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Management im GesundheitswesenKoppel A, Kahur K, Habicht T, Saar P, Habicht J, van Ginneken E (2008). Estonia: Health system review. Health Systems in Transition 10(1): 1-230

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Estonia: Health system review

Koppel A, Kahur K, Habicht T, Saar P, Habicht J and van Ginneken E
Health Systems in Transition. 2008; 10(1): 1-230



Estonia has recognized that a healthier population is a key asset for achieving economic growth. It is therefore investing in further improving the performance of Estonia’s health system. This is one of the conclusions drawn from a new health system review on Estonia. Estonia’s Minister of Social Affairs, Maret Maripuu, and the WHO Deputy Regional Director for Europe, Nata Menabde, launched this newest review during the WHO European Ministerial Conference on Health Systems on 25 June 2008.
Estonia has health outcomes that still lag behind compared with the European Union (EU) average and therefore faces important public health challenges that especially affect the working-age population. The relatively low life expectancy (78.1 years for women and 67.3 for men in 2005) is mainly a result of the relatively high premature mortality caused by external factors and lifestyle-related risk factors, such as tobacco and alcohol consumption, lack of physical activity and obesity. The comparatively high incidence and prevalence of HIV infection also require policy action. In recent years, the Government of Estonia has increased its efforts to strengthen broad and integrated public health programmes, including all government sectors, in responding to the key risk factors causing ill health. Reform of Estonia’s health system has been vigorous and successful. Life expectancy and public satisfaction with the health care system have steadily increased since the large-scale restructuring in the early 1990s that introduced mandatory social health insurance, a purchaser–provider split and health care centred on family medicine. Nevertheless, persistent inequity in health status and in access to health care remains a common concern. The limited resources available and growing out-of-pocket payments force the government to seek additional solutions to maintain solidarity and sustainability. The accountability of health care providers for containing costs and improving the quality of care needs to be further enforced through regulation and financial incentives. The launch of the review on Estonia also marks the 10th anniversary of the European Observatory on Health Systems and Policies. The Observatory, which is a joint partnership of international agencies, governments and academic institutions, emerged from the WHO Conference on European Health Care Reforms in Ljubljana in 1996. The Observatory has been coordinating the production of supporting evidence for the WHO European Ministerial Conference on Health Systems, which brings the Observatory into a new phase, informing policy-makers at the national and international levels in both eastern and western Europe on trends and experience in enhancing the performance of health systems towards better health and societal well-being. Technical information on Estonia’s 2008 HiT health system review This country profile provides an in-depth account of health system features and reforms in Estonia. It is part of the Health Systems in Transition (HiT) series, which covers the countries of the WHO European Region together with selected additional countries that are members of the Organisation for Economic Co-operation and Development. The HiTs series represents a key product of the European Observatory. HiT profiles are reports produced by the European Observatory on Health Systems and Policies that provide a detailed description of a country’s health system and of reform and policy initiatives in progress or under development. HiT profiles examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Ewout van Ginneken of the Berlin University of Technology edited Estonia’s HiT under the responsibility of Reinhard Busse, Research Director of the European Observatory on Health Systems and Policies.
The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health systems in Europe. The Observatory is a partnership between the WHO Regional Office for Europe, the Governments of Belgium, Finland, Greece, Ireland, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine. The European Commission has observer status with the perspective of joining as a full partner.

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