Experts urge government to address health fund deficit now

Experts told ERR that Estonia’s current government cannot leave the Health Insurance Fund’s nearly 100 million euro deficit for its successor to resolve, warning that delays could force people to pay more for medical care.

Estonia has a solidarity-based healthcare system in which workers’ social tax helps cover treatment for children and older people. But in the rapidly ageing society, social tax revenues are no longer sufficient to finance healthcare, leaving the Health Insurance Fund with a deficit of nearly 100 million euros for several years.

Social Affairs Minister Karmen Joller said last week that the current government would not change healthcare financing. She said the Health Insurance Fund’s reserves should last until 2029, after which decisions could be made.

Health analyst Kaija Kasekamp said the necessary decisions could not be postponed.

“In my view, these decisions were already unavoidable today, because the expectation that we can use reserves while maintaining access to healthcare at a similar level is actually an illusion,” Kasekamp said.

She said Estonia must now decide whether to continue with solidarity-based health insurance or require people to pay more for medical care themselves.

“International experience and research show that systems based on solidarity and equal access produce better health outcomes, while total healthcare costs are also lower,” Kasekamp said.

Priit Perens, head of Tartu University Hospital, said hospitals would manage for the next few years but problems were likely to emerge later.

“Healthcare services are becoming more expensive. Patients’ and the population’s expectations for the quality of healthcare are also rising. Both developments bring additional cost increases,” Perens said.

He said more cost-effective solutions could always be found, but savings would not be enough to fill the 100 million euro gap in the Health Insurance Fund’s budget. In his view, finding additional healthcare funding was a matter of social agreement. Without it, access to medical care could increasingly depend on patients’ ability to pay.

“The high end of healthcare requires such large investments simply to provide those services that if three people in Estonia can afford a specific service and others cannot, they will most likely go abroad to buy it. We cannot make such investments, and the private sector cannot either,” Perens said.

Family doctor Triinu-Mari Otsa said the state and healthcare organisers must explain to people what medical care can be provided. At present, that responsibility has largely fallen to family doctors.

“Unfortunately, at the primary-care level, a great deal of time is spent in one-on-one conversations with patients explaining what we are currently unable to provide because it is not based on need or affordable for the state,” Otsa said.