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Estonia, officially the Republic of Estonia, is located in the
Baltic region of Eastern Europe. It is bordered to the north and
west by the Gulf of Finland and the Baltic Sea respectively, with
the Russian Federation to its east and Latvia to the south.
Estonians are descendants of the Finnic people and the sole
official language of the country, Estonian, is very similar to
Finnish. Formerly part of the Soviet Union, Estonia achieved
independence in 1991 and joined the European Union in 2004. With a
total land mass of 45,227 square kilometers and a population of
just 1.34 million, Estonia is one of the least populated member
states within the European Union. Increased investment followed
until 2008 when the global financial crisis hit, leaving the
Estonian economy in a state of distress. A number of economic
measures were adopted and Estonia joined the Euro Zone on 1
January 2010. In comparison to other former Soviet Republics,
Estonia’s relatively strong development has resulted in being
rated the highest GDP per person of such countries. Estonia is
widely acknowledged to have made considerable progress in the
areas of education, democracy and political freedom, press freedom
and economic freedom.
The health care system in Estonia has seen significant change
since the early 1990s. Reforms have been carried out on a number
of levels with the intention of redeveloping the public funding
system, improving efficiency at the nation’s hospitals, improving
the quality and accessibility of general medical care service, and
a more efficient use of resources - in particular resources
administering primary health care. A National Health Plan for 2009
to 2020 was created by the government with the intention of
building on previous successes, and to establish programs that
contribute toward continued improvements in the health care
system. Estonians now enjoy a good standard of health care and in
a recent EU study the country ranked a very respectable fourth
place for healthcare services within the European Economic
Community. These new national health reforms and programs have
given the Estonian health care system added impetus. One strong
indication of this success can be seen in the average life
expectancy rate rising from 67 years to 73 years. Despite this
notable success, population health in Estonia still falls short of
EU averages. Cardiovascular diseases and cancer remain the primary
cause of death in Estonia. A moderately high prevalence of HIV
(1.2 per cent of the total population) and TB also pose challenges
to public health resources and maintaining positive development.
The Ministry of Social Affairs has sole responsibility for
delivering the Estonian health care system with a public health
insurance fund being its primary source of finance. The Estonia
Health Insurance Fund (EHIF) comprises contributions from
employers and employees to ensure accessibility to primary level
health care and to cover payment of all costs related to the use
of health services by citizens in the event of illness. Employers
are required to pay social tax for all employees, currently at a
rate of 33 per cent of the taxable figure, of which 20 per cent is
allocated for pension insurance and 13 per cent for health
insurance. Children under 19 years of age, pregnant women, the
elderly and the unemployed, while not required to make
contributions to the fund, are members and enjoy the same benefits
as paying members. Children and the elderly in particular make up
nearly half of the fund’s members, representing a major fiscal
challenge in the years ahead.
Estonia has created family orientated countrywide primary care,
built upon an established network of well-trained physicians and
nurses. All persons insured with the EHIF have access to a local
family doctor. With the exception of emergency situations, the
family doctor is the first port of call for Estonian citizens
requiring medical assistance. Patients require a referral from
this practitioner to visit a medical specialist. No referral is
needed to visit a psychiatrist, gynecologist, dermatovenerologist,
ophthalmologist, dentist, infection specialist, surgeon or
orthopedist and some charges do exist for certain treatments.
Adults wishing to visit a dentist are expected to pay in cash at
the time of treatment for the majority of dental services offered.
Following independence, Estonia’s hospital network underwent major
reorganization with the aim of reducing the large number of
military hospitals that remained from the Soviet era. A number of
infrastructural programs succeeded in both reducing the number of
hospitals and modernizing the main health care system. Complicated
medical treatment involving advanced procedures and technology has
been relocated to the country’s larger hospitals. There are four
national hospitals capable of providing secondary and tertiary
care and two of these hospitals are located in the capital city
Tallinn. Mustamae hospital and East Tallinn Central hospital
provide specialist care and emergency services to residents of
Tallinn and the surrounding Harju County. Pärnu Hospital and
Ida-Viru Central Hospital serve citizens resident in Pärnu County
and Ida-Viru County respectively. Tartu University hospital
provides regional hospital services to residents of Southern
Estonia.
Estonia is a member of the European Economic Area (EEA) and it has
signed bilateral medical agreements with fellow member states. EEA
citizens visiting Estonia who require emergency medical care and
who hold a European Health Insurance Card (EHIC) are ensured
access to emergency care on the same terms as Estonian citizens.
Estonia boasts a high level of medical care, particularly in
Tallinn, and other large cities such as Tartu and Pärnu. Estonia’s
medical professionals are well trained but often complain of a
lack of resources and equipment, particularly those operating in
smaller cities and rural areas.
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