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Public Sector Spending Efficiency in Estonia: Healthcare and Local Government

  • Zuzana Smidova
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    The Estonian fiscal position is much better than in many OECD countries, the country stands out for having a rather lean government sector and the authorities are striving for efficient use of existing resources. Both healthcare and local government were particularly hit the by the decrease of resources as a result of the unprecedented GDP fall during the downturn. As a return to high revenue buoyancy will not be immediate, there are challenges for delivering the same with less money but it is also an opportunity to reconsider provision of public services. The healthcare sector is state dominated and offers some scope for efficiency improvements. On the supply side, further streamlining of the existing hospital network, emphasising primary care, and keeping an eye on the standard of quality of care, would be helpful. A number of market signals are already in place on the demand side, such as fees and drug co-payments. Yet these raise issues of accessibility of healthcare, in particular for financially distressed households. A cap on out-of-pocket spending together with active promotion of least expensive drugs use would help to address this issue. Local government seems rather extensive and fragmented for such a small country. Exploiting economies of scale, either by merging or requiring deeper co-operation, should bring gains in terms of public service efficiency. Offering greater scope for tax raising at the local level can incentivise the municipalities to adopt more growth-oriented economic policies. This working Paper relates to the 2010 Economic Survey of Estonia (www.oecd.org/eco/surveys/estonia). Efficience des dépenses du secteur public en Estonie : soins de santé et collectivités locales La situation budgétaire de l’Estonie est bien meilleure que celle de nombreux pays de l'OCDE ; ce pays se distingue en effet par un secteur public relativement resserré et les autorités s’y efforcent de faire un usage efficient des ressources existantes. Les soins de santé et les collectivités locales ont été particulièrement frappés par la diminution des ressources, qui s’explique par la chute sans précédent du PIB enregistrée pendant la récession. Alors que le retour à des recettes abondantes ne devrait pas être immédiat, la difficulté va consister à offrir les mêmes prestations avec moins d’argent, mais ce sera peut-être aussi l’occasion de reconsidérer la fourniture des services publics. Le secteur des soins de santé est dominé par l’État et comporte une marge d’amélioration de l’efficience. Du côté de l’offre, il serait utile de poursuivre la rationalisation du réseau hospitalier existant et de mettre l’accent sur les soins primaires, tout en veillant à préserver la norme de qualité des soins. Du côté de la demande, un certain nombre de signaux de marchés sont déjà en place, par exemple les honoraires ou les franchises sur les médicaments. Ceci soulève toutefois des questions en termes d’accessibilité des soins de santé, en particulier pour les ménages en proie à des difficultés financières. Plafonner les dépenses restant à la charge des patients et promouvoir activement les médicaments les moins chers permettrait de s’attaquer à ce problème. Les collectivités locales paraissent relativement nombreuses et dispersées pour un si petit pays. Exploiter des économies d’échelle, soit en procédant à des regroupements, soit en imposant une plus grande coopération entre les différentes collectivités, permettrait de réaliser des gains sur le plan de l’efficience du service public. Donner aux municipalités plus de latitude pour lever des impôts au niveau local les inciterait sans doute à adopter des stratégies économiques plus délibérément axées sur la croissance. Ce Document de travail se rapporte à l'Étude économique de l'OCDE de l’Estonie 2011 (www.oecd.org/eco/etudes/estonie).

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    Paper provided by OECD Publishing in its series OECD Economics Department Working Papers with number 881.

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    Date of creation: 19 Jul 2011
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    Handle: RePEc:oec:ecoaaa:881-en
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