Estonia's National Audit Office: access to healthcare continues to worsen
The annual report of Estonia's National Audit Office finds that despite sharply higher health spending, access to specialists has not improved and the family doctor shortage is deepening.
Estonia's National Audit Office, the country's supreme audit institution, concluded in its annual report published on 5 November that access to specialist medical care has not improved despite a substantial rise in health spending. At the same time, the shortage of family doctors is becoming more acute.
More spending, fewer appointments
According to the office, health spending rose by about 61% between 2020 and 2025 and exceeded €3.3 billion last year. Yet in 2025 the number of outpatient specialist appointments was 8% lower than in 2019, even though spending by the Health Insurance Fund, the state health insurer, on specialist care grew by roughly 70% over the same period.
In March 2026, more than 10,500 bookings for a first specialist appointment involved a wait of over 60 days, and more than a third of those patients had to wait longer than 90 days. At some medical institutions, waits to see an ophthalmologist reached 126–208 days.
Family doctors and emergency care
The number of people without a permanent family doctor is growing. In 2022 about 72,500 people were on substitute doctors' lists; now the figure is almost 110,700. More than half of the family doctors who keep their own patient lists have reached the age of 60.
Emergency departments were visited more than 452,000 times in 2025, almost 5% more than in 2021. In 58% of cases the visit fell into the green, or lowest, urgency category. This does not mean the care was unjustified, but some of these problems could be handled outside emergency departments if alternatives were available. The Health Insurance Fund says the situation has improved this year.
Reform plans outstrip capacity
The audit office argues that reform plans exceed the system's ability to carry them out: too many changes are being drawn up and implemented at once, without enough staff, funding or IT capacity. State Controller Janar Holm said there is little benefit in announcing a new reform if there are no workers, money or means to assess whether people are better off. He said the Ministry of Social Affairs should decide which changes to pursue first and which to postpone.
The office also points to the lack of a long-term solution for health financing. In 2024, out-of-pocket payments by Estonian residents made up 21% of all health spending, compared with an EU average of 15% in 2023.
The ministry said it considers the criticism justified and is continuing its reforms. Its priorities include disease prevention, closer cooperation between medical and social services, developing family medicine and clarifying the division of duties among hospitals. Annika Lai, the ministry's vice-chancellor for health, said a bill on jointly organising medical and social services is before the Riigikogu, Estonia's parliament.
