In Estonia, health services and social services, such as social rehabilitation, have traditionally been offered separately, with distinct funding and operating principles. The Health Insurance Fund oversees one system, while the Social Insurance Board manages the other.

This division has led to a number of persistent issues, which the government now aims to resolve. The two systems often fail to coordinate and services are sometimes duplicated.

For example, rehabilitation providers currently do not have access to the national health portal and often lack a clear overview of what services a person has already received elsewhere. When rehabilitation teams request medical information, individuals or their family members may be forced to manually transfer paper documents or digital files from one institution to another.

According to the Ministry of Social Affairs, this information can end up being incomplete or inaccurate, such as when data about ongoing treatments or current medications never reaches the rehabilitation team.

Last year, around 11,000 people in Estonia received social rehabilitation services. These services are provided by professionals such as social workers, psychologists, physiotherapists, speech therapists, special education teachers and various creative and activity therapists.

Recipients include children with learning difficulties or behavioral problems, adults with mental health conditions, people with mobility impairments and elderly individuals with chronic illnesses. Stakeholders acknowledge that navigating between the two systems is often problematic and agree that the current setup is neither practical nor efficient for the state.

In July, the Social Affairs Ministry completed its development intent document — a reform package outlining proposals to integrate the health and social care systems and resolve these long-standing issues.

Under the ministry's plan, future collaboration between health and social services would be restructured significantly. One key proposal is the introduction of a new type of specialist — tervisejuht or "health coordinator" — who would work within family doctor teams or at health centers.

These coordinators would be responsible for managing a person's care and treatment across both health and social service sectors. For instance, if a family doctor identifies a need for support, the health coordinator would determine what services the person should receive from both systems.

The ministry envisions that health coordinators would have access to data on all health and social services provided to a person and would have the authority to initiate and coordinate collaboration among various service providers, including those in healthcare, social care and rehabilitation.

The plan also proposes creating new regional coordination bodies, known as TERVIK-s, to oversee the delivery of both healthcare and social services at the county level.

Interest groups concerned over service continuity

Both the Estonian Association of Rehabilitation Institutions and the Chamber of People with Disabilities have expressed concern that transitioning to a new social rehabilitation system could result in service disruptions.

"The ministry has promised that staff will be hired within the regional TERVIK coordination bodies to ensure a smooth transition, but the logic behind the funding remains unclear," said Kristi Kähär, an advocacy adviser for benefits and services at the Chamber of People with Disabilities.

The ministry itself acknowledges in the reform plan that if establishing the new TERVIK organizations in the counties is delayed, the provision of rehabilitation services could be interrupted.

"As an unintended consequence, the new system may not meet the needs of all target groups during the transition, which creates a risk that some individuals will lose access to nearby services, especially if service providers, particularly in rural areas, shut down," the ministry writes in its development intent document.

Marilin Vaksman, head of the Association of Rehabilitation Institutions, said that although the ministry has identified potential risks, such as people temporarily losing access to services, it has not taken concrete steps to mitigate them.

"For instance, the ministry has not planned for a transition period when moving to the new system," Vaksman said.

"At the moment, it feels like the entire reform is being rushed through. Everything is supposed to happen very quickly. We need to take a moment to think things through more calmly," said Liis Rooväli, head of the Tallinn Family Doctors' Society.

Social rehabilitation to disappear in a year and a half

According to the development plan, the Ministry of Social Affairs aims to send the health and social care integration proposal out for its first round of approval in September. The ministry hopes to present a draft bill to the government by January, with the Riigikogu expected to begin deliberations early next year.

Marilin Vaksman, head of the Estonian Association of Rehabilitation Institutions, said the ministry has clearly communicated to institutions currently providing social rehabilitation services that, as of 2027, the service in its current form will no longer continue.

"That's 100 percent certain. The Social Insurance Board now wants to sign a final one-year contract with us," she noted.

Until July, when the ministry unveiled its new reform plan, there had been uncertainty across the sector about what would replace the current social rehabilitation service. According to Vaksman, it's still not entirely clear what exactly will happen starting in 2027.

"We know the new system is supposed to begin then. We've also previously suggested to the minister that perhaps the rollout could be delayed — otherwise, everything is being rushed. But we don't know what the state will ultimately decide," she said.

From social worker to health coordinator

Vaksman explained that if the new health and social care integration plan is ultimately passed into law in the first half of 2026, the state might have only about six months to train the so-called health pathway coordinators.

Under the ministry's vision, a health pathway coordinator is a professional with a background in nursing or social work who has completed specialized additional training.

The ministry believes these coordinators could primarily be social workers already employed in rehabilitation teams, as they are already familiar with case-based work and the rehabilitation process.

However, these individuals still need to be properly trained in time to assess people's health needs and support the prevention and monitoring of chronic illnesses.

