by Ransho Ueno, Fall 2022
Estonia has the most advanced e-health system in the world. Bertelsmann Stiftung published the data about the Digital Health Index, and Estonia had the highest of 81.92, followed by Canada’s 74.73 and Denmark’s 72.47. Digital Health Index measures how prepared the government is to use technology in the healthcare field. The question here is, how did this small country in the Baltic Sea achieve this score? The author went to the e-Estonia briefing Center in Talin to unlock the myth and found multiple reasons behind it – strong political initiative, data infrastructure, and cultural and contextual reasons.
Before diving into the reasons, let’s see what Estonia’s e-health looks like. One example is the Patient Portal System, which started in 2009. In this portal, citizens can view their data from various medical providers in one place, make declarations including donations allowance, look at their treatment bills, and more. Vice versa, all the licensed healthcare providers can access patients’ information and issue e-transcription. Surprisingly, 99% of the transcriptions were issued online through the Patient Portal system in 2019. This system benefits all the stakeholders – government, hospitals, and citizens. The government can collect patients’ information consistently, doctors spend less time issuing prescriptions, and citizens would receive the benefit of convenience.
Historically, Estonia has long been occupied by the Soviet Union. After 50 years of Soviet independence, it regained its independence in 1991, and since then, the government has had a strong commitment to the digitalization of public administration, and e-health was also achieved under its initiative. Estonia was relatively poor when it gained independence, and its way of modernizing was through digitizing the society. President Kersti Kaljulaid mentioned to CNBC that “We have a generation who has grown up knowing that you communicate digitally with your school because we have an e-school system, with your doctor because of e-health.”
Besides, its advanced digital infrastructure has also been the backbone of the success of e-health, which has two pillars: X-Road, which is the data transfer layer, and a compulsory national digital ID. The X-Road is the data exchange layer that allows secure and efficient data transfer among all the private and public sectors. The combination of the X-Road and digital ID allows the Estonian government to connect and store all the citizens’ information, as explained above. This is incredible, as in other countries, including Japan, much of the medical information is stored in different locations, making it hard for medical providers to comprehensively understand patients, resulting in ineffective healthcare.
From the cultural perspective, Estonia shared certain cultural expectations with other Scandinavian countries, including relatively transparent and evidence-based decision-making due to the widespread exposure to Western media and values even during the Soviet occupation. For instance, no severe privacy concerns have been reported since the Patient Portal system started. This is because there is full transparency in the system where citizens can view who accesses their information as all the activities are logged and available to them, and healthcare providers who violate this will be penalized. Furthermore, historically, Estonia had been the battleground of the inter-state war in Europe, and they had an urge to digitize all the citizens’ information.
Therefore, the strong political commitment to digitize public administration, well-established digital infrastructure, and cultural and historical reasons allowed Estonia to have the most advanced e-health system in the world.