Estonian case study: Roundtable discussion on how institutions can work together to ensure financial sustainability Ivar Sikk Deputy Secretary-General of Fiscal Policy 28.06.2012 Key issues • Best possible allocation of resources between all areas taking into consideration long-term financial sustainability • Fiscal rules for following agreed fiscal framework • Maintaining efficiency of health system • Flexibility for responding to environmental changes • Accumulation of reserves Health insurance sustainability (% of GDP) Expenditure Income Gap Source: Praxis. Short- and medium-term sustainability • Sustainable. Possible things to do: • increase efficiency • the hospital network • increase co-ordination between hospitals and services • establish stronger control of purchasing very expensive medical instruments. • increase the responsibility of the people Long-term sustainability • Not sustainable. • Some possible solutions: – expanding the tax base – financing partly from state budget – individual health accounts – inclusion of the private insurance • No decisions, ongoing evaluation of different possibilities. Strengthening co-operation … … between ministries and Health Insurance Fund: • Closer co-operation in forecasting, medium- and long term planning. • Synchronizing the decision making process.