Inquiry regarding the healthcare funding crisis (No. 811)
Session: The 15th Riigikogu, 6th Session, Plenary Sitting
Date: 2025-11-03 20:26
Participating Politicians:
Total Speeches: 33
Membership: 15
Agenda Duration: 56m
AI Summaries: 33/33 Speeches (100.0%)
Analysis: Structured Analysis
Politicians Speaking Time
Politicians
Analysis
Summary
The Riigikogu debate centered on an interpellation submitted to Minister of Social Affairs Karmen Joller concerning the healthcare funding crisis. The interpellation was presented by members of the Social Democratic Party and other opposition factions, led by Tanel Kiik. The interpellators highlighted the chronic deficit of the Health Insurance Fund (200–300 million euros) and the underfunding of Estonian healthcare compared to the OECD and EU averages, warning that government inaction would deepen waiting lists and inequality. Questions addressed ensuring sustainability, covering the 2026 deficit, involving private capital in primary care, and reducing patient co-payments. Minister Joller acknowledged the funding problem but stressed that the government's priority is first to streamline healthcare expenditures and optimize the hospital network to ensure funds are directed toward results-based objectives. She explained that the 2024 budget deficit was successfully reduced by 70 million euros due to better collection of social tax and efficiency measures. Joller criticized the opposition's focus solely on accessibility, emphasizing the importance of treatment quality. She confirmed that the government’s specific proposals for long-term funding would be presented in February, but conceded that finding a large volume of additional funds would necessitate new tax increases or the reallocation of resources from other priorities, such as national defense. The discussion also brought up concerns about two-tier medicine and the future of regional hospitals (e.g., Hiiumaa) within the context of optimizing the hospital network.
Decisions Made 1
No decisions were made
Most Active Speaker
Tanel Kiik (Social Democratic Party, left) was the most active speaker as the initiator of the interpellation, stressing the government's inaction in resolving the healthcare funding crisis and warning against the worsening of two-tier healthcare.
Esimees Lauri Hussar
AI Summary
Chairman Lauri Hussar introduced the fifth item on today's agenda, which was the interpellation submitted to Minister of Social Affairs Karmen Joller by members of the Riigikogu (led by Tanel Kiik) concerning the healthcare funding crisis, and asked Tanel Kiik to come to the podium to present the interpellation.
Tanel Kiik
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Tanel Kiik, representing the concerns of the Social Democrats, emphasized the severity of the healthcare funding crisis, which has resulted in a chronic deficit of 200–300 million euros for the Health Insurance Fund (Tervisekassa). He demanded immediate, concrete plans and decisions from the Government of the Republic to secure additional funding (not solely through the social tax), arguing that the current model is unsustainable due to demographic changes. He concluded by presenting the minister with four crucial questions concerning the sustainability of funding, covering the 2026 deficit, involving private capital, and reducing patients' excessively high co-payments.
Esimees Lauri Hussar
AI Summary
Chairman Lauri Hussar offered his thanks and invited Minister of Social Affairs Karmen Joller to the Riigikogu rostrum so that she could respond to the interpellation that had been submitted.
Sotsiaalminister Karmen Joller
AI Summary
Social Minister Karmen Joller responded to questions regarding the sustainability of healthcare funding, emphasizing that covering the long-term deficit requires streamlining the system, conducting a thorough analysis (with proposals due to the government in February), and implementing a quality system. This is necessary to ensure expenditures are purposeful and to identify savings. Furthermore, she promised to address the reduction of uneven patient co-payments, focusing specifically on dental care and over-the-counter medicines.
Esimees Lauri Hussar
AI Summary
Chairman Lauri Hussar thanked the respected minister, informed the assembly that questions had been submitted to him, and then invited Jaak Aab to the podium.
AI Summary
Jaak Aab points out that healthcare costs increase by approximately two percent annually due to population aging and technological advancements. Consequently, he asks the minister how the lengthening of specialist medical care waiting lists has been assessed, given a situation where the increased financial requirement is not fully covered by existing contracts, despite the number of treatment cases remaining constant.
Sotsiaalminister Karmen Joller
AI Summary
Social Affairs Minister Karmen Joller is criticizing political slogans promising short waiting lists. She emphasizes that the problem with specialist medical care isn't just about the number of cases treated or funding, but rather systemic inefficiency, noting that roughly a third of patients end up seeing the wrong specialist. The solution, she argues, lies in a strategic approach and the broader implementation of the e-consultation service, which will improve the quality of referrals, provide family doctors with necessary guidance, and ensure that available appointment slots are allocated to those who genuinely need them.
