NATIONAL SOCIAL REPORT 2014 Estonia
Table of contents Introduction... 3 A decisive impact on the eradication of poverty and social exclusion... 3 Recent reforms in social inclusion policies... 4 People with disabilities... 4 Families with children... 4 New Child Protection Act... 5 Changes in provision of labour market services... 5 Reducing gender segmentation in the labour market and facilitating women s labour market participation... 7 Recent reforms to achieve adequate and sustainable pension... 9 Accessible, high-quality and sustainable health care and long-term care...10 Health promotion and disease prevention...10 Larger reforms in the health care system...10 E-health developments...12
Introduction The present social report of Estonia has been drafted, considering the recommendations of the Social Protection Committee and the principles of open coordination method, as well as the common goals of the areas of social protection and inclusion, pensions, health care and long-term care. It aims to provide comprehensive information on the implementation of the general overarching and specific objectives of social protection and social inclusion and gives an overview of the reforms enacted during years 2013-2014. National Reform Programme Estonia 2020 sets two primary and central challenges for Estonia s growth to achieve rapid growth in productivity and to return to the high employment level of the pre-crisis period. Estonia has set objectives to increase the labour market participation rate and employment rate and to reduce the long-term unemployment rate, youth unemployment rate and at-risk-of-poverty rate. According to the recent statistics, Estonia has made progress towards most of the objectives. A decisive impact on the eradication of poverty and social exclusion Reducing the share of those living in relative poverty after social transfers is one of the main objectives of Estonian Government. The main measures to archive this target remain the same, being related mostly to employment and education - Supporting the low-skilled unemployed in beginning vocational education studies, developing career and job placement services, improving the employment and working of people with disabilities or incapacities, developing social services in order to improve access to labour market services and recruitment etc. The progress in reducing poverty after social transfer has remained stable during last years - the relative poverty rate stayed at the same level (17.5%) and the at risk-of poverty rate decreased for families with children and increased somewhat for old-age pensioners. The stabilization is due to an increase in the at-risk-of poverty threshold which was the result of a continued increase in employment rate and income level. The future ambition is to reduce the at-risk-of-poverty rate after social transfers to 16.5% by 2015 and to 15% by 2020. In addition to the policy measures listed in National Reform Program, Estonia is offering from the 1st of July 2013 additional needs based support for families living below poverty line. The amount of support is progressively increasing depending on the number of children. Also the regular child allowances has been increased to all families with three or more children, birth support has increased in case of multiple birth starting from triples. The impact of these newly introduced measures could be estimated in the coming years. The enacted incapacity for work scheme reform will also contribute to reducing poverty as the allocation of corresponding benefit will be more needs-based and less depending on the amount of overall pension rights.
Recent reforms in social inclusion policies People with disabilities One of the major reforms in this field is definitely a finalizing of legal framework in order to introduce a new work ability allowance instead of current incapacity for work pension system, which was criticised for being a passive pension scheme, that does not meet people s needs in terms of rehabilitation services provision and social inclusion. The work ability allowance act was signed into law. Families with children A new conception i.e. the green book of family allowances and services was developed to ensure better financial coping for families, to decrease of the risk of poverty and to increase employment, as well as development of allowances and services for families. It was approved by the government in the 4th quarter of 2014. The purpose of the green book is to work out measures that reduce the poverty of children and families, support the compatibility of work and family life and promote an increased birth rate. For this, policy recommendations are made in the green book for the further development of the system of allowances, services and parental leaves intended for families. Three analyses were ordered for compiling the green book; during the last year, the Analysis of the Estonian Parental Leave System (2013) was completed along with the Possibilities for Increasing the Birth Rate and Influencing the Birth Rate: A Short Analysis (2014); and Analysis on the Impact of Pre- School Education and Child Care on the Allowances Intended for Families completed in the autumn. A seminar and roundtable of experts and interest groups in the field were carried out in the 1st quarter of 2014 for the purpose of compiling the green book. In the context of the green book the influence of the current state allowances and other allowances facilitating the coping of families on poverty and employment was determined, and the possible influence of various scenarios of amounts and payment terms of allowances on the poverty of children and families with children and on employment were simulated. Also, the models of child care currently used by local governments (including financing, cooperation between local governments, etc.) was mapped out, the influence of the current child care system on poverty and employment has been analysed and possible solutions for child care system were offered to ensure a flexible and available child care service for families with children (including the day care service for children of 1.5 to 3 years of age). The aim of the green book is to reach the solutions, by which support to families is preferably based on a reasonably balanced system of service offer, provision of universal services and financial support, with the goal to provide more support to those who actually do need more help and who have more children, while avoiding adverse impact on the coping of other families and other undesirable side effects. Besides that, in order to offer better protection to families with children both needs-based family support and universal child allowances has been significantly raised (+50%) starting from the 1st of July 2013. The next increase (+50%) will take effect on the 1st of January 2015. Parental benefits regulation has also been reviewed in order to avoid possible distortionary labour market effects. From 2014 onwards a working parent, who receives
