On International Universal Health Coverage Day 2023, a new report on affordable access to health care in Estonia reveals that 1 in 14 households (7%) experienced catastrophic health spending in 2020 as a result of having to pay out of pocket for health care. People who experience catastrophic health spending may not be able to pay for other basic needs such as food, housing and heating. In the same year, out-of-pocket payments pushed 2% of households in Estonia into poverty or made them even poorer.
Although catastrophic health spending continues to be higher in Estonia than in many European Union (EU) countries, the situation improved between 2015 and 2020. This reflects positive changes in coverage policy and other factors, according to a new WHO/Europe study launched today at the Health Systems Conference marking the 15th anniversary of the Tallinn Charter.
The report “Can people afford to pay for health care? New evidence on financial protection in Estonia 2023” shows that financial hardship is mainly driven by out-of-pocket payments for outpatient medicines and dental care, and is heavily concentrated among households with low incomes.
Gaps in coverage undermine financial protection
The study identifies gaps in all 3 dimensions of health coverage:
- Who is covered – linking entitlement to payment of social health insurance contributions leaves 10% of working-age people without coverage.
- Which services are covered – the health-care benefits package provided by the Estonian Health Insurance Fund (EHIF), while quite broad, offers limited coverage of adult dental care.
- The proportion of costs covered – although the Government has tried to improve protection from copayments for outpatient prescribed medicines and dental care, more can be done to protect people with low incomes.
“The Tallinn Charter signed in 2008 highlighted that people in Europe shouldn’t become poor because of ill health. Since then, the Government of Estonia has redesigned some aspects of coverage policy to improve the affordability of outpatient medicines and dental care,” explained Dr Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems at WHO/Europe.
She added, “Based on the analysis in our new report, we call on the Government to continue to reduce out-of-pocket payments for these and other services, and to focus on strengthening protection for households with low incomes.”
Making health care more affordable for people with low incomes
To improve financial protection, Estonia can:
- close the gap in population coverage by changing the basis for entitlement to EHIF benefits to residence;
- increase and fine-tune benefits to better serve the people in most need;
- increase protection from all copayments, especially for households with low incomes;
- abolish balance billing for primary-care services to ensure that access does not depend on ability to pay;
- reduce out-of-pocket payments in long-term health care; and
- reduce out-of-pocket payments for outpatient medicines through incentives to prescribe and dispense the cheapest alternatives, price regulation, and improvements to how over-the-counter medicines are sold and used.
About the report
The report draws on data from household budget surveys conducted in 2015, 2016, 2019 and 2020; data from the Estonian System of Health Accounts for 2021; data on unmet need for health care and dental care up to 2022; and information on coverage policy up to 2023. It benefited from financial assistance from the EU through the European Commission’s Directorate-General for Health and Food Safety.
About WHO/Europe’s work on financial protection
Financial protection is central to universal health coverage and a core dimension of health system performance assessment. It is an indicator of the Sustainable Development Goals, part of the European Pillar of Social Rights, and at the heart of the European Programme of Work, WHO/Europe’s strategic framework.
WHO/Europe monitors financial protection through the WHO Barcelona Office for Health Systems Financing, using regional indicators that are sensitive to equity. The WHO Barcelona Office provides tailored technical assistance to countries to reduce financial hardship and unmet need by identifying and addressing gaps in health coverage.
link