Web-economic-crisis-health-systems-and-health-web

Estonia
Triin Habicht and Mall Leinsalu
Economic trends
• In 2009, real GDP per capita contracted by 11.8%, although growth
returned the following year and by 2011 was in the top quintile of the
European region. Unemployment also increased sharply and is curently
still above the European average. From 2000 to 2007, government
spending as a share of GDP was below the European mean; however,
spending in 2009 as a share of GDP was above the mean. While there
was a government deficit in 2008 and 2009, by 2010 the government was
again running a budget surplus.
• Estonia's health spending priority has been stable although at a level
slightly lower than the European mean. Per capita public health care
spending growth was near 0 in 2009 and negative in 2010, but grew by
3.2% in 2011. OOP expenditure declined to a greater extent than public
spending (Estonia: Figs 1 and 2).
Policy responses
Changes to public funding for the health system
• Spending on health by the Ministry of Social Affairs was 27.1% lower
in 2009 than in 2008, largely because capital expenditure was no longer
being funded by the state budget (without capital expenditure, the
spending decrease was 6.8%), but increased by 4.7% in 2010 and 1.9%
in 2011.
• EHIF's revenues were 11% lower in 2009 and 5% lower in 2010 as a
result of higher unemployment and lower salaries, but increased by 6% a
year in 2011 and 2012.
• EHIF reserves were used to compensate for some of the fall in revenue
(equal to about 5% of the social health insurance budget in 2009) but the
government did not allow these reserves to be depleted.
Changes to health coverage
Population (entitlement)
• Coverage extended to people registered as unemployed for more than
nine months who were seeking work (2009).