Esimees Lauri Hussar
AI Summary
Chairman Lauri Hussar gave the floor to Reili Ranna.
Reili Rand
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Reili Rand is seeking clarification from the minister regarding exactly what is meant by the proposed streamlining of the hospital network, which has been put forward to ensure the sustainability of healthcare funding. She emphasizes that this "notorious" concept needs to be defined specifically from the perspective of the residents of Hiiumaa, Saaremaa, and Läänemaa, as it is a phrase that can be interpreted in vastly different ways.
Sotsiaalminister Karmen Joller
AI Summary
Social Affairs Minister Karmen Joller emphasizes that optimizing the hospital network is a crucial step to ensure high-quality and accessible medical care, especially given the staff shortages and the aging population. She confirms that while small hospitals, such as those in Hiiumaa and Saaremaa, must remain operational, their services need to be strategically adapted, focusing on common needs and the treatment of chronic illnesses. She promises, however, that these changes will be implemented gradually and no hospitals will be shut down.
Esimees Lauri Hussar
AI Summary
Chairman Lauri Hussar addressed Helmen Kütt, who was asked to begin speaking, but the content of her address is not reflected in the given text.
Helmen Kütt
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Helmen Kütt recognizes the minister's stance on the importance of timely and appropriate treatment, but she urgently requests clarification regarding an earlier public statement about the need for a referral when contacting emergency medical services. This statement has caused public confusion and fear that people might avoid visiting the emergency department, thus risking complications.
Sotsiaalminister Karmen Joller
AI Summary
Social Affairs Minister Karmen Joller emphasizes the importance of distinguishing between ambulance services and the Emergency Department (ED) and rejects the currently considered idea of widespread patient redirection, citing a lack of readiness and necessity among both general practitioners (GPs) and the EDs themselves. The main issue is the overload of EDs (especially in Tallinn and Tartu) with trivial cases, such as a common cold or a horsefly bite. Therefore, triage nurses should have the authority to redirect clearly unnecessary cases—for instance, to a pharmacy. Conversely, patients presenting with serious concerns (like suspected pneumonia) should not be immediately turned away. She also stresses that any changes will be implemented in cooperation with ED personnel.
Esimees Lauri Hussar
AI Summary
Chairman Lauri Hussar gave the floor to Riina Sikkut.
Riina Sikkut
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Riina Sikkut highlights the chronic underfunding of Estonian healthcare compared to the European Union average, and emphasizes that, given the aging population and the expectation of services comparable to those in neighboring countries, it is impossible to modernize the system and guarantee necessary treatment without a significant and swift additional contribution from the state, asking the minister for solutions concerning the pace and volume of this funding.
Sotsiaalminister Karmen Joller
AI Summary
Social Affairs Minister Karmen Joller emphasizes that Estonian healthcare must shift its focus from accessibility to quality, taking patient opinions into account, and disciplining rude staff, noting also that treatment waiting times in Estonia are often shorter than in the Nordic countries or Germany. While acknowledging the need for additional funding (approximately 800 million euros), it is stressed that this requires a political decision to either raise taxes or make cuts in other sectors, especially given the current high priority of defense spending due to the eastern neighbor.
Esimees Lauri Hussar
AI Summary
Chairman Lauri Hussar called upon Tanel Kiik to step forward and deliver his speech.
Tanel Kiik
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Tanel Kiik criticizes the minister for getting bogged down in details, emphasizing that the fundamental concern of healthcare is the lack of additional funding. Therefore, the government is being asked for a clear answer regarding whether and when steps are planned to be taken to cover the deficit in the Health Insurance Fund's budget and to find the necessary supplementary financing required to guarantee services.
Sotsiaalminister Karmen Joller
AI Summary
Social Minister Karmen Joller confirms that the solidarity-based healthcare system will remain, dismissing accusations of privatization. However, she stresses the urgent need to find areas for savings and shift healthcare funding to a performance-based model in order to utilize the 2.5 billion euro budget more efficiently. She cited the success story of family doctor care as an example, expressing hope that the new head of the Health Insurance Fund (Tervisekassa) will implement these changes by focusing on improving outcomes and the quality of treatment.
