Financing and list of health care services

The list of health care services includes all medical treatments, procedures, pharmaceuticals needed by hospitals, and other necessities which are part of health insurance package. EHIF pays to medical institutions for services in the health insurance list if these have been provided to insured persons for medical indications. 

The cost of means of service provision, such as devices, instruments, etc., change and the methodologies used in health care and medical management advance. Therefore, costs are also changing and funding must be in line with that. Thus, the selection of healthcare services and prices must be constantly updated. Making decision on changes requires previous cooperation with specialists, involvement of experts in their fields and conduct of broad analysis. The list of health care services is updated in cooperation with hospitals and specialists. The criteria for changing the list and their evaluation conditions and procedures have been set by the Government of the Republic.

 

Health care services funding

Health care is financed mostly from the state budget under the health insurance budget through the means of the Estonian Health Insurance Fund, as well as through direct allocations.  Health care also gets finances from the rural municipality and city budgets, through patient deductible fees (e.g. fees of medical specialist visits) and from other sources. Compulsory health insurance has been in force in Estonia since 1992. Health care funding is regulated by the Health Insurance Act.

Health insurance is a system for covering health care expenses incurred to finance the disease prevention and treatment of and purchase of medicinal products and medical devices for insured persons and to pay benefits for temporary incapacity for work and other benefits.

An insured person is a permanent resident of Estonia or a person residing in Estonia on the basis of a temporary residence permit or the right of residence or a person legally staying and working in Estonia based on a temporary ground for stay for whom an employer must pay social tax or who pays social tax for themselves   The following persons for whom social tax is not paid are considered to be equal to insured persons: 

  1. pregnant women whose pregnancy has been identified by a doctor or a midwife;
  2. children and adolescents under 19 years of age;
  3. persons who receive a state pension granted in Estonia;
  4. persons with up to five years left until attaining the retirement age who are maintained by their spouses who are insured persons;
  5. persons acquiring basic education (up to 21 years of age)or general secondary education (up to 24 years of age), persons acquiring formal vocational education and higher education students who are permanent residents of Estonia and study in an educational institution in Estonia founded and operating on the basis of legislation or in an equivalent educational institution abroad.

EHIF pays for insured person’s: