Critics skeptical of Estonia's planned social, healthcare merger
In a major reform, Estonia plans to merge social and healthcare services to simplify care, but local governments and interest groups oppose the plan.
Currently, people in Estonia must navigate between family doctors, social workers and pharmacies, often leaving providers without a full picture of their needs despite the country's centralized medical records.
Under the combined system, elderly and other patients who need both medical care and social support would have a single point of contact — a health manager coordinating their care plan.
"This would include their medication list, their doctor's appointments, who can help, who their social worker is and who their family doctor is," explained Kadri Oras, head of the Home Services Department at Viljandi Hospital.
The Ministry of Social Affairs says the reform won't create new financial burdens for local governments, since the state would manage the system. It remains unclear, however, how much funding will be needed or where it will come from in the state budget.
Minister of Social Affairs Karmen Joller (Reform) noted that the Estonian Health Insurance Fund (EHIF) will review its own funding, and results — including how much emergency room visits drop and how often people end up in the hospital — could determine how much money is required.
"If our main additional expense right now is health managers' salaries, that's negligible compared with overall healthcare costs," Joller said.
The ministry has applied for €14.7 million in EU funding to implement the reform. External aid ends in 2027, by which time the system is expected to be ready. Anneli Taal, head of integration and primary healthcare policy at the ministry, said the state hopes to have nationwide readiness by early 2028.
Local governments and other interest groups, however, remain skeptical.
Tallinn Deputy Mayor Karl Sander Kase (Isamaa) said the plan would add another layer of management, overlapping the work already done by existing agencies without providing any additional funding.
"The best way to do this would be to finally integrate social information systems with health databases, so the same social worker could access a person's health data, and a healthcare worker could see assessments and analyses from the social sector," Kase said.
It's simply a technical matter of developing a single information system, he added.
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Editor: Johanna Alvin, Aili Vahtla