Aseesimees Arvo Aller
AI Summary
Vice-Chairman Arvo Aller Lauri Läänemets was called by name to the rostrum so that he could begin his presentation.
Lauri Läänemets
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Lauri Läänemets sharply criticizes the government for the lack of a clear plan to cover the healthcare funding deficit, noting that a yawning gap of hundreds of millions exists in the budget of the Health Insurance Fund (Tervisekassa). He demands a concrete answer from the minister regarding the specific measures that will be used to substantially reduce this shortfall, especially given the already high level of public dissatisfaction.
Aseesimees Arvo Aller
AI Summary
Vice-Chairman Arvo Aller delivered an extremely brief yet clear procedural notice, simply stating, "Your time!"—thereby signaling either the start of the next speaker or the expiration of the allotted time.
Lauri Läänemets
Profiling Sotsiaaldemokraatliku Erakonna fraktsioonAI Summary
Lauri Läänemets poses a brief but pointed question, demanding clarification regarding which resource or whose expense the planned activity or outcome will be achieved.
Sotsiaalminister Karmen Joller
AI Summary
Social Affairs Minister Karmen Joller is clarifying the healthcare financing strategy, specifically addressing criticism regarding the use of reserves. She confirms that by improving service efficiency and achieving better social tax collection, a total of 100 million euros will be generated, 70 million of which will be channeled into reserves. The primary objective is to ensure that the funds freed up through these efficiency measures are invested in innovation and digital solutions, while simultaneously enhancing the quality and accessibility of services. The Minister stresses the necessity of eliminating financial opacity (such as the cross-subsidization of hospital departments) and redirecting misspent funds (for instance, replacing expensive specialized medical care with primary care provided by family doctors) to areas where they are genuinely needed, viewing the healthcare network holistically.
Aseesimees Arvo Aller
AI Summary
Following a brief introduction, Deputy Chairman Arvo Aller gave the floor to Anti Allas, inviting him up to the podium.
Anti Allas
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Anti Allas is putting two questions to the minister concerning the accessibility of healthcare services: first, is it justified that a person with a serious health issue can receive treatment significantly faster by starting at a private clinic than through their family doctor, and second, where is the limit to ensure that in family doctor practices taken over by private clinics, the availability of the doctor does not decrease due to excessive efficiency.
Sotsiaalminister Karmen Joller
AI Summary
The Minister of Social Affairs, Karmen Joller, highlighted the unethical issue of two-tier healthcare and the evolution of family medicine, explaining that the role of general practitioners has become more complex and the significance of nurses and other specialists in health centers has grown. She simultaneously promised to actively tackle both the bypassing of ownership restrictions for private clinics and the establishment of a currently absent quality system, which is expected to be finalized in the coming years.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller invited Ester Karuse to the podium.
Ester Karuse
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Ester Karuse is raising the issue of strengthening the supervision of healthcare funding, asking the minister to explain exactly how the financing of both network hospitals and private clinics is currently monitored. She also wants to identify which specific areas of concern could benefit from better oversight to ensure that the money reaches the right people in need of assistance.
Sotsiaalminister Karmen Joller
AI Summary
Social Minister Karmen Joller emphasizes that healthcare quality is more important than the length of waiting lists, criticizing the Health Insurance Fund for its lack of funding oversight. She demands that doctors' competency certificates and mandatory training be standardized even in HVA hospitals, necessitating the development of a new system where the use of taxpayer money is linked to clear quality indicators.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller thanked the participants, concluded the questioning phase, and officially opened the negotiations, inviting Tanel Kiik to the podium first.
Tanel Kiik
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Tanel Kiik expresses the Social Democrats' sincere concern regarding the underfunding of Estonian healthcare, sharply criticizing the government's budget choices. These choices prioritize tax giveaways and security, leaving the solidarity-based healthcare system struggling, relying solely on old reserves. This situation, in turn, deepens social inequality and creates a two-tier healthcare system, where the wealthier can buy faster access through private treatment. He emphasizes that the government fails to grasp the urgency of the funding crisis and demands immediate and concrete steps—such as establishing a healthcare insurance tax for children—to ensure the system's true solidarity and prevent it from speeding towards the abyss.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller closed the debate on the fifth agenda item, confirming that there were no further requests to speak and that the minister also did not wish to elaborate on the topic, thereby declaring the item concluded.