Estonia

Healthcare System

Estonia’s healthcare system is the Health Insurance System, described as “solidarity-based health insurance” [1], and the Estonian Health Insurance Fund (EHIF) is the public law organization responsible for providing the organization of national healthcare services in accordance with the Health Insurance Act, the Health Services Organization Act, and other legislation.

The body responsible for healthcare and all social policies in Estonia is the Ministry of Social Affairs. The Health Board is its child agency. Estonia’s Public Information Act details the terms of compliance to request information not already publicly available. The request is exempt from covering expenses if the request is made for research work.

Administrative or Claims Data

Estonian Health Insurance Fund (EHIF) Database

[2]

Sponsor, manager or home institution: Estonian Health Insurance Fund (EHIF); The Ministry of Social Affairs

Type of information: Medical contacts (physician visit, hospital stay, etc.), including diagnostic tests, prescription medicine, medical devices, and treatment.

Source of Information: Based on claims data from all Estonian healthcare providers that have signed a contract with EHIF and deliver EHIF-financed healthcare.

Data level: Patient level.

Number of Records: 1.3 million people, i.e. 95% of Estonia's population.

Date Range: 2004 onwards.

Open data access: Data is partially publicly available. Publicly available data can be found here. Information on how to access the data can be found here.

Link/Contact for data request: Contact information.

Registries

Estonian Cancer Registry

Primary purpose: A complete and reliable registration of incident cancer cases in Estonia.

Sponsor, manager, or home institution: The National Institute for Health Development; Ministry of Social Affairs.

Available databases: The Health Statistics and Health Research Database and the Statistics Estonia Database

Available type of information: Datasets about the incidence of cancer in general and specific types of cancer, sortable by year, sex, site and age group, as well as causes of death and death rates.

Available data level: National level. Malignant neoplasms' statistics are submitted by 15 counties.

Type of Information: patient name, identification number, gender, date of birth, place of birth, residence, marital status, nationality, primary site, date of diagnosis, confirmation methods of diagnosis, tumour morphology and grade, extent of disease, primary treatment (surgery, radiotherapy, cytostatic chemotherapy, hormone therapy, other treatment), follow-up data (date of death or emigration) and cause of death, source of information

Number of records: Every registered Estonian citizen.

Data source: “Reporting of cancer cases is compulsory to all physicians working in Estonia who diagnose or treat cancer. Data are submitted to the registry also by forensic pathologists-experts” [3].

Cancer areas of interest (ICD): All sites (C00–C97); All sites except other skin (C00–C97, except C44); Lip, oral cavity and pharynx (C00–C14); Digestive organs (C15–C26); Respiratory and intrathoracic organs (C30–C39); Female genital organs (C51–C58); Male genital organs (C60–C63); Urinary tract (C64–C68); Brain and central nervous system (C70–C72); Leukaemia (C91–C95); Lymphomas (C81–C85/C96); county-level lymphoma data include Hodgkin’s disease as well as non-Hodgkin lymphomas.

Link/contact: Contact information.

Database: Cause of Death

Sponsor, manager or home institution: Statistics Estonia.

Primary purpose: The database provides information on deaths of Estonian permanent residents, including causes of death, to be used for population statistics, mortality rate assessment, population forecasting, and comparison with other EU member states, as well as by various state institutions, statisticians, and international organizations.

Type of information: The number of deaths registered during the calendar year and the distribution of the dead by demographic indicators and medical causes of death; indicators are published in absolute and relative numbers (multipliers). By type of deceased settlement unit, place of residence and month of death, gender, age group, nationality, marital status, education level, cause of death. Perinatal deaths; Stillbirths. Infant deaths by gender, age, place of residence, date of birth, mother's age, mother's marital status, mother's level of education.

Available type of information: Total deaths, death rate, standardized death multiplier, death per 100,000 population, cause of death, sex, and age.

Source of Information: Census.

Data level: Patient level.

Available data level: National level.

Number of Records: Unknown.

Date Range: 1989 onwards.

Cancer Areas of Interest:

Open data access: Data is partially publicly available. Publicly available data can be found here at "Population > Population indicators and composition > Population and population composition". Information on how to access full database can be found here.

Information/Contact for data request: Contact information can be found here.

