IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v130y2023ics0168851023000052.html
   My bibliography  Save this article

30 years of primary health care reforms in Estonia: The role of financial incentives to achieve a multidisciplinary primary health care system

Author

Listed:
  • Habicht, Triin
  • Kasekamp, Kaija
  • Webb, Erin

Abstract

Estonia has a legacy of hospital-focused service provision, but since the 1990s, has introduced a series of reforms to strengthen primary health care (PHC). The recent PHC reforms have placed an increasing focus on multidisciplinary care, involving home nurses, midwives, and physiotherapists, and emphasize PHC centres over single physician practices. These incremental reforms, without a supporting legal basis nor explicitly defined timelines and targets, nonetheless demonstrated the ability of financial incentives to drive change. EU structural funds in particular provided essential funding for infrastructure investments in PHC. Yet not all stakeholders supported these initiatives, largely due to the uncertain sustainability of funding. The EHIF also adjusted contract and payment terms to support PHC reforms, with some concessions to PHC providers operating as single practitioners. Despite substantial progress over the last three decades to shift the focus to PHC, there are some important bottlenecks that hinder the progress. These include PHC providers’ hesitance to give up their freedom as single practitioners, low interest from specialists to start working at the PHC level, and a lack of financial incentives and adequate funding for a broader scope of PHC services. This looks to become more challenging in the future, as nearly half of family physicians are 60 years old or older. The development of the new PHC strategy in 2023 is very timely to comprehensively address these bottlenecks and to set the vision for the future of PHC in Estonia.

Suggested Citation

  • Habicht, Triin & Kasekamp, Kaija & Webb, Erin, 2023. "30 years of primary health care reforms in Estonia: The role of financial incentives to achieve a multidisciplinary primary health care system," Health Policy, Elsevier, vol. 130(C).
    • Handle: RePEc:eee:hepoli:v:130:y:2023:i:c:s0168851023000052
    DOI: 10.1016/j.healthpol.2023.104710
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851023000052
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2023.104710?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Koppel, Agris & Meiesaar, Kersti & Valtonen, Hannu & Metsa, Andrus & Lember, Margus, 2003. "Evaluation of primary health care reform in Estonia," Social Science & Medicine, Elsevier, vol. 56(12), pages 2461-2466, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mauro, Marianna & Giancotti, Monica, 2023. "The 2022 primary care reform in Italy: Improving continuity and reducing regional disparities?," Health Policy, Elsevier, vol. 135(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Simic, Snezana & Milicevic, Milena Santric & Matejic, Bojana & Marinkovic, Jelena & Adams, Orvill, 2010. "Do we have primary health care reform? The story of the Republic of Serbia," Health Policy, Elsevier, vol. 96(2), pages 160-169, July.
    2. Daisy Volmer & Martin Mäesalu & J. Simon Bell, 2008. "Pharmacy Students' Attitudes Toward and Professional Interactions With People With Mental Disorders," International Journal of Social Psychiatry, , vol. 54(5), pages 402-413, September.
    3. Groenewegen, Peter P. & Dourgnon, Paul & Greß, Stefan & Jurgutis, Arnoldas & Willems, Sara, 2013. "Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries," Health Policy, Elsevier, vol. 113(1), pages 170-179.
    4. Samuel S. Lieberman & Adam Wagstaff, 2009. "Health Financing and Delivery in Vietnam : Looking Forward," World Bank Publications - Books, The World Bank Group, number 2594.
    5. Habicht, Jarno & Kunst, Anton E., 2005. "Social inequalities in health care services utilisation after eight years of health care reforms: a cross-sectional study of Estonia, 1999," Social Science & Medicine, Elsevier, vol. 60(4), pages 777-787, February.
    6. Akinci, Fevzi & Mollahaliloğlu, Salih & Gürsöz, Hakki & Öğücü, Fatma, 2012. "Assessment of the Turkish health care system reforms: A stakeholder analysis," Health Policy, Elsevier, vol. 107(1), pages 21-30.
    7. Põlluste, Kaja & Kasiulevičius, Vytautas & Veide, Sarmite & Kringos, Dionne Sofia & Boerma, Wienke & Lember, Margus, 2013. "Primary care in Baltic countries: A comparison of progress and present systems," Health Policy, Elsevier, vol. 109(2), pages 122-130.
    8. Domantas Jasilionis & France Meslé & Vladimir M. Shkolnikov & Jacques Vallin, 2011. "Recent Life Expectancy Divergence in Baltic Countries," European Journal of Population, Springer;European Association for Population Studies, vol. 27(4), pages 403-431, November.
    9. 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.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:130:y:2023:i:c:s0168851023000052. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.