Possibilities for Sustainable Financing of the Estonian Social Insurance System Priit Kruus Presentation at EHMA Annual Conference Bern,15.06.2012
Conducted by: Praxis Centre for Policy Studies Project partner: Tallinn University Commissioned by: Ministry of Finance of Estonia + Ministry of Social Affairs of Estonia Estonian Health Insurance Fund Estonian Unemployment Insurance Fund Estonian Insurance Association Bank of Estonia Estonian Trade Union Confederation Estonian Employers Confederation 2
Authors: Ain Aaviksoo (Praxis) Priit Kruus (Praxis) Lauri Leppik (Tallinn University) Riina Sikkut (Praxis) Vootele Veldre (Praxis) Andres Võrk (Praxis) Guest researchers: Hans Maarse (Maastricht University), Ralf-Martin Soe (Maastricht University), Harles Luts (Tartu University), Mikk Medijainen (Tartu University) 3
Presentation contents Context Method Results Policy impact and discussion 4
Health care accounts for more than 28% of social expenditure Unemployment 6.4% Familiy and children 11.9% 0,0% Other 1.4% 0,0% Health care 28.4% Old-age 41.9% Incapacity and disability 9.9% Source: Statistics Estonia, Eurostat Structure of social expenditure 2009 Social security expenditure 2007 2008 2009 % GDP 12,0 14,7 19,0 % of public sector 40,3 42,4 47,1
Health and other social insurance expenditures depend heavily on labour taxes Unemployment Labour taxes Old age Consumption taxes Incapacity and disability Taxes on capital Health insurance Source: Tax Board, Statistics Estonia, authors calculations
Context Dependency on demographics as a risk for sustainability. Expenditures increasing Income decreasing Comprehensive study commissioned with the aim to assess the long-term financial and social sustainability of the system and analyse possible policy choices. 7
Method 1. Assessment of sustainability of the current system (scenarios under assumptions) 2. Analysis of possible policy choices for a list of impact criteria with different quantitative and qualitative methods. Criteria: financial sustainability social sustainability impact on solidarity impact on economy impact on behaviour impact on adjustability to external risks technical feasibility 8
IMPACT Method Extent of policy change Base scenario Areas (paragraphs) Pension insurance Parametric change Unemployment insurance Structural change Health insurance Private insurance Incapacity and disability Current problems, stakeholder imput (15 meetings), international experience
2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060 % of GDP Revenues, spendings and their difference in Estonian health insurance during 2011 2060, % of GDP 6% 5% 4% 3% 2% Spendings Revenues Difference 1% 0% -1% -2%
% of GDP 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060 1,0% Difference between revenues and spendings of health insurance at different presumptions on nominal wage developments, % of GDP 0,5% 0,0% -0,5% Growth rate of nominal wages -0,5% Base scenario -1,0% -1,5% Growth rate of nominal wages +0,5% -2,0% -2,5%
Results: impact analysis for 55 policy choices, 18 in health insurance Pension insurance Health insurance Unemployment insurance Incapacity and disability schemes Parametric change Structural change Private insurance
Results of health insurance aggregated into 4 broad alternatives: 1. increasing income by raising taxes or broadening the tax base E.g increasing labour taxes; taxing other income for health care revenue 2. decreasing costs by making the health system more efficient E.g rising the role of primary care, improving timeliness of care by providing insurance for the currently uninsured 3. decreasing costs by increasing individual responsibility with implementing private health insurance or medical savings accounts E.g substitutive, complementary, supplementary insurance; hypothetical MSA system 4. strengthening other social insurance schemes E.g incapacity and disability, unemployment or pension scheme incentives 13
Currently incapacity and disability scheme scattered 14
Expected reform 15
Policy impact of the project Creating a national incapacity and disability insurance by incorporating the current incapacity and disability schemes sickness benfits + disability pension + rehabilitation + insurance of occupational accidents if social tax level left the same an extra 11% of funds available for health expenditure Discussions about broadening the tax base of health insurance Private insurance and MSAs currently off the general discussion Other (pensions, unemployment) 16
Discussion Broader picture of social insurance system needed a toolbox of different possibilities. Final assessment strongly dependent on value judgments, on attitudes towards solidarity and individual responsibility. Mutual impact of various schemes of social insurance is important. Social insurance (incl health insurance) system needs to adjust with population trends. 17