Estonia: Service Availability & Readiness

Estonia’s independence from the Soviet Union in 1991 sparked a series of reforms that strengthened primary health care through provider training.1 2 Estonia accomplished this by establishing family medicine as a specialization for both doctors and nurses. This change to curricula was coupled with robust training and guidelines on management of chronic illnesses for primary care providers and strong gatekeeping mechanisms that financially incentivized patients to visit a primary care provider before seeking specialist care. These interventions were designed to improve the comprehensiveness and coordination of care by increasing the competency of providers to manage complex cases and also establishing clear structures for referral when necessary. In fact, following these interventions, it was found that patients who attended a PHC visit in the previous year had fewer inpatient admissions.2 All of these reforms were supported by strong support, collaboration, and commitment from the Ministry of Social Affairs and the Estonian Health Insurance Fund. Additionally, Estonia has empaneled a significant amount of its population, and this has given patients a clear point of entry into the health system and a point of contact to coordinate care. A more detailed case study on Estonia’s revitalization of their primary health care system can be found here.


  1. Primary Health Care Performance Initiative. Estonia: Establishing family medicine as a specialty to strengthen primary health care. 2015 Sep;
  2. Atun R, Gurol-Urganci I, Hone T, Pell L, Stokes J, Habicht T, et al. Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data. J Glob Health. 2016 Dec;6(2):020701.