Cross-population evaluation of cervical cancer risk prediction algorithms.

BACKGROUND: Cervical cancer is a preventable disease, despite being one of the most common types of female cancers worldwide. Integrating existing programs for cervical cancer screening with personalized risk prediction algorithms can improve population-level cancer prevention by enabling more targeted screening and contrive preventive healthcare innovations. While algorithms developed for cervical cancer risk prediction have shown promising performance in internal validation on more homogeneous populations, their ability to generalize to external populations remains to be assessed. METHODS: To address this gap, we perform a cross-population comparative study of personalized prediction algorithms for more personalized cervical cancer screening. Using data from the Norwegian and Estonian populations, the algorithms are validated on internal and external datasets to study their potential biases and limitations when applied to different populations. We evaluate the algorithms in predicting progression from low-grade precancerous cervical lesions, simulating a clinically relevant application of more personalized risk stratification. RESULTS: As expected, our numerical experiments show that algorithm performance varies depending on the population. However, some algorithms show strong generalization capacity across different data sources. Using Kaplan-Meier estimates, we demonstrate the strengths and limitations of the algorithms in detecting cancer progression over time by comparing to the trends observed from data. We assess their overall discrimination performance in personalized risk predictions by analyzing the accuracy and confidence in individual risk estimates. DISCUSSION AND CONCLUSION: This study examines the effectiveness of personalized prediction algorithms across different populations. Our results demonstrate the potential for generalizing risk prediction algorithms to external populations. These findings highlight the importance of considering population diversity when developing risk prediction algorithms.

Kas tervishoiuteenused on inimestele taskukohased? Uued tõendid rahalise kaitstuse kohta Eesti tervisesüsteemis 2023

Käesolev ülevaade ilmub riigipõhiste uurimuste sarjas, kus avaldatakse uusi tõendeid inimeste rahalise kaitstuse kohta Euroopa ja Kesk-Aasia tervisesüsteemides, käsitledes tervishoiuteenuste taskukohasust. Rahaline kaitstus on kõikse tervisekaitse keskne aspekt ja tervisesüsteemide toimivuse põhimõõde. Eestis on rahaline kaitstus aastatel 2015–2020 seoses positiivsete muutustega ravikindlustuspoliitikas ja muude asjaoludega paranenud. Katastroofiliste tervishoiukulude tase Eestis on siiski jätkuvalt kõrgem kui paljudes teistes Euroopa Liidu riikides ja selle peamine põhjus on suur omaosalus ambulatoorsete ravimite ostmisel ja hambaravis. Eriti suur on katastroofiliste tervishoiukulude osatähtsus madala sissetulekuga leibkondade segmendis. Ka katmata ravivajaduse tase on Eestis WHO Euroopa piirkonna keskmisest palju kõrgem, mis on tingitud pikkadest järjekordadest eriarstiabis. Eesti ravikindlustuse kõigis kolmes mõõtmes esineb lünki, mis õõnestavad rahalist kaitstust ja mõjutavad ennekõike madala sissetulekuga leibkondi. Kuna tööealise elanikkonna õigus ravikindlustusele on seotud ravikindlustusmaksete tegemisega, on 10% Eesti tööealisest elanikkonnast ravikindlustuseta. Tervisekassa hüvitiste pakett on küll üpris suur, kuid täiskasvanute hambaravi hüvitised on siiski piiratud. Eesti valitsus on püüdnud omaosalust ambulatoorsete ravimite ja hambaraviteenuste puhul vähendada, kuid madalama sissetulekuga inimestele sellest piisanud ei ole. Rahalise kaitstuse parandamiseks võiks Eesti teha järgmist: siduda ravikindlustuse saamise õigus residentsusega; suurendada ja täpsustada hüvitisi, et need jõuaksid inimesteni, kes vajavad neid kõige rohkem; vähendada omaosalust pikaajalises õendus- ja hooldusabis; ja suurendada rahalist kaitstust omaosaluse eest üldiselt, eriti madala sissetulekuga leibkondade segmendis.

Estonia: Health System Summary, 2024

This Health System Summary is based on the Estonia: Health System Review published in 2023 in the Health Systems in Transition (HiT) series. Health System Summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.

Estonia: Health System Review.

This analysis of the Estonian health system illustrates recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In general, Estonia spends less per capita on health than the European Union average, although public expenditure has been growing steadily, with an increasing role of government budget transfers towards the social health insurance model. Despite these efforts, more than a fifth of current health expenditure comes from out-of-pocket payments, creating pressure to develop new and strengthen existing financial protection instruments. Life expectancy in Estonia has increased rapidly over the past decade, but not fast enough to meet the targets set in strategic documents. The first years of the COVID-19 pandemic were marked by a decline in life expectancy and high excess mortality, which set back progress. Despite this, Estonia's gains in population health were more pronounced in 2022. Overall, health inequalities between socioeconomic groups remain high, prompting policymakers to take steps to increase equity in access to care. The outstanding challenges for the Estonian health system include: addressing the shortage of primary and mental health experts, especially given the growing burden of chronic conditions and other needs of the ageing population; minimizing stark socioeconomic inequalities in health outcomes; renewing the outdated public health framework; and further improving integration and coordination of care and clinical decision-making.

Can people afford to pay for health care? New evidence on financial protection in Estonia 2023

This review is part of a series of country-based studies generating new evidence on financial protection – affordable access to health care – in health systems in Europe and central Asia. Financial protection is central to universal health coverage and a core dimension of health system performance assessment. Financial protection improved in Estonia between 2015 and 2020, reflecting positive changes in coverage policy and other factors. However, catastrophic health spending continues to be higher in Estonia than in many European Union countries – mainly driven by out-of-pocket payments for outpatient medicines and dental care – and is heavily concentrated among households with low incomes. Levels of unmet need for health care are also well above average for the WHO European Region, reflecting long waiting times for specialist care. Gaps in all three dimensions of health coverage undermine financial protection in Estonia and systematically affect households with low incomes. Linking entitlement to payment of contributions leaves 10% of working-age people without coverage. The benefits package – while quite broad – provides limited coverage of adult dental care. The Government has tried to protect people from co-payments for outpatient prescribed medicines and dental care but these efforts have not been sufficient for people with lower incomes. To improve financial protection, Estonia can change the basis for entitlement to residence; increase and fine-tune benefits to better target those in most need; reduce out-of-pocket payments in long term health care; and increase protection from all co-payments, especially for households with low incomes.

Estonia: health system summary, 2022

This Health system summary is based on the Estonia: Health System Review published in 2018 in the Health Systems in Transition (HiT) series, and is significantly updated, including data, policy developments and relevant reforms as highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in July 2022 unless otherwise stated. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.

Lessons learned from the Baltic countries' response to the first wave of COVID-19.

The Baltic countries of Estonia, Latvia, and Lithuania shared a similar response to the first wave of the COVID-19 pandemic. Using the information available on the COVID-19 Health System Response Monitor platform, this article analyzed measures taken to prevent transmission, ensure capacity, provide essential services, finance the health system, and coordinate their governance approaches. All three countries used a highly centralized approach and implemented restrictive measures relatively early, with a state of emergency declared with fewer than 30 reported cases in each country. Due to initially low COVID-19 incidence, the countries built up their capacities for testing, contact tracing, and infrastructure, without a major stress test to the health system throughout the spring and summer of 2020, yet issues with accessing routine health care services had already started manifesting themselves. The countries in the Baltic region entered the pandemic with a precarious starting point, particularly due to smaller operational budgets and health workforce shortages, which may have contributed to their escalated response aiming to prevent transmission during the first wave. Subsequent waves, however, were much more damaging. This article focuses on early responses to the pandemic in the Baltic states highlighting measures taken to prevent virus transmission in the face of major uncertainties.

Kas inimesed saavad endale tervishoiu eest tasumist lubada?: uued tõendid finantskaitse kohta Eestis

Tervishoiule tehtavate kulutuste katastroofiline tase on Eestis kõrgem kuipaljudes teistes ELi riikides, ent siiski madalam kui Lätis ja Leedus. 2015.aastal tasus 7,4% Eesti leibkondadest katastroofiliselt kõrget omaosalust.Pisut üle 5% olid pärast omaosaluse tasumist vaesunud, veelgi enamvaesunud või vaesumisohus.Puudujäägid tervishoiuteenustega kaetuses ei vii mitte üksnes leibkondaderahaliste raskusteni teenuste kasutamisel, vaid tekitavad juba ka takistusiteenuste kättesaadavuses. Kasvav rahuldamata vajadus teenustekättesaadavuses ning üha suurenev sissetulekutega seotud ebavõrdsus sellesosas, on olulised probleemid Eesti jaoks. Sissetulekutega seotud ebavõrdsusrahuldamata vajaduse osas on eriti oluline hambaravis ja retseptiravimiteosas. Rahuldamata nõudlusega tegelemine ja samal ajal finantskaitseparandamine nõuab täiendavaid avaliku sektori vahendeid tervisesüsteemi.Planeeritud avaliku sektori kulutuste suurendamine tervishoius peakskeskenduma omaosalussüsteemi keerukuse vähendamisele ja vaesemateleibkondade ning regulaarselt tervishoiuteenuseid kasutavate inimesteolukorra parandamisele.

