According to Katrin Rehemaa, secretary general of the Estonian Medical Association, the current situation with Health Insurance funding means there will be significant cuts. No matter how the cuts are implemented, the result will be less access for patients.

"The news is that the budget forecasts have been made in such a way that no salary increases are foreseen for the next four years. We had the same situation between 2009 and 2012 when there was no increase in salaries and no increase in minimum payments. The consequence of this was that about 140-150 doctors left Estonia every year," Rehemaa said.

According to Rehemaa, this means that as things stand, the negotiations have ended without a consensus and the matter will be referred to the national conciliator to resolve the deadlock.

"Obviously, if we don't reach an agreement there either, then unfortunately there is no way we can maintain industrial peace in this situation for four years," said Rehemaa.

According to Urmas Sule, head of the Estonian Hospital Association, the current financial situation makes it difficult to meet the wage conditions currently set out in the collective agreement. "The current outlook for the next few years is very negative for the health sector," Sule said.

According to Pille Banhard, a member of the Health Insurance Fund's board, the Health Insurance Fund's budget for 2025 has also been calculated based on the need for cutbacks, and there are no plans to increase salaries.

"The Health Insurance fund's longer-term forecast, the four-year forecast, is, at the moment, to maintain today's level. In other words, no growth is foreseen for the next four years, and the reality is that at the end of 2027, we will have used up the unallocated surplus and reserves," Banhard said.

The current collective agreement was signed in 2023. At that time it was agreed that the minimum hourly rates would increase by nearly 20 percent from April 1 of that same year, and by a further 10 percent in 2024. The agreement also included increases in night and weekend premiums as well as on-call pay for home visits. Night work is currently paid at 1.4 times the regular day rate and work on Saturdays and Sundays at 1.25 times the regular rate.

Under the current collective agreement, the minimum hourly rate is €19.70 for doctors, €21.40 for specialists and €12 for nurses.

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