EHIF's supervisory board has submitted proposals to the Ministry of Social Affairs to update covered healthcare services, adjust ambulance and remote consultation payments, and revise capitation fees — the per-patient payments family doctors receive for primary care.

Liis Kruus, EHIF's portfolio manager for healthcare service development, said the main change is factoring in patient disease burden alongside age — in other words, how many illnesses a patient has.

"Age groups of 0–3, 3–6, 7+ years and disease burden groups of 0, 1, 2, 3–4 and 5+ illnesses will be created," she confirmed to ERR.

Separate capitation fees will also be introduced to family doctors practicing independently and those working in health centers under a single legal entity. The fee cap will also cover costs not dependent on patient numbers, such as practice space and IT.

Distance fees, currently based solely on the distance to the nearest hospital, will also be revised to consider facility density and regional poverty.

For specialized care, new cost-effective, evidence-based services will be added in cardiac surgery, diagnostics and other areas, while individual physical therapy services will be optimized. Existing service prices will also be updated to improve treatment options and optimize costs.

Under proposed updates, psychiatric case management will be extended to ensure continued mental healthcare coverage, while caps and conditions for services in otorhinolaryngology (ear, nose and throat, or ENT) and pathology will also be modernized.

Lab services facing 15 percent cut

Caps on laboratory services will drop 15 percent while a new cost structure is finalized, sparking mixed reactions from hospitals.

Last week, daily Postimees reported (link in Estonian) that large hospitals will be most affected by the planned cuts, which EHIF expects will save €24 million.

East Tallinn Central Hospital (ITK) chair Tarmo Bakler said EHIF should also raise funding for services whose current caps don't cover actual costs.

Tallinn Children's Hospital (TLH) is also concerned. Hospital board chair Konstantin Rebrov said pediatric services are already underfunded and need to be updated to align with real costs.

Smaller hospitals could benefit, however. Arvi Vask, board chair at South-Estonian Hospital outside Võru, noted that money saved from labs could be redirected to emergency department readiness fees.

EHIF's proposals also include adjustments to readiness fees for hospital emergency rooms and detention facilities, though the direction of those changes has not yet been clarified.

Screenings and preventive care to expand

Estonia's healthcare fund has proposed nationwide newborn cystic fibrosis (CF) screening and extended its lung cancer screening pilot project through 2027. Family doctors joining the lung cancer project in its first year could receive a bonus.

The cap for colorectal cancer fecal occult blood tests will also change due to new pricing components. Kruus said updates reflect procurement and test organization, which will be handled by approved labs starting in early 2026. The target group for colorectal screening will expand to include 56-year-olds.

Coverage for new hospital medications will be added for several cancers, two severe chronic illnesses and two rare diseases. Target pneumococcal vaccination groups will be broadened as well.

Changes in nursing and dental care, meanwhile, will be minimal, Kruus said.

Overall, EHIF's planned updates are expected to cost €5.07 million next year. The fund faces a projected €105 million shortfall, with the government calling for budget cuts and greater operational efficiency.  

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