Reforms to the Estonian health care system were being planned even before independence and a social health insurance system was established in 1992, based on insurance payments rather than state revenues. Since 1993 health care provision and insurance have been the responsibility of the Ministry for Social Affairs. The organisation of health care, including primary and secondary care, at local government level is overseen by the municipality or town council and the municipal physician. Health insurance is administered by the Central Sickness Fund and 17 regional sickness funds, which are based in each of the counties and the country’s two cities. Health care providers contract with the sickness funds, which plan according to their best interpretation of regional needs and previous patterns of service use. These decentralisation measures have proved costly, however, and may be reversed in some areas, including responsibilities for primary care passing to county authorities. A Hospital Master Plan will make provision for specialist care.6
A leader in the development of palliative home care in Estonia summarises the general situation of palliative care in the country as follows:
‘The attitude of the politicians is positive, but all the funds are insufficient and limited for active treatment. They are doubtful in supporting palliative care. Feedback from [the general public] in Estonia is positive and supportive. The professionals consider palliative care psychologically hard [to accept] and take it as “defeat” …Where the cancer home care teams work, the situation is satisfactory, [but] the financial support for palliative care is insufficient and there are not enough hospital beds.’7
Source: WHO Regional Office for European Health for All database and HiTs
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