Can people afford to pay for health care? New evidence on financial protection in Estonia

The incidence of catastrophic spending on health is higher in Estonia than in many European Union countries, but lower than in Latvia and Lithuania. Catastrophic spending, primarily due to medicines, affects the poorest households the most. Estonia’s relatively high incidence of catastrophic spending on health partly reflects a level of public spending on health that is well below the European Union average and slightly lower than Estonia can afford. It also reflects substantial gaps in all three dimensions of health coverage: population coverage, service coverage and user charges. Gaps in coverage not only lead to financial hardship but also create barriers to access. Growing unmet need – and rising inequalities in unmet need – are significant problems in Estonia. Addressing high levels of unmet need and, at the same time, improving financial protection will require additional public investment in the health system. It will also require attention to the design of coverage policy. This review is part of a series of country-based studies generating new evidence on financial protection in European health systems.

Out-of-pocket payments and health care utilization in Estonia, 2000–2012

This paper analyses out-of-pocket payments, their impact on catastrophic expenditures and impoverishment in Estonia from 2000 to 2012. Microdata from the Estonian Household Surveys collected by Statistics Estonia were used, complemented by utilization data from other studies. Statistical and econometric methods were applied. The results show that out-of-pocket expenditures peaked in 2006 and dropped thereafter. The decline is explained by the relative increase of pensions during the crisis years, promotion of generic drugs and reduced utilization of health care, especially dental care. Analysis of income-related inequalities in health care financing and utilization continues to show that for those services that are more dependent on out-of-pocket payments, there were either more inequalities in utilization, clearly demonstrated in adult dental care, or there was more risk of being pushed into poverty, such as in the case of spending on prescription and over-the-counter drugs by pensioners. Compared to previous studies, the impact of drug purchases on catastrophic expenditure has declined, which may be explained by both the changing attitudes towards cheaper drugs and increasing pensions relative to drug prices. Regarding the dental care, however, the picture is similar to earlier studies that high out-of-pocket payments cause low-income households to withdraw from the utilization of dental care services.

Responding to the challenge of financial sustainability in Estonia's health system

Estonia explores how to move from values to action by implementing the Tallinn Charter: Health Systems for Health and Wealth. There are many options for change, but only some will help the health system to achieve its objectives. This report brings together the views and values of stakeholders, recent data on health financing and new revenue and expenditure projections from now to 2030.

Võimalused Eesti tervisesüsteemi rahalise jätkusuutlikkuse tagamiseks: Kokkuvõte

Tervisesüsteemi rahaline jätkusuutlikkus on Eesti tervisepoliitika keskmes olnud alati, kuid hiljutine ¬nantskriis on tõstnud selle esmatähtsaks poliitiliseks küsimuseks mitte ainult Eestis, vaid kogu maailmas. Aruandes hinnatakse Eesti tervisesüsteemi toimivust ja selle rahalist jätkusuutlikkust. Analüüsitakse, kas praegune rahastamissüsteem on pikas perspektiivis (aastani 2030) elujõuline, ning pakutakse välja võimalusi rahastamispoliitika tõhustamiseks.

Responding to the challenge of financial sustainability in Estonia’s health system: executive summary

Health system financial sustainability has always been a central health policy issue, but the recent financial crisis has forced it to the top of the policy agenda the world over. With the aim of supporting a financially sustainable, high-performing health system, this report assesses health financing policy in Estonia. It looks at how well-placed current financing policy is to enable goal attainment in the medium-to-long term (to 2030) and identifies ways to strengthen financing policy.

Income-related inequality in health care financing and utilization in Estonia 2000–2007: health financing technical report

This paper analyses out-of-pocket payments (OOPs), their impact on catastrophic expenditures and the distribution of the taxation burden to finance health care in Estonia from 2000 to 2007. It also looks at income-related inequality in Estonian health care utilization in 2006. We use microdata of the Estonian Household Surveys collected by Statistics Estonia, national health accounts data, detailed tax revenue structure from 2000–2007, results from the ALAN microsimulation model, statistical and econometric methods outlined in Xu (2005), Klavus (1998), Habicht et al. (2006) and van Doorslaer and Masseria (2004).The results show that out-of-pocket expenditures have increased since 2000. The socioeconomic factors that determine the relatively high household health expenditure relative to capacity to pay are those that describe income level, on the one hand, and health expenditure, on the other hand. Most affected are elderly people whose expenditure for both prescription and over-the-counter drugs increases their risk of impoverishment. The analysis of inequality in health care utilization shows that after taking into account the need for health care, the use of dental care, phone consultations and other medical specialties are positively related to income. Day treatment utilization also turns out to be highly related to income, though it is statistically insignificant due to very small number of people it in our sample who have used. The increasing share of OOPs has lead to a decline in the progressivity of overall health care financing.