Press release: Financial results of the Estonian Health Insurance Fund FY 2015

In 2015, the total health insurance commissioned from the Health Insurance Fund amounted to EUR 974 million, which is approximately EUR 65 million more than the same period last year. Health care services were financed for EUR 713 million; medicinal products were compensated for EUR 113 million and benefits for temporary incapacity for work were EUR 117 million.

Compared to the same period last year, financing of health care services grew by 7%, i.e., by EUR 49 million, financing of primary medical care increased by 12%, financing of specialized medical care increased by 6%, financing of nursing increased by 16% and financing of dental care increased by 9%.

In the first half of the year 2015, family primary medical care was financed for a total of EUR 93 million, which is EUR 10 million more than the year before. The increase is due to the price limits that have been growing since the beginning of the year including a second family nurse allowance, increases in the basic allowance and the capitation fee, and an allowance for working after hours. In addition, as a new opportunity, the use of the therapy fund will be financed for the family physicians for referring patients to speech therapy and psychological services. In 2015, the threshold of the Fee for Services fund for all family physicians also increased.

In 2015, close to 800 people used the services of specialist medical care, and EUR 562 million was paid by the Health Insurance Fund to the health care institutions for the 3.3 treatment cases provided by them, which is approximately EUR 33 million more than the same period the year before.  Of the scheduled first contact of outpatient specialist medical care appointments, 71% of them took place during the maximum allowed time of the waiting list (up to 42 calendar days).

In 2015, the Health Insurance Fund paid EUR 28.5 million for the provision of nursing services; in comparison to the year 2014, the funding of inpatient nursing care services has increased by 15%. The number home nursing visits increased by 4%. The result is as expected since the objective of the Health Insurance Fund is to improve the accessibility of independent nursing care and in particular the accessibility of home nursing services and inpatient nursing care.

Last year, the Health Insurance Fund paid a total of EUR 22.6 million for Dental Services. Moreover, the number of children who received dental care has increased by over 2000.

Discount drugs were compensated for to the extent of EUR 113 million on the basis of 8 million medical prescriptions. Compared to the same period last year, funding for medicinal products has increased by approximately 3%.

Temporary incapacity for work was compensated for EUR 117 million, which is nearly 13 million more than in the same period last year. The benefits of temporary incapacity for work have increased due to a higher average salary, the number of employed insured persons and an increased number of certificates for maternity leave.

Compared to the year 2014, the volume of medical device benefits has increased by 3%, amounting to EUR 9 million. The number of users of medical devices has grown by 9%.

In 2015, treatment abroad of insured Estonians was financed for EUR 8.5 million, out of which the Health Insurance Fund paid EUR 5.1 million to the other EU Member States for the health care services provided to posted workers and pensioners residing in another Member State, and to persons temporarily staying in another Member State; scheduled treatment abroad provided on the basis of a prior authorization of the Health Insurance Fund was financed for EUR 3 million and the Health Insurance Fund received treatment invoices from other countries for 282 persons. Of these, 94 had received treatment, 161 underwent examinations, and 27 insured persons had expenses related to the search for a bone marrow donor.

The full report is available on the financial data page of the Estonian Health Insurance Fund.

Additional Information:

Kertu Eensaar

Head of the Division of Health Promotion and Communication

Estonian Health Insurance Fund

Phone 6208 459

kertu.eensaar [at] haigekassa.ee