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Estonian case study:
Roundtable discussion on
how institutions can work
together to ensure financial
Ivar Sikk
Deputy Secretary-General of Fiscal Policy
Key issues
• Best possible allocation of resources
between all areas taking into consideration
long-term financial sustainability
• Fiscal rules for following agreed fiscal
• Maintaining efficiency of health system
• Flexibility for responding to environmental
• Accumulation of reserves
Health insurance sustainability (% of GDP)
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
• Closer co-operation in forecasting,
medium- and long term planning.
• Synchronizing the decision making process.

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