Financial results of the Estonian Health Insurance Fund for the year 2016

The Supervisory Board of the Estonian Health Insurance Fund confirmed last year's financial results on 26 April. The Supervisory Board also approved the amendments to the list of health services. The wage increase for health workers, calculated on the basis of the collective labor agreement concluded between healthcare parties, will take effect retroactively from 1 April.

The year 2016 budget implementation was influenced by the receipts of social tax, overtime invoices submitted by hospitals, an increase in the cost of medical cases, higher use of certificates of incapacity for work, as well as the addition of new pharmaceuticals to the list. For example, in January 2016, compensation for new pharmaceuticals for hepatitis C was started, thereby rendering them more accessible to the insured, and enabling a very large proportion of the patients to get rid of the virus.

Last year, the Health Insurance Fund paid approximately EUR 756 million for healthcare services provided to the insured, which is EUR 43 million more than in 2015. Compared to the previous year, the average cost per insured person per month increased by 8%.

In 2016, the volume of family healthcare was nearly EUR 103.1 million, which is about EUR 9.5 million more than the year before. There is also an increased use of the fund, in addition to the Fee for Services Fund, there has been an increase in the use of the family physicians’ therapy fund to which the physiotherapy service was included, in addition to speech therapy, and psychology services. The usage of e-Consultation has increased more than two times over the year; the service was provided in approximately 5600 cases. During the entire year, nearly 238,000 calls were made to the family physician’s counseling line.

Services of specialist medical care were used by about 800 thousand people, and EUR 577 million was paid by the Health Insurance Fund to healthcare institutions for the 3.2 million treatment cases provided by them. The volume of specialized medical care has increased by EUR 28.5 million. The list of specialized medical care services increased by 24 new services.

For the provision of nursing services, the Health Insurance Fund paid EUR 30.1 million, and services were provided to 12 thousand people. Home nursing service was rendered to nearly eight thousand people.

The volume of dental care last year was EUR 23.3 million. Dentist appointments among 3 to 19-year-old patients amounted to over 150 thousand, or 63% of all children in this age group. Orthodontics services were provided to almost 21 thousand children, which is 5% more than in the previous year. Adult emergency dental services were provided to nearly 17 thousand people.

Discount drugs were compensated for on the basis of 8 million medical prescriptions in the volume of EUR 131.2 million. Compared to the same period last year, the volume of medicinal products has increased approximately by 16%. Last year, compensation of 16 new active substances was initiated.

Temporary incapacity for work was compensated for EUR 130.3 million, which is nearly EUR 13 million more than in the same period last year. In 2016, 5.9 million days of incapacity for work were compensated for to the insured on the basis of 392 certificates of incapacity for work. The reason for the increase in the benefits of temporary incapacity for work is a higher average salary and the increase in the number of certificates for maternity leaves.

The treatment abroad of Estonian insured was compensated for EUR 9.1 million.

The total net gain of the fiscal year was minus EUR 29.6 million, which is 20.5 million more negative than projected. Compared to the same period last year, the volumes of healthcare services grew by 6%, i.e., by EUR 42.3 million - primary medical care increased by 12%, specialized medical care increased by 5%, nursing care increased by 6% and dental care increased by 3%.

The Health Insurance Fund, in collaboration with the Software Technology and Applications Competence Centre, STACC, created a simple interactive overview of the revenue and expenditure of the Health Insurance Fund. In addition, the graph also enables to view the compliance of the costs with the planned budget and assesses the speed of increasing costs. Reports can be found here.

The full report is available here.

Additional Information:

Liis Hinsberg Head of the Division of Health Promotion and Communication Estonian Health Insurance Fund Phone 6208 459 kertu.eensaar [at] (liis[dot]hinsberg[at]haigekassa[dot]ee)