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H ow institutions can work together to ensure financial sustainability

H ow institutions can work together to ensure financial sustainability. by Ivi Normet Ministry of Social Affairs of Estonia. the role of the M o SA in health financing policy in Estonia.

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H ow institutions can work together to ensure financial sustainability

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  1. How institutions can work together to ensure financial sustainability by Ivi Normet Ministry of Social Affairs of Estonia

  2. the role of the MoSA in health financing policy in Estonia

  3. Estonia’s health system is largely publicly financed through anearmarked tax on wages (the social tax). 2/3 oftotal health financing comes from the social tax. The single payer system – autonomous agency Health Insurance Fund (EHIF).

  4. The health insurance is separated from other forms of socialinsurance (e.g. pensions and unemployment benefits). EHIF is governed by a 15-member Supervisory Board, withthe Minister of Social Affairs as its Chairman.

  5. At national level, the MoSA is responsible for health, social and labour policy. MoSA is responsible for overall health systemstewardship regarding: • policy development, • regulation and supervision ofhealth services.

  6. The MoSA finances services available tothe whole population such as emergency care, public health programmes, emergency care services provided to uninsured individuals etc.

  7. Main policy document National Health Strategy 2008–2020 follows the health for all principles and sets out the basis for all activities and investment areas for all ministries and agencies that aim to improve the public health situation in Estonia.

  8. responding to the challenge of financial sustainability

  9. Health system analysis Health System Performance Assessment Analysis of Financial sustainability of health financing (cooperation with WHO) Analysis of Financial sustainability of social insurance system (cooperation MoF)

  10. Broaden the public revenue base • non-employment-based taxes on capital and consumption; • social tax to dividends from capital investment; • central government contributions to EHIF • Improve financial protection review user charge policies for all health services

  11. Improve health system performance through better resource allocation and purchasing MoSAshould develop astronger strategy for guiding investment in andthe design of hospital infrastructure. .....work closely withother ministries to generate sufficient investment in public health programmes and prevention ...... work with EHIF toboost the primary care focus of the health system.

  12. Maintain strong governance of the health system Monitoring and evaluating provider activity across the health system Investing in e-health Providing policy direction for the whole health system, ensuringa sufficient flow of resources...

  13. respond to the financial crisis

  14. Social tax and EHIF expenditures, 2001 – 2012 euros

  15. Monitoring the impact of crisis

  16. Decisions affecting health system made due to financial crisis • cancelled compensation of capital costs from the state budget to Health Insurance Fund (EHIF) • increased general value added tax (18%→20%) • increased the value added tax on medicines (5%→9%) • decreased funding of public health programmes (26%) - mainly NCD, but also ambulance services budget (3.4%) • increase of unemployment tax (0.9%→1.5% → 4.2%)

  17. Priorities and measures to maintain health • EHIF started use its accumulated reserves • health budget is less affected than general state budget and other sectors • within health budget primary care and communicable diseases prioritised • rising of excise taxes for tobacco and alcohol(four times since 2008) • state contributes insurance of unemployed • state pays for emergency care of uninsured people

  18. Other measures • use of EU structural funds: acute and nursing care hospitals infrastructure + public health activities • use of funds from carbon dioxide quota trading to renovate hospitals more energy saving • use of Norway and Swiss grants

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