"You can't start training health pathway coordinators before there's a legal basis to do so," Vaksman noted.

The ministry also acknowledges in its reform plan that ensuring timely and sufficient training for these coordinators during the system's transition will be critical.

From one system to another in less than a year

With the planned system changes, rehabilitation centers that wish to continue offering health services will need to obtain a healthcare service license. According to Vaksman, such services include physiotherapy, speech therapy and clinical psychology.

"Healthcare services are subject to very strict regulations. Documentation and everything involved is a completely different world. It's going to be a real challenge for today's service providers to apply for those licenses in time," she explained.

The ministry also acknowledges in the development plan that this requirement may be especially difficult for smaller providers, who could face challenges in securing the necessary licenses.

"As a result, the number of service providers may temporarily decline. Rehabilitation services are already unevenly accessible across regions, but the TERVIK cooperation network will have the authority to purchase rehabilitation services from other regions if needed," the document states.

To mitigate this risk, the ministry plans to offer guidance materials, informational sessions and opportunities for experience-sharing.

Health Insurance Fund does not approve

The ministry's reform plan has already drawn criticism from Rain Laane, head of the Health Insurance Fund, who told Eesti Ekspress that the fund does not intend to approve the ministry's development proposal.

Laane told the newspaper that the state plans to shift a number of services from the Social Insurance Board to the Health Insurance Fund without providing a corresponding increase in funding.

"The Health Insurance Fund cannot approve these development proposals in any way. This is where claims arise that the fund is unwilling to cooperate. We are openly opposing both the idea of merging the health and social care systems and the plan to unify funding for assistive devices and medical equipment," Laane said.

In July, ERR reported that the government hopes to save around €50 million within three years of transitioning to the new model.

Family doctors: Health access might deteriorate instead

Liis Rooväli, head of the Tallinn Family Doctors' Society, said she suspects that people's access to health and social services could actually worsen after the reform. She believes that the ideas outlined in the development plan may ultimately come at the expense of healthcare services.

Rooväli noted that while the ministry has promised to transfer some budget funds from the Social Insurance Board to support rehabilitation services, the healthcare sector has previously had negative experiences with similar budget shifts from the state budget to the Health Insurance Fund.

"For example, ambulance services, care for uninsured individuals, training of medical residents, HIV and tuberculosis medications and vaccines — all of these were moved over from the state budget. The goal at the time was to create efficiency within the healthcare system, to make everyone happy and to save money. But today, we see that the Health Insurance Fund is running a significant deficit," she said.

Rooväli added that family doctors are concerned that transferring even more services to the Health Insurance Fund could overburden healthcare providers.

"We also worry that access to care for acute or seriously ill patients will suffer, because long-term patients will already be tied into these social rehabilitation services," she said.

While Rooväli agrees that integrating health and social care is a reasonable idea, she questions whether it's necessary to bundle in a complete overhaul of the social rehabilitation system at the same time. The concept of health coordinators is, in her view, a good one — but she pointed out that hospitals already employ social workers who address patients' social issues.

She explained that asking health coordinators in primary care centers to manage not only social issues but also direct patients to social rehabilitation and draft well-being plans is simply too much for one person to handle.

"In our view, the health pathway coordinator should help relieve some of the burden currently carried by family doctors and nurses — and also take on responsibilities that today aren't being handled at all. But this development plan wants to shift existing case managers from the social system into the healthcare system. That's a solution we're not really in favor of," Rooväli said.

Tallinn deputy mayor also critical of state's plans

Tallinn Deputy Mayor Karl Sander Kase (Isamaa) also criticized the Social Affairs Ministry's reform plan in a Facebook post. While he acknowledged that, on the surface, integrating the health and social care systems sounds promising, he argued that after reviewing the development proposal, it becomes clear that true integration is not actually being pursued.

"Instead, yet another management layer is being created — one that duplicates the work of already existing institutions and makes the entire service system even more confusing," Kase wrote.

He pointed out, for example, that the ministry plans to establish regional "well-being areas" along with cooperation councils. According to the reform plan, these areas would not function as administrative units but would serve coordination and collaboration roles.

"There's no answer to the question of why this couldn't be handled by the National Institute for Health Development or the Social Affairs Ministry itself, whose responsibility it should be to set strategic goals and direction," Kase wrote.

Kase also criticized the creation of the new coordination bodies known as TERVIK-s. Under the plan, TERVIKs would not provide health or social services directly, but rather collect and analyze data and make recommendations to the state, cities and municipalities.

"Again, there's no answer as to why this couldn't be done by the National Institute for Health Development or the Social Affairs Ministry. Instead, the chosen path seems to be the formation of what are essentially county-level health and social service administrations," Kase wrote.

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