parental benefit and who s earnings exceed the parental benefit rate, has a right to at least a half of the benefit granted. The introduced change is supposed to smoothen a parent s return to active work life. New Child Protection Act The draft of the Child Protection Act was approved at the meeting of the Government of the Republic on 29 May 2014 and sent to the Riigikogu for passage. The draft has passed the first reading in the Riigikogu and has been continued to the second reading, which will occur during the autumn session. The Child Protection Act establishes the principles for ensuring the protection of children s rights and wellbeing and describes the clear obligations, responsibilities and supervision related to the implementation of these principles. The law will also establish a central national implementation unit for child protection, with the task of coordinating the cooperation between the state and the local governments to ensure child wellbeing, and also cooperation related to child protection in various fields of activity. Another important objective is to create state support for the local governments in order to improve the quality of child protection work at the local level. The activities carried out under the law ensure a more productive and cost-effective organization of child protection, develop prevention and the early intervention to prevent problems with children and support families. In the long term, the implementation of measures included in the draft law will reduce the costs related to dealing with the problems. The deadline for the enactment of the law is 1 January 2016. The implementation of the Child Protection Act will not result in any direct revenues. Nevertheless, considering the practices of other countries, one can assume that upon the implementation of the Child Protection Act, i.e. as the result of greater preventive activities and more timely intervention, it will be possible to reduce the costs related to child protection about ten-fold. At the same time, timely intervention to this extent will have a longer term effect. Considering the costs planned for the implementation of the Child Protection Act, it can be assumed that, as a result, the costs for dealing with the consequences will decrease about 5% between 2015 and 2020. This means that in summary the state s budgetary cost savings (revenue) is estimated to be close to 400,000. Changes in provision of labour market services The provision of labour market services and payment of labour market grants, similar to the 2012-2013 Employment Programme, will be continued in 2014 and 2015. Compared to the 2012-2013 Employment Programme, the following changes have been made: 1) the range of people who have the right to continue to participate in labour market services after being removed from the unemployment rolls has been expanded. The right to participate in labour marketing training, job seeking consultations, consultations for eliminating obstacles to employment and for obtaining qualifications will continue for the people whose have been removed from the unemployment rolls due their becoming of age to receive their old-age pension or if they have been assigned an old-age pension prematurely;
2) the range of people will be expanded whose training costs will be compensated the employer will be expanded and the rate of compensation will be increased. Based on the previous employment programme, the employer was compensated for 25% of the training costs, if the employer organised training for an employee who could not perform his or her current work assignment due to health issues. According to the new employment programme, the employer will be compensated for 50% of the cost of the training, but not more than 1,250. The programme calls for the possibility of compensation of 50% of training costs to the employer if the employer has organised training for an employee who was unemployed for a long time (registered as unemployed for at least 12 months) before starting to work; 3) the provision of labour market training will be continued based on a training card for up to 2,500, but for one unemployed person training based on a training card to the extent of 2,500 will be provided over two years; 4) The compensation rate for the adaptation of workspace and tools by the employer will be increased from 50% to 75%. The employers who have adapted workspace and tools for employees with disabilities or long-term health problems will receive up to 75% of the cost of the adaptation; 5) the range of people will be expanded that will receive compensation of up to 75% for the adaptation of workspace and tools. In addition to employers, sole proprietors (hereinafter FIE) who have a disability or long-term health problem will receive compensation for up to 75% of the incurred adaptation costs; 6) the range of people will be expanded for whom longer (up to 6 months) work exercises will be organised. In addition to the long-term unemployed and those with special social needs, based on the new employment programme, the exercises can also be organised for unemployed people with disabilities or long-term health problems; 7) The volume of service involving working with a support person will be increased. Under the current Labour Market Services and Benefits Act (TTTS), this service can be provided for up to 700 hours, based on the employment programme for up to 1,000 hours. The division of hours during the working time is flexible compared to the provisions of the TTTS); 8) the opportunities for the continuation of enterprise grants will be expanded. The cost of an individual mentor will also be compensated for an entrepreneur who has received a grant from the unemployment insurance fund to start a business. 9) the range of services will be expanded in connection with which the unemployment insurance fund has the right to use the help of an expert. As well as in connection with people suffering from disabilities or long-term health problems, expert help can also be used in the provision of labour market services for long-term unemployed people with special social needs, addiction problems and other obstacles that need help in finding jobs. Link to the referenced new Employment Programme: https://www.riigiteataja.ee/akt/128042014003 An important development is the opportunity that was introduced into the Labour Market Services and Benefits Act in 2014 to register home caregivers who have received caregiver fees. They are registered as unemployed as a disabled person s caregiver, who wishes to
