General outline of health care system

Health insurance in Estonia is organised by the Estonian Health Insurance Fund (hereinafter the EHIF) and its 4 local departments. The Estonian Health Insurance Fund is the only organisation in Estonia dealing with compulsory health insurance.

Information on how to obtain the certain benefits can be found on our webpage. For additional requests please contact us.

Health care services

All persons insured with the EHIF have a family practitioner. A person not residing in Estonia may also visit a family practitioner. A person needs a referral from the family practitioner to visit a medical specialist. No referral is needed to visit a psychiatrist, gynaecologist, dermatovenerologist, ophthalmologist, dentist, pulmonologist (for tuberculosis treatment), infection specialist (for HIV/AIDS treatment), surgeon or orthopaedist (for traumatology).

In the case of emergency treatment, a person may always go to the emergency reception or call an ambulance on no 112. The attending physician decides whether the patient needs in-patient treatment.

The amount of the patient’s financial participation in the following cases:
- out-patient examination – a family practitioner can charge a visit fee of up to 5 EUR, when making a home visit;
- specialised medical care – a visit fee up to 5 EUR;
- transportation by ambulance in the case of emergency – free of charge;
- hospitalisation – an in-patient fee of up to 2.50 EUR per day for up to 10 days per hospitalisation.

There is no visit fee for pregnant women, children below the age of 2 and in case of immediate hospitalisation.

There is no in-patient fee for children below the age of 18, in cases related to pregnancy and childbirth and in the case of intensive care.

Estonian Health Care System

The organisation of the current health care system emerged from the health care reform of the 1990s, whose aim was to develop a modern and efficient health care system.

The Ministry of Social Affairs is the steward of the Estonian health care system. The ministry has to develop the relevant regulations and strategies. There are several agencies within the area of administration of the Ministry of Social Affairs; of them the State Agency of Medicines and the Health Board are responsible for health care matters. The principal tasks of the State Agency of Medicines include registration of pharmaceuticals, quality control and organisation of trade in pharmaceuticals. The Health Board’s basic task is to provide leadership in the degree specified in the legislation governing its spheres of activity and to perform surveillance and enforcement functions to assure compliance with legal requirements.

The Health Insurance Fund also operates within the area of administration of the Ministry of Social Affairs, however not as its agency but as an independent legal body under public law. The Health Insurance Fund has had its current legal status since 2001, when the system which consisted of the Central Health Insurance Fund and 17 regional health insurance funds was changed. The main duties of the Health Insurance Fund are the following: entry into contracts with health care providers for payment for the provision of care, payment for health services subject to reimbursement, payment for pharmaceuticals included in the list of pharmaceuticals distributed at a discount and payment of benefits for temporary incapacity for work.

The pillars of the Estonian health care system are separation of the provision of health services and funding thereof, the relative independence of health care providers in operational decision-making and the organisation of the health care system around family health centres. Separation of the health care providers and funding is achieved via the independent Health Insurance Fund, which plays no direct role in managing medical institutions (e.g. representatives of the Health Insurance Fund are not represented in the hospitals’ supervisory boards). Similarly the service providers are not involved in the management of the Health Insurance Fund (there are no service providers in the Health Insurance Fund Supervisory Board). Such separation of the health care providers and the funders guarantees unbiased funding decisions, aimed only at meeting the treatment needs of the insured and ensuring the use of health insurance moneys for the designated purpose.

Health care providers operate under private law. Despite that hospitals of strategic importance are owned by the public sector. Through their representatives in the hospitals’ supervisory boards the owners (state, local government) ensure that public interests are met and operating goals set to serve the public interests are fulfilled by the executives of the hospitals. The organisation of the activities of the service providers in this manner (i.e. combining public ownership and operation under private law) adds to the flexibility and efficiency of their management.

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