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Country profiles of health system responses to the crisis | Estonia
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The benefits package
• Financing of temporary sick leave benefits shifted to patients and employers
and benefits reduced.
• Benefits were now only paid from the fourth day (rather than the second day),
days four to eight paid by the employer (previously paid by the EHIF), the rate
of reimbursement reduced from 80% to 70% of wages and the rate for caring
for a sick child reduced from 100% to 80% (2009).
• Reduction of the cap on maternity leave from 154 to 140 days (2009).
• As a result, spending on temporary sick leave benefits fell by 42% in 2010
and its share of the health insurance budget fell from 20% in 2008 to 12%
in 2010.
• Eligibility for dental benefits removed from insured persons aged between 19
and 63 years (2009).
User charges
• Introduction of a co-insurance rate of 15% for nursing inpatient care (2010).
• Cap on reimbursement for drugs reimbursed at the 50% level abolished
(2012).
• Co-payments for outpatient specialist visits increased from €3.20 to €5 and
for inpatient stays from €1.60 to €2.50 following negotiation with providers
(2013).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Introduction of a new annual generic drug promotion campaign on
television and billboards (2010).
• Price agreements extended to medicines in the lowest (50%)
reimbursement category (some effective drugs and many less costeffective
drugs) (2010).
• Pharmacists must offer the drug with the lowest user charge and note if
patients refuse cheaper alternatives (2010).
• Reference pricing extended to drugs in the lowest (50%) reimbursement
category (some effective drugs and many less cost-effective drugs) (2010).
Salaries and motivation of health sector workers
• Basic salaries were not affected but reductions to additional remuneration
components affected the monthly salaries of most categories of health
sector personnel (2009–2012).