New WHO report on Estonia identifies policies to make health care more affordable for low-income people

On International Universal Health Coverage Day 2023, a new report on affordable healthcare in Estonia reveals that one in four households (7%) experienced catastrophic health expenditures in 2020 due to having to pay out of pocket . People who experience catastrophic medical expenses may be unable to pay for other basic needs such as food, housing, and heating. In the same year, out-of-pocket payments pushed 2% of Estonian households into poverty or even poorer.

Although catastrophic health spending in Estonia remains higher than in many EU countries, the situation improved between 2015 and 2020. According to the WHO/Europe health systems meeting today marking the 15th anniversary of the Tallinn Charter.

The report “Can People Afford Health Care?” “New evidence on financial protection in Estonia 2023” shows that financial hardship is mainly caused by out-of-pocket costs for outpatient medicines and dental care and is mainly concentrated among low-income households.

Coverage gaps weaken financial protection

The study identified gaps in all 3 aspects of health coverage:

  1. Who is insured – When entitlement is linked to social health insurance contributions, 10% of the working-age population is uninsured.
  2. What services are covered – The healthcare benefit plan offered by the Estonian Health Insurance Fund (EHIF), although quite extensive, has limited coverage for adult dental care.
  3. Proportion of costs covered – While the government has tried to improve co-pay protections for outpatient prescription drugs and dental care, more could be done to protect low-income earners.

“The Tallinn Charter, signed in 2008, emphasized that people in Europe should not be pushed into poverty because of poor health. Since then, the Estonian government has redesigned certain aspects of coverage policy to make outpatient medicines and dental care more affordable .” explained Dr. Natasha Azzopardi-Muscat, Director of the Department of Health Policies and Systems at WHO/Europe.

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

Make health care more affordable for low-income people

To improve financial protection, Estonia can:

  • Reducing the gap in population coverage by changing the basis for obtaining EHIF residence benefits;
  • Increase and fine-tune benefits to better serve those most in need;
  • Strengthen protections for all copayments, especially for low-income families;
  • Abolition of balance billing for primary care services to ensure access to services is not dependent on ability to pay;
  • Reduce out-of-pocket costs for long-term health care; and
  • Reduce out-of-pocket costs for outpatient drugs through incentives to prescribe and distribute the least expensive alternatives, price regulation, and improvements in how over-the-counter drugs are sold and used.

About the report

The report draws on data from the Household Budget Survey conducted in 2015, 2016, 2019 and 2020; data from the Estonian Health Accounts System in 2021; data on unmet health and dental care needs as of 2022; and as of 2023 Underwriting policy information for the year. It benefits from financial assistance provided by the European Union through the European Commission’s Directorate-General for Health and Food Safety.

About WHO/Europe’s work on financial protection

Financial protection is at the core of universal health coverage and a core aspect of health system performance evaluation. It is an indicator of the Sustainable Development Goals and is part of the European Social Rights Pillar and is central to the European Program of Work and the WHO/Europe Strategy Framework.

WHO/Europe monitors financial protection using equity-sensitive regional indicators through the WHO Health System Financing Office in Barcelona. WHO Barcelona provides countries with tailored technical assistance to reduce financial constraints and unmet needs by identifying and addressing gaps in health coverage.

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