The Story of the Estonian Health Insurance Fund. 20 Years of Treatment and Insurance

Grupi autorid

The Story of the Estonian Health Insurance Fund. 20 Years of Treatment and Insurance

Dear reader!

This year marks the passing of 20 years since the re-establishment of health insurance in the Republic of Estonia. That is a sufficiently long time to look back and recall how we have arrived at the present day.

We all tend to forget, especially those events and activities that do not have to be recalled every day. That is why we asked those people whose ideas have been implemented over 20 years and who have contributed to the development of our health system to recall their activities and write them down. This book does not aspire to absolute truth or precision in terms of facts, the aim is rather to present people’s memories as genuinely as possible.

As we read this book, we see that quite a lot of what was initially agreed on has been implemented over the course of 20 years. Diligent and persistent people have led the health care sector, and intense activity has carried on continuously. People’s way of thinking has changed over the years and the centre of gravity of thoughts and ideas has shifted in a definite direction. The initial objective of reorganising medical institutions and their financing has given rise to aims intended for patients and brought aspects associated with human values to the surface: solidarity, insurance coverage and the ability to pay for necessary health care expenditures. I am happy to say that this development has proceeded in the right direction and our current objective is to ensure that people receive high quality and timely medical care in the event that health problems arise.

I thank everyone who has contributed to the completion of this book with their advice and assistance and I wish pleasant reading!

Hannes Danilov

Chairman of the Board of the Estonian Health Insurance Fund

I

Development of Health Insurance: 1912–1991

Otto von Bismarck.

The Beginning of Sickness Insurance in Europe

The history of sickness insurance extends back to the 19th century when the first sickness insurance act was passed into law in Germany in 1883 at the initiative of Otto von Bismarck. Why was this necessary?

As industry evolved, industrial accidents became more serious compared to agricultural accidents and independent entrepreneurs were no longer able to pay for the treatment of workers to the extent that was necessary. It was, however, necessary to treat workers because due to the specialised nature of work, manpower became increasingly more valuable. Then the idea of centralising means by way of insurance payments emerged as a way of spreading out the risk of medical treatment expenses. Naturally, workers also demanded that manufacturers improve working conditions and cover medical treatment expenses in the event of accidents. Bismarck’s aim was nevertheless not only the better organisation of the treatment of industrial workers but also to improve cooperation and communication between manufacturers and workers’ health insurance funds.

The health insurance act created in Germany encouraged the workers of other countries to fight for their rights as well. Tempestuous events unfolded in all the major countries of Europe. In France, the first health insurance act was passed in 1894, whereas it was compulsory to insure miners. The laws passed in Italy, Belgium and Switzerland in 1910 also insured all women between the ages of 15–50, while the law passed in England in 1911 insured all workers over the age of 16.

The rulers and industrialists of tsarist Russia did not escape the workers’ growing pressure to change working conditions and the ordering of the affairs of the lives of workers either. During the revolution of 1905–1907, workers demanded, among other things, that the tsarist government provide insurance for old age, disability and illness. The Duma worked out the fundamentals for state insurance in 1905 already and draft legislation for health and accident insurance (HÕKS