health care system in estonia healthcare department ministry of social affairs of estonia
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Health Care System in Estonia
Healthcare DepartmentMinistry of Social Affairs of Estonia
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ESTONIA
Population – 1, 340 415 million Area 45 285 km² , density 31 /per km2
15 counties, over 200 municipalitiesUrban concentration ~ 67% (EU-15 average: 80%)
POPULATION PROFILE
Age structure 0–14 years 14% (EU-15 average: 18)Population 65+ years 14,5% (2000),15,9%(2003), 17,1% (2009) EU-15 average: 17%
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Mortality and health indicators, 1980-2008
Indicator 1980 1990 2000 2002 2003 2008Life expect. 69,1 69,7 70,6 71,0 71,6 74,0Life expect.F 74,2 74,7 76,0 77,0 76,9 79,2Life expect.M 64,2 64,5 65,1 65,1 66,0 68,6Infant mortality 17,1 12,3 8,4 5,7 7,0 5,0
Infant mortality has fallen steadily in recent years. Figures show a decline from 12,3 in 1990 to 5,0 in 2008
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Causes of death in 2006-2007
Coef/ per 100 000
Cardiovascular diseases 429.49
Cancer 198.86
External causes 107.88
Digestive diseases 46.76
Respiratory diseases 24.02
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Organizational structure
of the health care system
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Main actors in the system
Ministry of Social Affairs (health, social welfare, labour)National health care agencies which come under the Ministry of Social Affairs:
Health Care BoardState Agency of MedicinesNational Health Protection InspectorateHealth Development Institute
Estonian Health Insurance FundCounty governmentsProviders of careResearch institutesAssociations
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Organisational form Legal form
Primary care sole proprietors or companies
Specialist care (outpatient) companies, foundations or sole proprietors
Specialist care (inpatient) joint stock company or foundation
Emergency Care company, sole proprietor, foundation or a state or local government rescue service agency
Independent provision of nursing
companies, foundations or sole proprietors
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Health Care Reforms since 1991
Basic changes in HC system:from centralised and state-controlled health care delivery
system towards a decentralised one; from a general state funded system to one based on health
insurance.
Main issues of reforms:restructuring and reorganising of health care system
(emphasis on primary care: launching FPS, optimizing hospital sector)growing emphasis on public health
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Changes in number of hospitals and outpatient clinics during reforms (1992 – 2002)
5067687878797983107115118
625587
540525485
370342
300
246152147
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1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Hospital Outpatient health care
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List of acute care hospitals approved by the Government (19 hospitals)
2+1 regional hospitals (all specialities)
4 central hospitals (limited scale of specialities and services)
11 general hospitals (more limited scale of specialities and services)
1 local hospitals (more limited scale of specialities and services)
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Estonian Hospital Masterplan 2015
Aimed to
reduce the share of inpatient care
increase the share of outpatient care, daycare and nursing care
concentrate the more sophisticated and expensive specialist care to fewer hospitals
2001 2007 2015
Acute care hospital beds*
6500 5100 3200
Average length of stay
6,7 5,9 4,6
Bed occupancy rate
67% 76% 83%
* Psychiatry, tuberculosis, rehabilitation and nursing not included
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Changes in hospital sector
400
500
600
700
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1000
1980 1985 1990 1995 2000 2005 2010
EstoniaEU members before May 2004 EU members since May 2004
Acute care hospital beds per 100000
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Changes in hospital sector
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1980 1985 1990 1995 2000 2005 2010
EstoniaEU members before May 2004 EU members since May 2004
Average length of stay, acute care hospitals only
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Primary Care
organized around family practices
organized on the county level
free choice of a FP
every FP has a list of patients (up to 2000 persons, arverage size ~1700)
FP as a “gatekeeper” for HC system
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Challenges in Primary Care in 2008
Strengthening the role of FP as an activ “gate-keeper” in the HC system
Widening the scale of services in Primary Care level (MW services, home nursing, physiotherapist services, mental health nursing ect)
More emphasis on disease prevention and health promotion activities on PC level
Better cooperation with specialist care, social system,education ect.
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Long-term care and nursing care
Services for elderly In health sector (inpatient/outpatient nursing care services) In social sector (institutional care, home care)
General objectives (LTC DP 2004-2015)
Availability and quality of both ambulatory and in-patient nursing care services.
A possibility of providing more diverse services through integrating health and social care services to meet the needs of ageing population.
When providing services, thoroughly evaluated need has to be taken into consideration.
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2004Belgium2003Switzerland2002Netherlands2004Norway2003Germany2003Iceland2004Malta2004Ireland2004Estonia1999United Kingdom1997Luxembourg2004Denmark2003Lithuania2003France2003Austria2004Czech Republic2004Hungary2002Spain1989Greece2004Sweden
Nursing and elderly home beds per 100000, Last available
Financing Health Care
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Health insurance system in Estonia
Social health insurance MandatoryBased on solidarity
Tax paid by employersproportional as a flat 13% surcharge on salaries
Coverage 94,7% of the populationwider than actual contributors
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Health insurance budget
Specialist care servicesPrimary care servicesDrug reimbursementBenefits for temporary incapacity for workPreventionLong term careAdministrative costs
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State budget
Emergency ambulance services
Emergency care provided to persons not covered by health insurance
Public Health programmes
Capital investments of providers
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