find work. Pursuant to the law, the caregivers who receive support from rural municipality and city governments are equal to other persons who take care of disabled people, the elderly or sick and who are registered as unemployed based on the TTTS. Reducing gender segmentation in the labour market and facilitating women s labour market participation During the period 2013-2014, following activities have been or are implemented in order to promote gender equality in the labour market, including to decrease gender segregation of the labour market and to facilitate women`s labour market participation. From January 2013, a remuneration on the basis of fathers` average wage was reinstated for a 10-working-days paternity leave which can be taken during mothers pregnancy and maternity leave or within 2 months after the birth of the child. The aim of this measure is to encourage fathers to stay at home after birth to bond with the child from the very start. In 2013, in the framework of Estonian ESF programme Promoting Gender Equality 2011-2013, the Ministry of Social Affairs carried out an awareness raising campaign with an aim to tackle gender stereotypes and to demonstrate their negative influence on work and career choices and people`s lives. The main activities of the campaign were career days for boys and girls, a widely noticed series of video clips and several PR-initiatives. In the framework of career days pupils from 10th and 11th grades (upper secondary school level) were introduced the topic of gender stereotypes and to professions traditionally considered as (more) suitable for the other sex. They were able to try out practical tasks related to these professions and met people who had already made untraditional career choices. The career days` events were mainly carried out in different establishments of vocational or higher education. Traditionally female professions, e.g. nurse, tailor, teacher were introduced to boys and traditionally male professions, e.g. ground engineer, soldier, miner, but also programming (IT), to girls. The feedback from participating young people was positive and although not many were considering afterwards choosing exactly the professions they have been introduced, most of them said that they see their career choices more widely now. In October 2013, the Government of the Republic established Gender Equality Council, set forth in the Gender Equality Act and functioning as an advisory body to the Government. Its main responsibilities are advising the Government in matters related to strategies for the promotion of gender equality, approving general objectives of gender equality policy and presenting opinions to the Government concerning the compliance of national programmes with gender mainstreaming obligation. In spring 2014, three analytical studies financed through the before mentioned ESF programme were published: a study on possibilities for greater flexibility in measures aimed at supporting reconciling work and family life, a study on work and family life of non-ethnic- Estonian population and a study on gender-based and sexual harassment at work. In April 2014, on Equal Pay Day, as an awareness raising tool, discussions concerning gender pay gap were organised in all 15 counties. These events were also financed from the ESF programme.
Gender pay gap is also the main subject of one of the projects implemented in 2013-2015 by the Statistics Estonia financed by the Norway Grants 2009-2014 under the programme Mainstreaming Gender Equality and Promoting Work-Life Balance and aimed at increasing the availability of more up-to-date and detailed gender pay gap statistics in Estonia. Another pre-defined project financed under the same programme is implemented by the Gender Equality and Equal Treatment Commissioner and is more widely aimed at promoting gender equality through empowerment, awareness raising and gender mainstreaming. Also, four large-scale gender equality projects are financed from the Norway Grants programme through an open call scheme. Two of the chosen projects aim to integrate gender equality issues into higher education curricula. Two other projects aim to improve possibilities for reconciling work and family life. One of these projects, implemented by the Responsible Business Forum, aims at improving the situation of work-life balance among the employees of Estonian enterprises. To that end a series of activities are planned, including a training programme for mentors for employers; a development programme for employers, a study visit to Norway and one-on-one meetings with mentors; awareness raising events for wider audience of employers and employees; a survey and a media campaign for employers and employees and a seminar for journalists. The second project is aiming at creating a mechanism design for providing efficiency and equity in matching kindergartens and children. This project is implemented by the Tallinn University of Technology. Additional small-scale projects will be financed from the same programme though a small grant scheme.
Recent reforms to achieve adequate and sustainable pension There were no recent reforms made into pension system in 2013-2014 (except finalizing legal frame work for introduction of work ability allowance that would replace incapacity for work system, mentioned earlier in this document). However an analysis of adequacy and sustainability of Estonian pension system has been finalised and presented to the government. Public discussions of the issues raised in this document are planned for 2015.
