This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. In 2017, the Estonian government took the historic step of expanding the revenue base of the health system, which has been a longstanding challenge. However, in terms of percentage of gross domestic product (GDP) it remains a small increase and long-term financial sustainability could still pose a problem. That said, if these additional funds are invested wisely, they could play a positive role in further improving the health system.

Although Estonia has made remarkable progress on many health indicators (e.g. the strongest gains in life expectancy of all European Union (EU) countries, sharply falling amenable mortality rates), there are opportunities for improvement. They include overcoming the large health disparities between socioeconomic groups, improving population coverage, developing a comprehensive plan to tackle workforce shortages, better managing the growing number of people with (multiple) noncommunicable diseases and further reaping the benefits of the e-health system, especially for care integration and clinical decision-making.

In terms of quality, large strides have also been made, but the picture is mixed. Avoidable hospital admissions are among the lowest in the EU for asthma and chronic obstructive pulmonary disease (COPD), about average for congestive heart failure and diabetes, but among the worst for hypertension. Moreover, the 30-day fatality rates for acute myocardial infarction and stroke are among the worst in the EU. These outcomes suggest substantial room to further improve service quality and care coordination. The new national health policy, which is currently being revised, will play a crucial role in the success of future reform efforts.