Health Policy Monitor
Skip Navigation

Changes in Hospital Reform process in Estonia

Partner Institute: 
PRAXIS Center for Policy Studies, Tallinn
Survey no: 
Agris Koppel, Ain Aaviksoo
Health Policy Issues: 
Pflege, Organisation/Integration des Systems, Zugang
Reform formerly reported in: 
Revision of Hospital Reform
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein nein nein ja nein


In April 2006 the Minister of Social Affairs launched a revision of Estonian Hospital Master Plan ? the cornerstone of hospital reform in Estonia. The plan also targeted smaller hospitals in less populated areas, which currently do not belong to the privileged short-list of 19 out of 52 hospitals, used for preferred contracting by health insurance and capital investments from EU structural funds. The overall plan has failed as no structural changes were done before the end of duty in April 2007.

Neue Entwicklungen

The main purpose of the policy was to make amendments to the development plan of Estonian hospital reform. In April the Minister of Social Affairs formed a commission consisting of representatives of the Ministry of Social Affairs. The work of Commission was based on the political assumption that the planned hospital network is not proper and sufficient for Estonia in the light of accessibility and responsiveness of health care services.

The commission had about 6 planned meetings during 2006. The main objective was to create a renewed hospital master plan 2015 considering on:

  • clarified terminology about the health care system
  • comparing the prognosis of 2015 to new data from 2005
  • benchmarking on health care data in Finland, Denmark, Germany, Slovakia and Hungary


Characteristics of this policy

Innovationsgrad traditionell traditionell innovativ
Kontroversität unumstritten recht kontrovers kontrovers
Strukturelle Wirkung marginal recht marginal fundamental
Medienpräsenz sehr gering sehr gering sehr hoch
Übertragbarkeit sehr systemabhängig recht systemabhängig systemneutral
current current   previous previous

The commission worked under strong influence and mandate from one political party (Central Party) and there was no innovative methods used by the experts. For the same reason there was much controversy in the commission because the aim of the whole work was to find a way to keep small general hospitals still in the small serving areas. There is no systemic impact seen in the work of the commission as they did not come up with proposals about changes in the Estonian hospital network.

Unfortunately, at the same time the whole process of commission work was very covered and public visibility has been very low.

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein nein nein ja nein

Initiators of idea/main actors

  • Regierung
  • Leistungserbringer
  • Kostenträger
  • Wissenschaft
  • Meinungsführer

Stakeholder positions

The main objective of the commission was to create a new hospital master plan after evaluation of the current situation, viewing international experience and taking into account the development scenarios prognosis from the Estonian Hospital Master Plan 2015. The changes were planned to be implemented through changes in legislative acts and writing a new master plan document.

The commission consisted of experts from following organisations:

  • Ministry of Social Affairs
  • National Health Care Board
  • Estonian Health Insurance Fund
  • Tartu University
  • Estonian Hospital Association
  • Estonian Medical Association
  • Estonian County Doctors Association
  • two experts as opinion leaders in medical society

There were three main tasks given to the commission by the Minister of Social Affairs:

  • changing the structure and presumptions of the data regarding to the planning of the hospital network in Estonia
  • make proposals about changes in the Estonian Hospital Master Plan 2015 and the ministerial act about the hospital requirements
  • make proposals on the planning methodology of medical professionals.

Most stakeholders outside the Ministry of Social Affairs did not support the activities strongly as the objectives of the commission were unclear and seen as a one party game. The process faced quite strong opposition from the Estonian Hospital Association, but mainly because there was no well reasoned basis for starting to change the earlier master plan. The Estonian Medical Association was supportive as there are leaders who have always believed that merging hospitals and concentrating high-quality care into bigger units is not reasonable. Generally, the commission consisted of experts who have been opposed to the Estonian Hospital Master Plan 2015.

However, during six month time the commission reached consensus in reorganising emergency care in smaller hospitals. The commission also made draft changes to the ministerial act of hospital requirements as diminished the criteria and requirements for emergency care. However, these suggestions have been very general and have not led to relevant structural changes.

Actors and positions

Description of actors and their positions
Ministry of Social Affairssehr unterstützendunterstützend stark dagegen
National Health Care Boardsehr unterstützendneutral stark dagegen
Association of County Doctorssehr unterstützendunterstützend stark dagegen
Estonian Hospital Associationsehr unterstützenddagegen stark dagegen
Estonian Medical Associationsehr unterstützendunterstützend stark dagegen
Estonian Health Insurance Fundsehr unterstützendneutral stark dagegen
Health Care Department of Tartu Universitysehr unterstützendneutral stark dagegen
Mr Raul Talviksehr unterstützendunterstützend stark dagegen
Mr Vello Ilmojasehr unterstützendunterstützend stark dagegen
current current   previous previous

Influences in policy making and legislation

No influences on legislative process were seen as the period of commission work was too short and no conclusions were reached.

Legislative outcome


Actors and influence

Description of actors and their influence

Ministry of Social Affairssehr großgroß kein
National Health Care Boardsehr großgering kein
Association of County Doctorssehr großgering kein
Estonian Hospital Associationsehr großgroß kein
Estonian Medical Associationsehr großgering kein
Estonian Health Insurance Fundsehr großgroß kein
Health Care Department of Tartu Universitysehr großgering kein
Mr Raul Talviksehr großneutral kein
Mr Vello Ilmojasehr großneutral kein
current current   previous previous
Association of County Doctors, Estonian Medical AssociationMr Raul Talvik, Mr Vello IlmojaMinistry of Social AffairsNational Health Care Board, Health Care Department of Tartu UniversityEstonian Health Insurance FundEstonian Hospital Association

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

As the commission did not come up with concrete results and suggestions about changes in the hospital systemthere was nothing to adopt or implement.

Expected outcome

The outcome of the commission's work is not measurable as most of the work done in 2006 was preparatory work and also some analysis of the current situation.

Impact of this policy

Qualität kaum Einfluss wenig Einfluss starker Einfluss
Gerechtigkeit System weniger gerecht neutral System gerechter
Kosteneffizienz sehr gering low sehr hoch
current current   previous previous

Because no changes followed the work of commission it is not possible to measure any impact of its work. But certainly a mid-term evaluation of the Estonian Hospital Master Plan 2015 is needed to avoid any deprivation in hospital care quality and ensure the cost-efficiency of the whole health system.


Sources of Information

The main source of information has been the Ministry of Social Affairs and all protocols about commssion meetings are available for experts.

Reform formerly reported in

Revision of Hospital Reform
Process Stages: Idee

Author/s and/or contributors to this survey

Agris Koppel, Ain Aaviksoo

Empfohlene Zitierweise für diesen Online-Artikel:

Agris Koppel, Ain Aaviksoo. "Changes in Hospital Reform process in Estonia". Health Policy Monitor, April 2007. Available at