The role of digital claims management for Estonia’s health insurance: a leverage for making healthcare purchasing more strategic

Overview

This study explores how the claims management process of the Estonian Health Insurance Fund has been digitalized over time and illuminates how this has enabled the introduction of other advanced purchasing instruments, such as contract setting and contract execution monitoring. Moreover, the study assesses the benefits of digital claims management in relation to desirable health financing attributes and the intermediate and final objectives of universal health coverage. Finally, the study outlines the lessons learned and provides policy considerations for other countries.