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Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality

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  • Habicht, Triin
  • Habicht, Jarno
  • van Ginneken, Ewout

Abstract

As of 2014, the Estonian Health Insurance Fund has adopted new purchasing procedures and criteria, which it now has started to implement in specialist care. Main changes include (1) redefined access criteria based on population need rather than historical supply, which aim to achieve more equal access of providers and specialties; (2) stricter definition and use of optimal workload criteria to increase the concentration of specialist care (3) better consideration of patient movement; and (4) an increased emphasis on quality to foster quality improvement. The new criteria were first used in the contract cycle that started in 2014 and resulted in fewer contracted providers for a similar volume of care compared to the previous contract cycle. This implies that provision of specialized care has become concentrated at fewer providers. It is too early to draw firm conclusions on the impact on care quality or on actors, but the process has sparked debate on the role of selective contracting and the role of public and private providers in Estonian health care. Lastly, the Estonian experience may hold important lessons for other countries looking to overcome inequalities in access while concentrating care and improving care quality.

Suggested Citation

  • Habicht, Triin & Habicht, Jarno & van Ginneken, Ewout, 2015. "Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality," Health Policy, Elsevier, vol. 119(8), pages 1011-1016.
    • Handle: RePEc:eee:hepoli:v:119:y:2015:i:8:p:1011-1016
    DOI: 10.1016/j.healthpol.2015.06.002
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    References listed on IDEAS

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    1. Alexander S. Preker & Xingzhu Liu & Edit V. Velenyi & Enis Baris, 2007. "Public Ends, Private Means : Strategic Purchasing of Health Services," World Bank Publications - Books, The World Bank Group, number 6683.
    2. Atun, Rifat Ali & Menabde, Nata & Saluvere, Katrin & Jesse, Maris & Habicht, Jarno, 2006. "Introducing a complex health innovation--Primary health care reforms in Estonia (multimethods evaluation)," Health Policy, Elsevier, vol. 79(1), pages 79-91, November.
    3. Mesman, Roos & Westert, Gert P. & Berden, Bart J.M.M. & Faber, Marjan J., 2015. "Why do high-volume hospitals achieve better outcomes? A systematic review about intermediate factors in volume–outcome relationships," Health Policy, Elsevier, vol. 119(8), pages 1055-1067.
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    Cited by:

    1. Mozhaeva, Irina, 2022. "Inequalities in utilization of institutional care among older people in Estonia," Health Policy, Elsevier, vol. 126(7), pages 704-714.
    2. Montás, Marie C. & Klasa, Katarzyna & van Ginneken, Ewout & Greer, Scott L., 2022. "Strategic purchasing and health systems resilience: Lessons from COVID-19 in selected European countries," Health Policy, Elsevier, vol. 126(9), pages 853-864.
    3. Dale, Elina & Evans, David B. & Gopinathan, Unni & Kurowski, Christoph & Norheim, Ole F. & Ottersen, Trygve & Voorhoeve, Alex, 2023. "Open and inclusive: fair processes for financing universal health coverage," LSE Research Online Documents on Economics 119795, London School of Economics and Political Science, LSE Library.
    4. Klasa, Katarzyna & Greer, Scott L. & van Ginneken, Ewout, 2018. "Strategic Purchasing in Practice: Comparing Ten European Countries," Health Policy, Elsevier, vol. 122(5), pages 457-472.
    5. Ali Reza Kalantari & Mohammad Jafari Sirizi & Mohammad Hossein Mehrolhassani & Reza Dehnavieh, 2019. "Challenges of implementation: Strategic purchasing in Iran Health Insurance Organization," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 875-884, January.

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