Expert: Plan to bring private money into healthcare is slippery slope

Hospital bed in Estonia.
Hospital bed in Estonia. Source: ERR

The coalition's plan to secure private funding for health care has raised concerns due to the possibility that access to health services could deteriorate rather than improve.

The main weakness of the Estonian health system is a lack of money. While on average in Europe, countries spend 9-10 percent of GDP on health, in Estonia this percentage has remained at six, and during the pandemic period it rose above seven due to emergency injections.

"We have taken pride in our low tax burden, and as a result, we have a low level of public services," Andres Võrk, an analyst at the University of Tartu's IT Impact Research Centre, said. "So we cannot have so-called good healthcare with low taxes. It is as simple as that. In other European countries the tax burden is simply higher."

In his analysis of health-care financing, Võrk pointed out that a big problem is also the growth in demand, as the proportion of elderly people in the population is increasing, but funding is not keeping pace.

"If we want to get better health care, and we want to get it in a way that shows solidarity, we have to raise taxes or reduce some of the other spending that we do with taxpayers' money."

There is also the question of efficiency - whether money is being spent wisely. There are two sides to health care, Võrk said.

"First, money should go where it can does the most good. We should give money to strengthen family medicine and only then to specialists, because family medicine would address the majority of problems. The second objective is that the health care system be technically efficient, i.e., waste-free. So that there are no empty beds, so that doctors are not working overtime, or vice versa, waiting for patients in their offices."

"Our free medical care is provided by the Health Insurance Fund, which within the limits of its available funds commissions services from hospitals based on the demand in different regions," Võrk said adding that the supply is always less than the demand, so patients must wait months to see certain specialists.

"We may suggest that the health fund would send money into areas with high waiting lists, but that begs the question of where the money would come from. So, where are we cutting money from?"

Võrk siad that it is not necessary to increase the tax in order to increase the funding of the health insurance fund. Particularly in the already painful debate on tax increases. Money can also be allocated to the health fund on an emergency basis, as was done during the pandemic period. The new coalition will try to find more money from the private sector, but this must be carefully thought through, Võrk said. For example, buying health care through private insurance could mean more patients being diverted away from the GP, increasing even further the burden on specialists.

"The risk of private insurance is that it can bring the efficiency of the whole system down. So if we encourage it, we need to look very carefully at what the impact is - that if we bring in private money, how it will affect our health insurance system."

Võrk said that private insurance is affordable for people with higher tax brackets, so salaries are higher and doctors have an incentive to move to private healthcare. "This means that to a shortage of nurses and doctors, particularly in specific specializations, some medical treatment may become less accessible in a solidarity system."

Võrk said that if we want to continue with the current solidarity-based health care system and at the same time get better medical care, we need to tackle three core problems at the same time.

"We need to reduce demand - which means healthier people in the long run. The other option is to increase the amount of money, which will also improve access to services. And the third, we try to make the health system more efficient, so that there is as little waste as possible."


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Editor: Kristina Kersa

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