title: Estonia: health system review.
abstract: This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system.
authors: Ministry of Social Affairs, Estonia.
authors: Taavi
authors: T
authors: Lai
authors: Estonian Health Insurance Fund, Tallinn, Estonia.
authors: Triin
authors: T
authors: Habicht
authors: HC Management Consulting Ltd, Estonia.
authors: Kristiina
authors: K
authors: Kahur
authors: WHO Country Office, Estonia.
authors: Marge
authors: M
authors: Reinap
authors: University of Tartu, Estonia.
authors: Raul
authors: R
authors: Kiivet
authors: Berlin University of Technology and European Observatory on Health Systems and Policies.
authors: Ewout
authors: E
authors: van Ginneken
mesh_terms: D002423:Cause of Death / Q000639:trends; D003363:Cost Control / Q000379:methods; D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration / Q000639:trends; D057172:Economic Recession; D004957:Estonia / Q000453:epidemiology; D005062:European Union; D018166:Health Care Reform / Q000191:economics* / Q000458:organization & administration; D006291:Health Policy / Q000191:economics* / Q000639:trends; D006295:Health Resources / Q000191:economics* / Q000639:trends; D054624:Health Status Disparities; D061889:Healthcare Financing; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D008017:Life Expectancy / Q000639:trends; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000458:organization & administration* / Q000639:trends