Health Insurance Fund cuts could lengthen healthcare queues

Health Insurance Fund spending cuts will likely have to come at the expense of services, leading to longer queues, health policy expert Andres Võrk told ERR. Confido chief executive and general surgeon Edvard Garder said the healthcare system could not become sustainable without major reforms.

The Health Insurance Fund’s supervisory board approved a draft budget for next year on Friday. Social Affairs Minister Karmen Joller said the goal for the coming years was to bring the fund out of its financial crisis and reach a balanced budget or even a surplus by 2030.

Võrk, a lecturer in econometrics at the University of Tartu, said little information was currently available about the fund’s plans. The only clear measure was postponing a planned pay rise for healthcare workers, he said.

“This will clearly create very significant tension with healthcare workers, who have said in wage negotiations that salaries should rise at the rate of average wage growth or even faster,” Võrk said.

He added that the Ministry of Finance forecasts average wage growth of 5.6 percent this year and 4.7 percent next year. It was difficult to see where such an increase in healthcare workers’ wages would come from if it was not included in the price component of healthcare services, he said.

“The minister indicated that the Health Insurance Fund would not raise wages and that healthcare institutions could find an internal buffer for pay rises. But healthcare workers’ wages account for a very large share of total costs, amounting to half at hospitals and more than half at family doctor centres. Given that other input prices are also rising, finding such a buffer is unlikely,” Võrk said.

He said the Health Insurance Fund could reduce costs not only by limiting price growth but also by reducing the number of services. More information was needed on how the planned volume of healthcare services would change, where it would change, whether anything would be reduced and how this would affect queues, he said.

Although the fund has said access to healthcare services will not be reduced, this may not be enough, Võrk said. The population is ageing and demand for healthcare services is growing, so maintaining the current level of visits would mean longer queues.

Võrk said the minister and the chair of the Health Insurance Fund’s management board had both stressed the need to improve efficiency and patient care pathways. Efficiency was always important, whether the system had too much or too little money, he said.

When the system lacks money, this forces hospitals to become more efficient, Võrk said. However, funding must be directed to areas where it creates more added value and brings greater benefit.

“This may mean making different choices between specialist care and primary care, or between different fields of specialist care, so that funding is increased more in some areas than in others,” Võrk said.

As a health economist, Võrk said he believed the Health Insurance Fund should have significantly more staff and much greater analytical capacity. The fund took pride in having low costs and efficient management, he said, but it should in fact be a stronger negotiating partner and counterparty for healthcare institutions when discussing prices and the value of healthcare services.

Confido chief says fund should act like an insurer

Garder said little information was currently available about the Health Insurance Fund’s budget plans. In general, the fund could achieve accounting balance, he said, but the question was how strained Estonia’s healthcare system would be afterwards.