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Estonian Human Development Report

Estonian Human Development Report - Eesti Koostöö Kogu

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Health care financing<br />

Health and health care are treated as a right in both the<br />

<strong>Estonian</strong> Constitution, which speaks of everyone’s right to<br />

health protection (Estonia…, 1992), and in the European<br />

Union Charter of Fundamental Rights, which defines preventive<br />

health care and treatment as a right based on the<br />

terms of domestic legislation and practices, (European<br />

Union Charter of Fundamental Rights, 2004). This right is<br />

defined by the general objectives of the health care system,<br />

which include the good health of the population, satisfaction<br />

with the system and protection against financial risks<br />

(The World Health <strong>Report</strong>, 2000).<br />

Estonia, like the majority EU countries, implements<br />

the principle of national health care insurance, whereby<br />

a third party (the Health Insurance Fund) provides the<br />

population with financial protection for the use of services.<br />

The money is collected as a social tax, the insurance<br />

is compulsory, the insurance coverage is universal<br />

and availability depends on need. These principles generally<br />

apply although various countries may organize<br />

the financing from general taxation, from income taxes,<br />

or from compulsory private insurance (Aaviksoo, Paat,<br />

2007).<br />

In addition to national health insurance and the<br />

national budget, which provide financing for the treatment<br />

costs of uninsured persons, financial coverage is also provided<br />

by private insurance. This component is currently<br />

marginal in Estonia.<br />

The other important aspect of health care related<br />

to financial resources is the distribution of costs or the<br />

rate of the patients’ cost-sharing. The largest portion<br />

of health care costs was covered by the Health Insurance<br />

Fund (in 2004, 66%, and the national budget 8.5%)<br />

and the self-financed portion was 21% (Aaviksoo, Paat,<br />

2007). Moreover, the patients’ cost-sharing has continually<br />

increased; in 1999 it was only 14%. The increase of<br />

health care costs in budgets is also confirmed by household<br />

surveys (Household Budget Survey, 2006). This is<br />

primarily related to paying for medicine, although in<br />

2003 and 2004, visit and in-patient fees were established<br />

and the procedure for paying for adult dental care was<br />

changed (Aaviksoo, Paat, 2007).<br />

Due higher health insurance tax revenues, the quantity<br />

of services financed by the Health Insurance Fund<br />

has also increased although, as mentioned above, the<br />

patients’ contribution has increased even more. Health<br />

insurance coverage has improved, although in 2007,<br />

there were still 60 thousand uninsured persons in Estonia.<br />

The waiting period for out-patient visits to specialists<br />

has constantly increased. However, assessments for<br />

the availability of medical treatment have not significantly<br />

worsened during the last few years (Aaviksoo,<br />

Paat, 2007).<br />

On the one hand, the situation in the health care system<br />

reflects the state of country’s well-being, while on the<br />

other hand it affects what happens in the economy. Statistics<br />

confirm that the greater the role of market relations<br />

in this field, the greater the increase in health care cost<br />

as related to the increase in the standard of living, both<br />

absolutely as well as in relationship to GDP. At the same<br />

time, this does not guarantee equal access to health care<br />

services. The US is a typical example of this (Paying for<br />

Healthcare, 2004).<br />

Figure 6.3.6. Assessment of the availability of medical<br />

services, 2001–2006<br />

100<br />

90<br />

80<br />

70<br />

60<br />

50<br />

40<br />

30<br />

20<br />

10<br />

0<br />

2001 2002 2003 2004 2005 2006<br />

Source: Aaviksoo, A., G. Paat (2007).<br />

Cannot say<br />

Poor<br />

Rather poor<br />

Rather good<br />

Good<br />

Figure 6.3.7. Figure 6.3.7. Average gross wages,<br />

old-age pensions and inflation, 1997=100%<br />

350<br />

300<br />

250<br />

200<br />

150<br />

100<br />

50<br />

0<br />

1997<br />

1998<br />

1999<br />

2000<br />

Source: Statistics Estonia.<br />

2001<br />

2002<br />

The financing of the <strong>Estonian</strong> health care system<br />

is designed according to a European model, whereby<br />

the basic part is covered by health insurance tax, and<br />

the service side is standardized to a great extent. This<br />

system, which has functioned with only small problems,<br />

has been implemented under conditions of certain<br />

economic growth. The expansion of the tax base<br />

has guaranteed the increasing flow of resources and<br />

has smoothed the faults of the system. Economic recession,<br />

the reduction in tax revenues and possible deficit<br />

of services will increase dissatisfaction with the system<br />

and will create pressure for the expansion of private<br />

insurance.<br />

Social insurance and the economy<br />

Expenditures on social insurance include pensions and<br />

pension supplements financed from social tax revenues<br />

and the national budget, national family and parental benefits,<br />

social benefits for disabled people, and other benefits<br />

paid to families (for instance funeral benefits, student<br />

loan write-offs). The largest ratio of these costs is pensions,<br />

which constituted 6% of GDP in 2007. In the same year,<br />

national family benefits constitute 1.1% of GDP, including<br />

parental benefits totalling 0.5% of GDP.<br />

The average old-age pension has increased 2.7 times<br />

between 1997 and 2007, while actual purchasing power<br />

has only increased 78.7%, since a portion of the nominal<br />

pension increase has been eaten away by inflation. During<br />

the same period, average gross wages increased 3.2 times<br />

and the actual wage increase was 106% (2.06 times). The<br />

2003<br />

2004<br />

2005<br />

2006<br />

2007<br />

Average<br />

gross wage<br />

index<br />

Average<br />

old-age<br />

pension<br />

index<br />

Inflation<br />

Actual average<br />

gross<br />

wage index<br />

Actual average<br />

old-age<br />

pension<br />

index<br />

135 |

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