Gap grows between medical liability insurance premiums and payouts
Estonia's new medical liability insurance system shows a wide gap between premiums and payouts, with hospitals paying in far more than patients receive in compensation.
At North Estonia Medical Center (PERH), annual premiums total about €500,000, including roughly €400,000 for the main hospital. Over roughly two years, payouts for treatment errors have totaled just over €50,000.
"Since the deductible is €50,000, all those amounts have fallen below that," said PERH quality manager Priit Tohver, explaining that the hospital has thus covered those costs itself anyway.
He said the imbalance reflects a lack of competition, with PZU Kindlustus currently the country's only provider. More competition could help bring costs and payouts into better balance, he added.
Tohver also noted that money spent on insurance is money not going into care.
"Making the system cheaper and more efficient would no doubt free up funds to invest in services that create value for patients," he said.
Beyond costs, the quality manager raised concerns about limited transparency in expert assessments, saying hospitals often do not know who drew up the opinions used in claims decisions.
Claims are rising; PERH handled 51 claims last year and 36 so far this year. However, over two years, only 18 cases have qualified as insured events. Disputes remain complex and time-consuming, with little change from the pre-reform system.
Still, Tohver said the system has improved reporting and patient safety culture, giving it a score of three out of five overall.
Millions in annual premiums
Nationwide, premiums totaled about €8 million last year, while according to the Health Board, payouts totaled under €200,000, with the largest single payout reaching €15,000.
Meanwhile, the Estonian Health Insurance Fund (EHIF) paid €4 million to healthcare providers to cover liability insurance costs last year, budgeting €6 million for the same in 2026.
Providers must match that amount from their own budgets, as EHIF covers up to 50 percent of premiums. That brought total system-wide costs to about €8 million last year. Providers without fund contracts also pay premiums themselves.
Mandatory medical liability insurance for healthcare providers took full effect on November 1, 2024.
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Editor: Aili Vahtla