Accessible, high-quality and sustainable health care and long-term care Health promotion and disease prevention During the last year Estonian government has adopted several strategies to set new perspectives for the health promotion and disease prevention in priority areas the green papers for alcohol and tobacco prevention and the white paper for drug prevention. The green paper on alcohol Estonia s new alcohol strategy builds on international strategies and scientific evidence, foreseeing activities in all 10 areas of WHO s strategy to reduce harmful use of alcohol. The priority is given to the taxation, advertising, availability to minors and health sector s response. The programme to develop the prevention and treatment system of alcohol abuse and dependence has been adopted for 2014-2020, funding for this period has been confirmed. The green paper on tobacco is in line with EU tobacco directive and is aiming to reduce the prevalence of smoking. The white paper on drug prevention is the basis for activities concerning prevention of drug abuse, demand reduction, supply reduction and treatment of drug users. The white paper on drug prevention combines different policy recommendations that should be taken into consideration when putting together action plans for major national strategies (e. g. National Health Plan 2009-2020, Strategy of Children and Families 2012-2020, Criminal Policy Development Trends until 2018 etc.). The programme to improve the quality and availability of the mental health services for children has been launched. Four regional service centres and new health care services are established, innovative web- and phone-based prevention activities are funded. Larger reforms in the health care system In order to strengthen primary health care, the addition of another family nurse to the family doctor s team was implemented, motivated separately monetarily. New requirements were established for nursing hospitals, the requirements for the personnel and furnishing were toughened to ensure quality. An organisation reform of the emergency medical services were carried out the number of regions was reduced thereby bringing them into greater conformity with those that apply in the rescue field, and thereby the number of small service providers was reduced for the optimal utilisation of resources and to improve the capability for operational reacting. The cross-border healthcare directive was implemented in Estonian and domestically (the previous borders between the 4 regions of the health insurance fund were eliminated to ensure the free movement of patients).
More information about the volume of services and also reimbursed medicines Specialised medical care: in 2013, specialised medical care received financing totalling 481.6 million, which is 31.1 million more than in 2012. Compared to 2012, the volume of specialist medical care services increased in 2013 by 0.6% (number of performed medical cases) (out-patient 0.6%, day care 3.9% and in-patient 0.1%). General medical care: in 2013, general medical care received financing totalling 76.1 million; compared to 2012, the budgetary increase was 5.9 million, which resulted primarily from the increase in proportion for the research fund and capitation fee, and the implementation of the additional fee for a second family nurse. In 2013, the number of general medical care visits (family doctor, family nurse and preventive visits) has decreased by 1.1% compared to 2012 (5,442,755 visits in 2012 and 5,385,611 visits in 2013). Nursing and long-term care: The regulation of the Ministry of Social Affairs no. 3 approved on 13 January 2014 called The list of nursing care services to be provided independently by nursing hospitals and the services included therein, and the requirements necessary for the independent provision of nursing care for the personnel, space, furnishing, equipment and tools. In 2013, the number of in-patient cased for long-term care was 18,647 and out-patient care cases was 35,540 (incl. home nursing care 29,542, home care for cancer patients 4,559 and geriatric evaluation 1,439) and increased by 9.8% and 9.5% respectively compared to 2012 (incl. home nursing 10.4%, home care for cancer patients 6.8% and geriatric evaluation 0.8%). The number of dental care cases in 2013 was 394,653 incl. children s dental care cases totalling 309,240 (change compared to 2012: 2.4% and 2.6%). Medicines reimbursed to the insured: Various discount rates are valid for various illnesses and medicines that are established by regulations by the Government of the Republic and Minister of Social Affairs, which in turn are based on the Health Insurance Act. In 2013, a total of 103.4 million in discounted medicines was reimbursed to the insured. The financing of reimbursed medicines increased by 4% compared to 2012. The growth is caused by the increase in the number of discounted prescriptions as well as the average reimbursed amount per each discounted prescription. The number of discounted prescriptions has increased by 3%; this reflects an increase in the use of medicines, which is expressed most in the discounted medicines that are reimbursed 50% or the expensive medicines that are reimbursed 100%. The insured s contribution to the purchase of prescription medicines has decreased during the year from 33% to 32.1%. The decrease is caused primarily by the elimination of the limits on the reimbursement of 50% discounted medicines. As a result, the patients contribution decreased by 1.5 million during the year.
The Health Insurance Fund financed medicines totalling 159.8 million from the healthcare services budget for out-patient medicine reimbursement and supplementary medicine reimbursement, which comprised 19% of the entire health insurance budget and is 5% more than in 2012. E-health developments Since the end of 2013 the Health Information System s scope - a database belonging to the Estonian State Information Systems, where the data related to health care are processed for entry into and performance of contracts for the provision of health services, for guaranteeing the quality of health services and the rights of patients and for the protection of public health, including for maintaining registers concerning the state of health, for the organisation of health statistics and for the management of health care - has been considerably expanded. Some new healthcare digital documents has been developed and implemented in 2014: Ambulance card Dental Care Map Declaration of Health, which gives the possibility to the persons making the health certificate request, also to fulfil the health declaration in patient portal electronically and monitor all the digitally composed certificates. Health e-certificate, mainly requested by persons wishing to obtain or renew their driving licence, is composed and signed digitally in ehealth central database and forwarded automatically to the final addressee (information system). Since 2014 it is also possible to digitally manage, process and archive all the medical images, made by any of operating healthcare providers. Digital images are stored in the central Images Bank, which belongs to Estonian Health Foundation.