The nation of Estonia, with its population of approximately 1.3 million, covers 45,228 square kilometers of land. Much of the population lives in the capital city of Tallinn, which is a short distance away from Stockholm and Helsinki. Among the Scandinavian countries, Estonia is one of the most inexpensive to live in. A place of rich Nordic and medieval history, Estonia enjoys vibrant cultural diversity too.
But what about the question of healthcare? How is it accessed?Estonian Health Insurance Fund
Estonia’s healthcare system is governed by the Ministry of Social Affairs, which handles the implementation of strategies and regulations related to the nation’s healthcare scheme. Estonia does belong to the European Union, but healthcare in the country is yet to achieve the standards set by Western and North American countries.
The law mandates that all those who are covered by the national health insurance fund must have a family practitioner. Estonian citizens and foreign nationals who make contributions to the social tax system can become part of the healthcare scheme. There are also certain other categories of Estonian residents that are covered by the scheme even though they do not contribute to social tax. These groups include pregnant women, those under 19 years, those receiving state pension granted in Estonia, dependent spouses of insured individuals who are at least five years away from reaching the age limit for old-age pension, permanent resident students and those who join the health insurance scheme on a voluntary basis.
The national health insurance fund is a compulsory policy that is paid for by a resident’s employer and involves contribution of social tax amounting to 33 percent, which includes pension insurance and health insurance. Estonia’s national healthcare scheme covers about 95 percent of its population. Apart from visits to family practitioners and specialists, hospital care and different types of examinations, the health insurance fund also offers benefit for temporary incapacity for work, dental care benefits for certain categories of patients, and supplementary benefit for medications and medical devices.
All individuals covered by health insurance have a family practitioner, who serves as the first point of contact in case of illness. A family practitioner provides treatment for minor illnesses, undertakes home visits and refers patients to medical specialists. The family practitioner must visit a patient with acute illness on the same day or within five working days. Referrals are not necessary in case of visits to psychiatrists, ophthalmologists, gynecologists, infection specialists, pulmonologists, orthopedists or surgeons. The official website of the Estonian Health Insurance Fund provides further information on family practitioners. Insured individuals can register with a family practitioner by placing an application to the selected doctor. They can change their selection by submitting a new application. Visits to the family physician are free for the insured person, although the physician may charge a fee for a home visit.
The contributions received by the national health insurance fund are utilized towards payment for medical services and health research on the basis of awarded contracts. All health services that are covered by the insurance scheme are included in the ‘treatment package’, which is reimbursed. Patients may have to pay partially for certain services and medicinal products. Some of the services that are fully or partially reimbursable include services provided at the healthcare institution such as doctor’s visits, treatments, diagnostic checks and surgeries; pharmaceuticals, medical devices such as blood glucose test strips; cash benefits such as in the case of temporary incapacity for work; and health promotion such as cancer prevention checks.
Specialized treatment abroad
Patients can receive certain treatments in other EU member states after applying for permission from the Estonian Health Insurance Fund. The fund covers medical expenses of the patient once the permit is issued and it is made clear that the same treatment cannot be carried out in Estonia. Once an application is received, doctors of that specific specialty are consulted to check the validity of the treatment. Applications must be submitted at least a month prior to the planned treatment.
Individuals with valid health insurance and those under the age of 19 are eligible to receive free dental care from Estonia’s national health insurance fund. However, only dentists that have a contract with the Estonian Health Insurance Fund will be able to provide free treatment.