Experts warn Estonia must act soon to fix health fund deficit or face higher patient costs
Experts say the current government cannot postpone solving the Health Insurance Fund's financial troubles for future administrations. Delaying decisions may lead to a situation where people will have to pay more out of pocket for medical care.
Estonia has a solidarity‑based healthcare system, meaning wage earners cover the treatment costs of children and the elderly. In a rapidly aging society, social tax revenue is no longer sufficient to fund healthcare, and the Health Insurance Fund has been running a deficit of nearly €100 million for several years.
Last week, Minister of Social Affairs Karmen Joller said this government will not change healthcare financing. The fund's reserves should last until 2029, and only then will it be time to decide.
"From my perspective, these decisions were unavoidable already today, because the expectation that using reserves will preserve access to care at the current level is actually an illusion," said healthcare analyst Kaija Kasekamp.
According to her, Estonia must now decide whether to continue with solidarity‑based health insurance or whether people will have to start paying more themselves.
"International experience and research show that systems based on solidarity and equal access have better health outcomes and, in fact, lower total healthcare costs," Kasekamp said.
Priit Perens, head of Tartu University Hospital, said hospitals will manage for the next couple of years, but problems are expected later.
"The issue is that healthcare services are becoming more expensive. Patients' and the entire population's expectations for service quality are rising. Both lead to additional cost growth," Perens said.
He added that while more efficient solutions can always be found, savings alone are not enough to fill the €100 million gap in the Health Insurance Fund's budget. Finding additional funding is, in his view, a matter of societal agreement — and if society does not consider it necessary, access to medical care may increasingly depend on a patient's ability to pay.
"The upper end of healthcare services requires such large investments that if only three people in Estonia can afford a specific service and others cannot, they will likely go abroad to buy that service. We simply cannot — and neither can the private sector — make such investments," Perens said.
Family doctor Triinu‑Mari Ots said it is the responsibility of the state and healthcare organizers to explain to people what kind of care can realistically be provided. Currently, this burden has been shifted onto family doctors.
"Unfortunately, at the primary‑care level, a lot of time is spent in one‑on‑one conversations with patients explaining what we are currently unable to provide, because it is not needs‑based nor affordable for the state," Ots said.
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Editor: Johanna Alvin, Argo Ideon
