will be paid for, or people will have to pay more out of their own pockets. This in turn exacerbates health inequality, which in Estonia is already among the highest in the EU, and if it rises further, it will be inefficient for society as a whole," Kasekamp said.

Minister of Social Affairs and chair of the Health Insurance Fund's supervisory board Karmen Joller (Reform) agreed that streamlining could save a lot of money.

"As a doctor, I can see that there are very many areas where we could amend the organization of work, financing, and use of resources, both in terms of people and in terms of equipment, analysis and examinations, to make it more effective for the individual," Joller said. The minister is set to meet with the Health Insurance Fund on August 22 and expects there a plan for where the money will be spent and how to make the use of funds more efficient.

"Our main concern is that we have not found or seen that they have come forward with substantive changes that take into account the possibilities we have. Perhaps some services need to be added somewhere so as not to overload specialist care. Perhaps somewhere else one service should be moved to another place. We are waiting for these proposals from the Health Insurance Fund. If we now simply find these hundreds of millions and put them into a system where we don't know exactly where the money is spent and how exactly, then I think it is an abuse of taxpayers' money," Joller said.

Riigikogu Social Affairs Committee member Tanel Kiik (SDE) said the healthcare sector's financing system needs to be updated, as it does not meet the needs of the population.

"The minimum that needs to be be done is that if the government says that money has been found and wants to start giving tax gifts to the wealthy, then that money should be directed into cutting healthcare waiting lists and improving accessibility. For example, former health minister Riina Sikkut has suggested that the state could start paying the health insurance contributions for children, just as it pays them today for the elderly. These options have been proposed, analyses have been made," Kiik said.

Next year's budget will likely have to be ensured from the Health Insurance Fund's reserve, Joller said. Kiik meanwhile said the budget negotiations should find additional money for healthcare and not tap into the reserve again.

Õhtuleht had last Monday put the cost of the fund's summer event, held at the Taagepera manor using the public purse, at over €100,000, though this was later reported as being around €84,000. Minister Joller, whose ministry's remit the agency falls under, had hit out not only at the cost but also a lack of transparency about that cost and the event. The agency also at the end of last year moved to newer premises in the Arteri kvartal in central Tallinn.

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