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Estonian health care system would benefit from restructuring and more funds

Irja Lutsar.
Irja Lutsar. Source: Siim Lõvi/Priit Mürk/ERR

To improve the situation in Estonia's health care system, it needs to be made more efficient. However, to do so, additional funds are needed, said virologist and member of the Social Affairs Committee of the Riigikogu Irja Lutsar (Eesti 200).

"One possibility would be to further streamline the health care system. However, this alone will not save €170 million a year," Lutsar told ERR in response to the announcement from Minister of Health Riina Sikkut (SDE) that there will be a €170 million shortfall in Estonia's health care funding by 2025.

Lutsar pointed to the centralization of obstetric care in larger hospitals as providing a good example of how savings could be made.

"In obstetrics, it has been shown that in order to ensure modern care and maintain staff expertise, a hospital should have at least 500 births per year. According to the Health Statistics and Health Research Database, in four of Estonia's twelve hospitals, which provide obstetric care, there were over 500 births in 2022 and this was the case for five hospitals in 2021. At the same time, it is also striking that the hospitals with the lowest number of births are located just 50 – 60 kilometers apart," Lutsar said.

"By centralizing obstetric care, it would be possible to provide better care for both mothers and babies, with fewer staff," she said.

While layoffs would cause discontent in society, Lutsar believes it would also lead to improvements in the quality of health care in the long term.

"A second option from within the system would be to ensure the right balance between the services of family doctors and specialists," Lutsar said in a written comment to ERR.

She pointed out that too often people go to hospitals' emergency departments (EMO) instead of first seeking help from their family doctor. "If a person decides to skip the family doctor and go directly to the EMO, the Health Insurance Fund (Terviseamet) will have to spend extra money on their treatment, because  money for the treatment of acute illnesses has already been allocated to family doctors as the primary payment," Lutsar said.

"The emergency care report completed in spring this year put forward several potential solutions to this problem, but they have not yet been implemented," she added.

"However, these savings alone will not add  an extra €170 million to the medical system. Compared to other OECD countries, Estonia is characterized as having relatively low public funding along with high levels of co-payment when it comes to healthcare costs. Estonian medical experts have repeatedly pointed out that for years the country has been contributing around three percent less than the OECD average to healthcare as a share of gross domestic product (GDP), and up to now, nothing has changed," Lutsar said.

"Therefore, if we want to maintain or improve the level of medical care, we should increase the state's contribution to health care financing and aim to reach at least the OECD average. However, we need to have societal agreement on this, as increasing the share of GDP spent in one area will inevitably come at the expense of others," she said.

At the same time, Lutsar pointed out that health care funding is likely to increase most once the national economy improves. "In richer countries, people's incomes are higher, and the state has the opportunity to invest more in health care, but also in innovation," she said.

Lutsar also pointed out that the burden on Estonia's health care services is increased due to unhealthy and addictive behaviors such as heavy alcohol consumption, smoking and high-sugar foods. In light of that, she believes an increase in the excise duty on alcohol is entirely justified.

"In comparison to wages, the cost of alcohol has fallen in recent years and this is reflected in the increase in alcohol-related deaths," she pointed out. 

"In the long term, the most cost-effective way forward is to invest in healthy lifestyles and the prevention of disease, and that is inevitable. However, it will not immediately solve the increasing shortage of money. This could be solved by, on the one hand, revising current spending and, on the other hand, by increasing the state's contribution," Lutsar said.


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Editor: Michael Cole

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