Income-related inequality in health care financing and utilization in Estonia since 2000

This paper summarizes recent research on income-related inequalities in health care financing and utilization in Estonia for the period 2000 to 2007. Quantitative analysis is used to analyse evidence for a number of priority policy issues. Considering prefinancing and out-of-pocket payments (OOPs) together, overall health care financing is mildly progressive. During the period studied about 3% of households (about 15 000) dropped below the national absolute poverty line after making OOPs. The number dropped from 3.7% in 2000 to 2.1% in 2007 due to wages and especially old-age pensions rising faster than the cost of living. For those services more dependent on OOPs, such as outpatient drugs and dental care, there are either more inequalities in utilization or households face higher risk of impoverishment. Thus the patterns of equity in both the finance and use of services are closely linked to the structure of the EHIF benefit package. Two recommendations are made, first to revise the structure of prescription drug copayments in order to ensure affordable access, in particular for pensioners, and secondly to improve financial access to adult dental care whilst concurrently maintaining the good protection that exists for other services, such as primary care, inpatient care and emergency care.