Activity License Registry

Primary purpose: A search tool for any pharmacy, wholesale distributor or manufacturer with an Estonian activity licence for handling medicines.

Sponsor, manager, or home institution: Estonian Agency of Medicine.

Available information: Site name, activity license holder, activity license number, county, city/town/village and type of activity license.

Level: City/town/village level.

Medical Products Registry

Primary purpose: To have an account of all medicinal products and their packages sold in Estonia.

Sponsor, manager, or home institution: Estonian Agency of Medicine.

Available information: Active substance, pharmaceutical form, strength, information about the marketing authorisation, the last date of import, reference price, discount prices and rates, unique codes for package sizes, among other information.

Electronic Health Records

Health Information System

Primary Purpose: Allowing healthcare service providers to see and share patient information and healthcare data across the country.

Sponsor, manager, or home institution: Ministry of Social Affairs (sponsor); Health and Welfare Information Systems Centre - TEHIK (manager)

Number of records: Any Estonian citizen who used a healthcare service since 2008.

Data source: Data inserted by healthcare providers.

Date range: 2008 onwards.

Link/contact: Contact information.

Clinical Practices Guidelines

Action Plan for Cancer Control

Primary purpose: Reducing the number of cancer cases and deaths, and improving the quality of life of cancer patients.

Sponsor, manager or home institution: Ministry of Social Affairs; National Institute of Health Development; Estonian Cancer Society.

Level: National level.

Cancer ares of interest: All.

Availability in English: No.

Good Practices Guidelines for Clinical Trials

Primary purpose: To ensure the rights, safety and well-being of the participant according to the principles of the Declaration of Helsinki.

Sponsor, manager or home institution: European Medicines Agency.

Level: National level.

Cancer Areas of Interest: All.

Availability in English: Yes.

Latest Policymaking Initiatives

Population Health Development Plan 2030

Institution: Ministry of Social Affairs

Primary purpose: National health plan to increase life expectancy and quality of life during later years, and decrease healthcare inequalities.

Type of information: A detailed plan to deliver on the goals stated above, with data to support policy decisions, which includes cancer-related decision-making.

Level: National level.

The State of Healthcare Integration in Estonia Report

Institution: Estonian Health Insurance Fund.

Primary purpose: Assess healthcare integration in Estonia.

Type of information: Overview of the Estonian healthcare system, information about avoidable admissions to hospitals and specialist visits, hospital stay, NMIS procedures, patient behavior, provider behavior, care continuity, preventive services, and other various information.

Level: National level.

"Quality Bonus System Needs Adjustment" Report

Institution: Estonian Health Insurance Fund.

Primary purpose: Point out flaws in the QBS system and suggest easy-to-make adjustments.

Type of information: Analysis of QBS score distribution including tables and graphs for various data, list of proposals for adjustments to the QBS system with details, among other information.

Level: National level.

Healthcare Costs 2019

Institution: National Institute for Health Development.

Primary purpose: Provide information about healthcare costs for anyone interested in healthcare.

Type of information: Total national health expenditure, comparisons to previous years, share of public sector and other details, household expenditures, and healthcare insurance fund expenditures, among others.

Level: National level.

Estonian Handbook for Guideline Development

Institution: Estonian Health Insurance Fund.

Primary purpose: To serve as an up-to-date practical resource for developing health guidelines.

Type of information: Guideline development process, topic proposals, evidence retrieving, report, dissemination of recommendations, among other topics.

Level: National level.

Marketing Authorization for a Drug

Institution: Medicines Board

Primary purpose: Legislation and Forms to inform the marketing authorization for drugs.

Type of information: Medicine-related laws, regulations, conditions, requirements and statutes related to the authorization of drug marketing, guides and manuals to inform the process as well as forms that are required to be authorized.

Level: National level.

Handling of Medicine

Institution: Medicines Board

Primary purpose: Legislation and Forms to inform the handling of drugs.

Type of information: Medicine-related laws, regulations, conditions, requirements and statutes related to the handling of drugs, guides to inform the handling of drugs as well as forms that are required to be authorized to handle drugs.

Level: National level.

Cancer-related Patient Associations and Resources

"Gift of Life" Foundation

Primary purpose: To support cancer treatment not covered by the Estonian Health Insurance Fund.

Level: National level.