Health care services

In Estonia, medical care is divided into three levels:

  • primary or family medical care
  • specialized medical care and
  • nursing care

As a rule, the first place to turn for medical care should be the family doctor, with whom patients are guaranteed a quick consultation, necessary examinations and treatments, and, if needed, a referral to the next level of care.

In case of a need for emergency medical treatment, one may go to the emergency room or call an ambulance.

It is very important to make sure that you have health insurance!

In case you DO qualify for Estonian Health Insurance, you do not need to buy private health insurance at the time you apply for a residence permit.

In case you do not qualify for health insurance, you are required to purchase a health insurance policy from a private insurance provider. This needs to be done before you apply for a residence permit.

What does the Health Insurance Fund cover?

1. Partial or complete payment for medical services to the health care institution, including:

  • seeing a doctor or nurse (see also service fees)

  • diagnostic analyses
  • medical procedures
  • preventive measures
  • surgeries, etc.

2. Provision of discounted medication for insured people.

3. Compensation for medical devices (e.g. glucose meter test strips).

4. Financial compensation for insured people (e.g. compensation for temporary inability to work).

5. Health promotion (e.g. funding cancer prevention check-ups).

Health insurance package - a list of health care services and prices

The money received by the Health Insurance Fund - the health insurance part of the social tax - is used to pay for the medical services and health research provided to the insured on the basis of the awarded contracts.
 
All the various services received for the insurance are included in the so-called treatment package which is reimbursed by the Health Insurance Fund. Sometimes people mistakenly assume that health insurance will cover all costs related to medicine. Most of the health care services are reimbursed by the Health Insurance Fund in full, but the patient will also have to pay partially for some services and for some medicinal products.
 
The services partially or fully reimbursable for the insured include:
 
1. Partial or full payment for health care services to the health care institution, including:
• Going to the appointment of the doctor or the nurse (see also fees)
• Diagnostic checks
• Treatments
• Preventive activities
• Surgeries etc.
2. Enabling more affordable medicinal products for the insured, or reimbursements to pharmacies for discount medicines (see also discount drug sheet)
3. Reimbursement of medical devices - such as the blood glucose meter test strips, intraoperatively or postoperatively mounted medical equipment, etc. The exact list is on the sheet of medical devices.
5. Health promotion - such as funding for cancer prevention checks
 

Health insurance is characterized by two dimensions: The insurance package demonstrates the extent of the number of services and other benefits that are financed by the Health Insurance Board (list of services). The depth of the insurance package explains the extent to which services and benefits are covered by the Health Insurance Fund (how much will the Health Insurance Fund pay for the service).

For what exactly and to what extent the EHIF pays the non-monetary benefits, is established in three legal instruments, of which the most important is the list of health services. The list of health care services contains all the medical services, procedures, the drugs necessary in the hospital and other items belonging to the health insurance package with their prices and the conditions of payment thereof.

Health Insurance Fund and health care institutions

The budget of the Health Insurance Fund consists mainly of the health insurance segments of the social tax, which are used mostly for payment of the medical services and medicines of the insured person. The medical services of the person insured by the Health Insurance Fund are paid for by the Fund to the medical institution under contract. The prerequisite for the payment is that the service provided by the medical institutions must be part of the health insurance package (see the first paragraph).

Agreements have been signed with health care institutions all over Estonia. The total amount of the Health Insurance Fund allocated to treatment services is distributed among regional offices of the Health Insurance Fund in accordance with the number of insured persons in the service area. Distribution of the budget of specialized medical care is performed on the basis of the number of all the insured in the area, in the case of children's dental care, the number of children under 19 years of age and in the case of nursing care, the number of persons more than 65 years old in the region. On this basis, the Health Insurance Fund enters into contracts with the medical institution for the purchase of medical services.

The list of health care services contains all the medical services, procedures, the drugs necessary in the hospital and other items belonging to the health insurance package with their prices and the conditions of payment thereof. The Health Insurance Fund pays for the services on the list of health care services to the health care institution if it is provided to the person with health insurance on a medical indication.

The criteria for amending the list, and the conditions and procedures of their assessment, is established by the Government of the Republic. The list of health care services will be updated annually, according to need and the financial resources of the fund, so that a person can receive the best possible care, taking into account the evidence-based manner of the treatment, including medical efficacy and cost-effectiveness.

The Health Insurance Fund is able only to pay for those health care services, under these conditions and at the maximum price, which is set by the Government of the Republic in the Regulation of Health Care Services. The cost of the tools for the provision of the services, such as equipment, instruments, etc., are changing, and the methodologies and the treatment organization used in health care are evolving. Therefore, the costs are also changing, and financing must go along with it. Thus, the choice of health care services and their prices must be constantly updated. In order to make decisions on amendments, advance cooperation is performed with specialists and involved experts in their field, and then a broad-based analysis is performed. The list of health care services is updated in collaboration with family doctors, hospitals, and specialists in the field.