Estonia
This chapter provides an extended look at health politics and the social health insurance system in Estonia. The chapter traces the historical development of the Estonian healthcare system through a series of regime changes, all of which affected healthcare. The post-1991 transformation of Estonia’s health system went rapidly and was marked by relatively high consensus and professionalism. Consequently, stable financing and a large tax component allowed Estonia’s national health fund to avoid the heavy dependence on out-of-pocket payments characteristic of many other transition countries. Despite plans for decentralized social insurance, by 2000 the decision was made to centralize the social insurance system, which has become essentially a single-payer system. This has allowed quite a bit of leverage for setting healthcare priorities. But, as the chapter argues, given the pressure for austerity after the 2008 financial crisis, reduced capacity has led to longer waiting times.