Estonia

The Estonian health system is centrally organised, with the Ministry of Social Affairs responsible for health policy development, strategic planning and regulatory oversight. It operates under a social health insurance model managed by the Estonian Health Insurance Fund (EHIF), which pools public funds and contracts with providers to deliver services. Although local governments are involved in some public health activities and own some hospitals, their role in the organisation and financing of health services remains limited, except for long term care. Health policy is guided by the National Health Plan, which sets strategic goals such as increasing life expectancy and reducing health inequalities. The EHIF aligns its plans with the National Health Plan through long-term development strategies and annual targets.

Health spending in Estonia has been rising steadily. In 2023, almost three-quarters of it came from public sources, over 20% from out-of-pocket payments and around 2% from voluntary health insurance. Recent reforms have attempted to strengthen financial protection against out-of-pocket expenses for pharmaceuticals and dental care, although private spending still exceeds the national target of 15% set in the National Health Plan 2020-2030. Other reforms focus on improving patient pathways and prioritising mental health through public health policies and prevention protocols.

All healthcare providers in Estonia operate under private law, regardless of ownership. The country has reduced its hospital and bed capacity and, since the 2017 reforms, has focused on strengthening primary health care. These reforms have emphasised incentivising establishment of health centers with multidisciplinary teams, strengthening the role of family nurses and investing in primary care infrastructure. Independent family doctors working either in solo or group practices are the first point of contact in the healthcare system.