WHO’s new Estonia report defines the policies that will make health care more affordable for low-income people

A new report on affordable access to healthcare in Estonia, released on International Universal Health Day 2023, reveals that one in 14 households (7%) experienced catastrophic health expenses in 2020 because they had to pay for healthcare out of pocket. People who suffer from catastrophic health costs may not be able to pay for other basic needs such as food, housing and heating. In the same year, self-imposed payments pushed 2% of Estonian households into poverty or made them even poorer.

Although catastrophic health expenditures are still higher in Estonia than in many European Union (EU) countries, the situation improved between 2015 and 2020. This reflects positive changes in coverage policy and other factors, says a new WHO/Europe study, which was launched today on the 15th anniversary of the Tallinn Charter of the Health Systems Conference.

The report “Can people afford to pay for healthcare? New evidence on financial protection in Estonia 2023” shows that financial difficulties are mainly caused by out-of-pocket payments for outpatient care and dental care, and are heavily concentrated in low-income households.

Deficiencies in coverage weaken financial protection

The study identifies gaps in all three dimensions of health care:

  1. Who is covered – Combining the right with social security contributions leaves 10% of working-age people without insurance.
  2. What services are covered – The health care benefit package offered by the Estonian Health Insurance Fund (SAI), although quite extensive, offers limited coverage of dental care for adults.
  3. Share of costs – although the government has tried to improve the out-of-pocket protection for medicines and dental care prescribed for outpatient care, more can be done to protect low-income people.

“The Tallinn Charter, signed in 2008, emphasized that the people of Europe should not become poor because of poor health. Since then, the Estonian government has redesigned some aspects of the coverage policy to improve the affordability of outpatient medicines and dental care,” explains Dr. Natasha Azzopardi-Muscat, Director of the WHO/Europe Country Health Policies and Systems Division.

He added: “Based on the analysis in our new report, we urge the government to continue reducing out-of-pocket costs for these and other services and to focus on strengthening protections for low-income households.”

Let’s make health care more affordable for low-income people

To improve financial protection, Estonia can:

  • narrow the population coverage gap by changing the criteria for nursing home benefits to residence;
  • add and fine-tune benefits to better serve the people most in need;
  • more protection against all installment payments, especially for low-income households;
  • remove balance billing for primary care services to ensure that access is not dependent on ability to pay;
  • reduce out-of-pocket costs for long-term health care; and
  • reduce out-of-pocket payments for outpatient medications by encouraging the prescribing and distribution of the cheapest alternatives, price regulation, and improving the sale and use of over-the-counter medications.

About the report

The report is based on household budget surveys conducted in 2015, 2016, 2019 and 2020; information on the Estonian health accounting system from 2021; data on unmet health and dental needs through 2022; and information on the coverage policy until 2023. It received financial support from the EU through the European Commission’s Directorate-General for Health and Food Safety.

About WHO/Europe’s economic protection work

Financial protection is a key part of general health care and a key dimension in evaluating the health care system’s performance. It is an indicator of the Sustainable Development Goals, part of the European Pillar of Social Rights and at the heart of the European Work Programme, the WHO/European Strategic Framework.

WHO/Europe monitors financial protection through the WHO Barcelona Health Systems Financing Office using regional equity-sensitive indicators. WHO’s Barcelona office provides tailored technical assistance to countries to reduce economic hardship and unmet need by identifying and addressing gaps in health coverage.

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