title: Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality.
abstract: As of 2014, the Estonian Health Insurance Fund has adopted new purchasing procedures and criteria, which it now has started to implement in specialist care. Main changes include (1) redefined access criteria based on population need rather than historical supply, which aim to achieve more equal access of providers and specialties; (2) stricter definition and use of optimal workload criteria to increase the concentration of specialist care (3) better consideration of patient movement; and (4) an increased emphasis on quality to foster quality improvement. The new criteria were first used in the contract cycle that started in 2014 and resulted in fewer contracted providers for a similar volume of care compared to the previous contract cycle. This implies that provision of specialized care has become concentrated at fewer providers. It is too early to draw firm conclusions on the impact on care quality or on actors, but the process has sparked debate on the role of selective contracting and the role of public and private providers in Estonian health care. Lastly, the Estonian experience may hold important lessons for other countries looking to overcome inequalities in access while concentrating care and improving care quality.
authors.affiliation: Ministry of Social Affairs, Estonia.
authors.forename: Triin
authors.initials: T
authors.lastname: Habicht
authors.affiliation: WHO Country Office, World Health Organization, Republic of Moldova.
authors.forename: Jarno
authors.initials: J
authors.lastname: Habicht
authors.affiliation: Berlin University of Technology, Germany; European Observatory on Health Systems and Policies, Belgium. Electronic address: ewout.vanginneken@tu-berlin.de.
authors.forename: Ewout
authors.initials: E
authors.lastname: van Ginneken
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D004957:Estonia; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration; D054625:Healthcare Disparities / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D062505:Value-Based Purchasing / Q000191:economics / Q000458:organization & administration*
keywords: Estonia; Hospitals; Quality of care; Selective contracting; Specialist care; Strategic purchasing