Position papers CASI Maha MUN - United Nations General

Country - Republic of Estonia Assembly

th
Committee - United Nations General Assembly 28 February 2020

Topic – Universal Healthcare and Technology in Health care

industry

Definition of Universal Health Coverage1

Universal health coverage (UHC) means that all people and communities
can use the promotive, preventive, curative, rehabilitative and palliative
health services they need, of sufficient quality to be effective, while also
ensuring that the use of these services does not expose the user to financial
hardship.

This definition of UHC embodies three related objectives:

1. Equity in access to health services - everyone who needs services should get them,
not only those who can pay for them;
2. The quality of health services should be good enough to improve the health of those
receiving services; and
3. People should be protected against financial-risk, ensuring that the cost of using
services does not put people at risk of financial harm.
UHC is firmly based on the WHO constitution of 1948 declaring health a fundamental
human right and on the Health for All agenda set by the Alma Ata declaration in 1978. UHC
cuts across all of the health-related Sustainable Development Goals (SDGs) and brings hope
of better health and protection for the world’s poorest.
On 23rd September 2019, world leaders adopted a high-level United Nations Political
Declaration 2on universal health coverage (UHC), the most comprehensive set of health
commitments ever adopted at this level.
The World Health Organization (WHO) and partners flagged the need to double health
coverage between now and 2030 or leave up to 5 billion people unable to access health care.
These include mechanisms to ensure no one suffers financial hardship because they
have had to pay for healthcare out of their own pockets and implementing high-impact health
interventions to combat diseases and protect women’s and children’s health.

1
(World Health Organisation n.d.)
2
(World Health Organisation 2019)

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Position papers CASI Maha MUN - United Nations General
Country - Republic of Estonia Assembly
th
Committee - United Nations General Assembly 28 February 2020

In addition, countries must strengthen health workforce and infrastructure and reinforce
governance capacity. They will report back on their progress to the U.N. General Assembly in
2023.
Since regaining independence from the Soviet Union in 1991, Estonia has achieved
near universal health coverage3, with about 95 percent of its population covered by its Social
Health Insurance (SHI), which is backed by the Estonian Health Insurance Fund (EHIF).
All Estonians are obliged to enroll in the Social Health Insurance (SHI) and their
contributions are linked to their wages. The health contributions of non-contributors—such as
children and pensioners—are subsidized by wage earners in the workforce. A sophisticated
payment mechanism covers expenses for specialist care and pharmaceutical drugs. All
Estonians are entitled to the same benefit package.
Estonia has reduced the number of hospitals from 120 to 19. Primary care reforms were
initiated as early as 1991. To increase the number of family physicians, family medicine was
introduced as a medical specialty in the early 1990. Today, it is mandatory for all Estonians to
register with a family physician. The 2001 Health Services Organisation Act specified that
healthcare providers in Estonia would operate as private entities under private law. The aim of
this policy was to decentralise hospital management but still preserve public influence through
hospital supervisory boards. Therefore the majority of hospitals could be considered as public
institutions. Primary care is mostly provided by family doctors (self-employed entrepreneurs).
In addition to these reforms, the pharmaceutical sector has been modernized with the
development of the essential drugs list (1992) and regularly updated guidelines for medicine
usage and reimbursement.
When it comes to technology, Estonia’s healthcare system has been revolutionized by
innovative e-solutions. Patients and doctors, not to mention hospitals and the government,
benefit from the convenient access and savings that e-services have delivered.
Each person in Estonia that has visited a doctor has an online e-Health record that can
be tracked. Identified by the electronic ID-card, the health information is kept completely
secure and at the same time accessible to authorised individuals. E-prescription also enables
prescriptions to be handled electronically.
The backbone of e-Estonia is the X-Road. It’s the invisible yet crucial environment that
allows the nation’s various e-services databases, both in the public and private sector to link
up and operate in harmony. KSI Block chain technology is being used for the system to ensure
data integrity and mitigate internal threats to the data. 4
The Estonian National Health Information System that is in operation since 2008 is part
of the X-road. Healthcare providers are connected to the health information system and
patient’s health data is stored centrally. There are more than 20 million different health

3
(World Bank 2015)
4
(Republic of Estonia - Ministry of Social Affairs 2017)

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Position papers CASI Maha MUN - United Nations General
Country - Republic of Estonia Assembly
th
Committee - United Nations General Assembly 28 February 2020

documents (case summaries, referrals, vaccinations, dental information, medical images etc.)
and over 300 million events stored in the health information system.
“Data belongs to the data subject” is the fundamental principle of the Estonian e-
governance. By law, citizens are provided with transparency tools showing how their personal
information is being used by the Estonian government. Citizens can also revoke access to their
health records to third parties if they wish to do so. Health data and health care e-services are
accessible to patients through the patient portal www.digilugu.ee.
Estonia’s database (including the health care records) is also stored in a “Data
Embassy”. 5Data Embassy is an extension in the cloud of the Estonian government, which
means the state owns server resources outside its territorial boundaries. This is an innovative
concept for handling state information, since states usually store their information within their
physical boundaries. Data Embassy resources are under Estonian state control, secured against
cyberattacks or crisis situations with KSI blockchain technology, and are capable not only
providing data backups, but also operating the most critical services.
Estonia’s Data Embassy is located in Luxembourg under a Tier 4 level of security – the
highest level for data facilities. It is not an embassy in the traditional diplomatic sense and
while the founding agreement does take into account the Vienna Convention on Diplomatic
Relations, it is something completely new under international law. It is fully under the control
of Estonia, but has the same rights as physical embassies such as immunity.
Estonia would like the Committee and the Chair members to encourage the use of
blockchain technology and Data Embassies for countries for better management and security
of database of citizens, (including health care records) of its member states. Countries such as
Bahrain have overhauled their healthcare and medical records using Estonia as an example6.
In today’s age of technology, one cannot lag behind. Estonia believes that while new
innovations in medicine and health care are important, it is equally important to have proper
administration so that health care reaches everyone effectively.

5
(E-Estonia n.d.)
6
(World Bank 2015)

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Position papers CASI Maha MUN - United Nations General
Country - Republic of Estonia Assembly
th
Committee - United Nations General Assembly 28 February 2020

References
World Health Organisation. n.d. Health Financing - What is health financing for universal
coverage? Accessed February 23, 2020.
https://www.who.int/health_financing/universal_coverage_definition/en/.
—. 2019. WHO welcomes landmark UN declaration on universal health coverage. 23
September. Accessed February 23, 2020. https://www.who.int/news-room/detail/23-
09-2019-who-welcomes-landmark-un-declaration-on-universal-health-coverage.
World Bank. 2015. Feature story - Lessons from Estonia: How Bahrain is improving its
healthcare. 2 February. Accessed February 25, 2020.
https://www.worldbank.org/en/news/feature/2015/02/02/lessons-from-estonia-how-
bahrain-is-looking-to-improve-its-healthcare
Republic of Estonia - Ministry of Social Affairs. 2017. Fact Sheet - E-health in Estonia.
Factsheet, Republic of Estonia - Ministry of Social Affairs, 2.
https://www.eiseverywhere.com/file_uploads/c5da2a5e465f932e6debe55020e70899_
E-health-factsheet.pdf.
E-Estonia. n.d. data embassy. Accessed February 25, 2020. https://e-estonia.com/solutions/e-
governance/data-embassy/.

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