Estonian case study: Roundtable discussion on how institutions can work together to ensure financial sustainability Ivar Sikk Deputy Secretary-General of Fiscal Policy

Key issues Best possible allocation of resources between all areas taking into consideration long-term financial sustainability Fiscal rules for following agreed fiscal framework Maintaining efficiency of health system Flexibility for responding to environmental changes Accumulation of reserves

Health insurance sustainability (% of GDP) Expenditure Income Gap Source: Praxis.

Short- and medium-term sustainability Sustainable. Possible things to do: increase efficiency the hospital network increase co-ordination between hospitals and services establish stronger control of purchasing very expensive medical instruments. increase the responsibility of the people

Long-term sustainability Not sustainable. Some possible solutions: – expanding the tax base – financing partly from state budget – individual health accounts – inclusion of the private insurance No decisions, ongoing evaluation of different possibilities.

Strengthening co-operation … … between ministries and Health Insurance Fund: Closer co-operation in forecasting, medium- and long term planning. Synchronizing the decision making process.