The Estonian Health Insurance Fund (EHIF) is an institution organizing national health insurance. The organisation was registered on August 30, 2002 in the National Register of Central and Local Government Agencies, registry code no. 74000091. EHIF is the only organisation in Estonia dealing with compulsory health insurance. The purpose of the funds activities is to compensate insured people for the costs of health care, to finance the purchase of medicines and medical appliances and pay for a variety of benefits.
The fund has more than 1.2 million customers. To ensure the availability of health care, subsidized medicines and medical equipment, EHIF work with approximately 3,000 cooperation partners all over Estonia.
In order to provide health insurance benefits, the Health Insurance Fund:
1) manages health insurance by ensuring the effective and purposeful use of health insurance money;
2) performs functions provided for by the Health Insurance Act of the Republic of Estonia and other legislative provisions;
3) maintain the database necessary for providing health insurance benefits and for the performance of other functions provided for by this Act;
4) examines the quality and necessity of services partially or fully compensated for by the Health Insurance Fund;
5) manages the performance of the international agreements concerning health insurance and the Health Insurance Fund;
6) participates in the planning of health care and gives opinions on the drafts of legislative provisions and of international agreements relating to the Health Insurance Fund and health insurance;
7) gives advice about issues related to health insurance.Estonian health insurance relies on the principle of solidarity. The Health Insurance Fund covers the costs of health services required by the person in case of illness regardless of the amount of social tax paid for the person concerned. The Fund uses the social tax paid for the working population, also for covering the cost of health services provided to persons who have no income with regard to work activities. The employers are required by the law to pay social tax for all persons employed, whereby the rate of this tax is 33 % of the taxable amount, and of which 20 % is allocated for pension insurance and 13 % for health insurance.
The purpose of health insurance in Estonia is to cover the costs of health services provided to insured persons, prevent and cure diseases, finance the purchase of medicinal products and medicinal technical aids, and provide the benefits for temporary incapacity for work and other benefits.
The supreme body of the Health Insurance Fund is the Supervisory Board. The Chairman of the Supervisory Board is Minister of Social Affairs. The Health Insurance Fund submits the draft annual budget to the Fund’s Supervisory Board for approval, revises and approves the budgets of 4 regional departments, manages and co-ordinates the activities of the regional departments of the Fund, and performs advisory, guidance and supervisory functions.
The regional departments of the Fund keep account of insured persons, conclude contracts with the providers of health services, check the quality of health services provided the insured, grant benefits for temporary incapacity for work and process the applications furnished by the insured.
Since 2012 we are holders of standard ISO 9001:2008 certificate.
The client information line of the Health Insurance Fund is 16363 (calling from abroad +372 669 6630).
The Estonian Health Insurance Fund, in collaboration with the Ministry of Social Affairs and the WHO Regional Office for Europe, was conducting in 2009 an in-depth analysis of the Estonian health financing system’s mid- and long-term sustainability.
The analysis addresses: the foundations of health financing in Estonia; how Basic principles and values have driven the development of the social health insurance system in the country; how those are understood by different stakeholders and the relative weight they apply to different principles/values; whether the principles/values have changed over time, and what effect this could have on the health insurance system’s future development; the performance of the health financing system and its ability to cope with future challenges.
During the process there were two workshops for health system leaders and stakeholders.
Opening seminar were held in April 3, 2009. Draft report was consulted with stakeholders in October 20, 2009. Workshop agenda and presentations are available here. Workshop summary is available here.
The launce of the report “Responding to the challenge of financial sustainability in Estonia’s health system” was in March 5, 2010. Read the full report and executive summary.
One year on
In autumn 2011, nearly one and a half year later, it is the right time to decide whether and how the recommendations, made back then, have been taken into account. The report “Responding to the challenge of financial sustainability in Estonia’s health system: one year on” presented on October 4, 2011, sums up the situation. The aim of the new short analysis is to address the main changes in the financing of health care since April 2009 when the preparation process of the initial report was launched. The analysis does not focus on assessing the impact of the analysis for 2010, but reviews the development in the areas that were pointed out in the report as potentially having a major impact on the financial sustainability of the health system.
Read the follow-up analysis here.