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68 Economic crisis, health systems and health in Europe: country experience
Consumption of pure alcohol per capita increased from 5.6 litres in 1995 to
12.6 litres in 2007 as the relative price of alcohol decreased as incomes grew
faster than alcohol prices. Alcohol consumption did fall during 2008–2010
(9.7 litres of pure alcohol per capita in 2010) as incomes dropped during the
economic crisis and as alcohol excise taxes were raised. During 2011 and 2012,
consumption increased to 10.6 litres of pure alcohol per capita as incomes
started to increase. Lower alcohol consumption rates explain the reduction in
injuries and deaths from external causes in 2008–2010; and it is also partly
the reason for increasing life expectancies. In addition, lower fatality rates
in road traffic accidents are probably also partly related to decreased alcohol
consumption: the number of death caused by road traffic accidents decreased
from 196 in 2007 to 132 in 2008 and to 100 in 2009 (Maanteeamet, 2013).
5. Discussion
5.1 Drivers of change
The response of the health system to the crisis was part of a coordinated
government policy guided by the aim of fulfilling Maastricht criteria in spite of
the unfavourable economic environment. The fact that the objective of joining
the Eurozone was publicly accepted made it easier for the government to justify
crisis-related reforms and decisions.
It took over six months for the government to understand the seriousness of the
crisis. The first signs were noticed in early 2008 but still most of the decisions
were made according to pre-crisis forecasts. In September 2008, the Ministry
of Finance's forecast were still calculated on the basis of 10% growth for EHIF
revenues in 2009, and in the following January the EHIF's supervisory board
approved an increase in health service tariffs. However, implementation of
this decision was postponed because of the increasingly pessimistic economic
outlook. By the end of February 2009, the parliament had approved an
amendment of the government budget. This amendment included a package of
decisions to contain and cut public sector expenditure, among which was the
reform of temporary sick leave benefits, which came into force in mid-2009.
This was a long-debated reform and a striking example of how the crisis created
an opportunity to reach political agreement and implement the otherwise
controversial cuts.
5.2 Content and process of change
At the end of October 2009, the scale of the crisis increased further, prompting
the approval of an overall reduction in health service tariffs by 6%, which came