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Maris Jesse, National Public Health Institute, Estonia


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Maris Jesse, National Public Health Institute, Estonia

  1. 1. Estonian experience in NCD controlMaris JesseJune 13, 2013
  2. 2. Population 1,3 mln (2012)Independent 1918-1940,re-gained independence 1991Member of EU from 2004Transparency International ranking32GDP per capita 13 136 € (2012)Health Expenditure (2011)• 5,9 % of GDP• Per person € 704,9• Public expenditure 79.3 %•Social health insurance 68.6%
  3. 3. Source: Statistics Estonia, 2013; calculation by T.LaiCardiovascularInjuriesNeoplasmsRespiratoryPerinatalCongenitalOtherPsychiatric-0.5 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0Gain in life-excpectancy 1994 vs 2011
  4. 4. Laying the foundations: (near) UHC• Move from state budget funded health care to social healthinsurance in 1992• Coverage 94-96%, incl all children, pregnant women, old-age anddisability pension recievers etc• Incentivised provider performancethrough new provider-payer relations- contracts and new payment methods• Challenge of overcoming undertreatmentand catching up with gapin use of technologySource: Kiivet, 1998
  5. 5. Laying foundations: Strengthening primary careFrom hospital-centered health care provision to one based on PHC1993 – family medicine established as a specialityresidency programmere-training programme for family medicine1998 – 2002 gradual implementation of new organisational andfunding model in support of strengthening PHCTreatment guidelines to support cooperation of primary and specialistlevel : - e.g. guidelines for hypertension in 1999, revision in 2012- targets and indicators in PHC quality bonus system based onguideline recommendation- patient materialsRole of FD and nurse in health promotion and prevention:Training in motivational interviewing (MI) and support materialsFrom 2013 second nurse focusing more on promotion-prevention
  6. 6. Health promotion1995 – first programs, advocated by the World Bank and financed bythe health insurance1995 – community level network of health promotion specialists2005–2011 national strategy on cardio-vascular disease preventiontobacconutritionstrengthening community networks2007 – Strategy on cancer preventiontobaccoalcohol2009 – 2013 support from EU Structural Funds to strengthen NCDprevention and community health promotion, incl work oninequities
  7. 7. Source: Adult population health behaviour survey, HBSC- NIHD; alcohol-Institute of Economic Research
  8. 8. Enhancing balanced nutrition: examples• Support for balanced nutrition- kindergartens 3 meals per day, co-payment by parents- free school lunches until 10th grade (16 year-olds)- regulated nutritional content- skills training, sample menus- professional reputation –- competition among school chefs• Internet based aid for planningmenus – from use by schools andkindergartens to use byindividuals• National nutrition guidelines• Renewal jointly withScandinavian renewal process
  9. 9. InformationAdvice , incl online Q&APromotion of healthy dietSocial marketing campaignsSalt calculator:
  10. 10. Male cardio-vascular diseasemortalityby age-group,comparision to1989 (1-point line)Female cardio-vascular diseasemortalityby age-group,comparision to 1989(1-point line)Source: Causes of death registry, NIHD
  11. 11. Lessons and challenges• Importance of foundations – health system• Alignment of understanding, objectives, priorities and activities• Within health system – public health and health care• Across sectors• Across levels• Bilateral and regional cooperation• Global response to a global challenge