Using digital solutions to protect people from user charges for health care: lessons from Estonia

Overview

The Estonian health system aims to protect people from user charges (‎co-payments)‎ for outpatient prescribed medicines by reducing them for people who spend more than a certain amount a year. Historically, only a few people benefited from this protection mechanism because the eligibility threshold was high and the process was administratively cumbersome – people had to keep track of co-payments and apply retrospectively for reimbursement. In 2018 the eligibility threshold was lowered and the protection mechanism was digitalized using an e-prescription system that tracks people’s co-payments and automatically reduces them once they reach the threshold. This brief summarizes the impact of the policy change and draws lessons for Estonia and for other countries concerned about the negative effects of user charges on affordable access to health care.