Estonia Advances EMS Reform for 2028
The Estonian Health Board and the country’s Health Insurance Fund are developing a new model for the country’s EMS under which the Baltic state’s ambulance service will be overhauled. Under the plan, a new streamlined structure will be introduced in 2028, mostly relying on two-person crews, according to the two public institutions.
As part of the planned reform of Estonia’s EMS, regional disparities will be reduced. In addition to two-person crews operating ambulances, fewer ambulance teams will work night shifts. The planned network model has been designed based on Estonia’s population distribution, ambulance call volumes, travel distances, historical response times, and regional characteristics.
The more flexible deployment and operating model will enable Estonia’s ambulance crews to be positioned closer to patients and ensure improved coverage in areas where the current network doesn’t offer access, the two institutions said in a joint statement.
“The central principle of the new deployment model is simple: ambulances should be located where people live and where emergency assistance is most frequently needed,” said Taavet Reimers, the deputy director general of the Estonian Health Board, in the statement.
“For patients, the most important thing is that necessary assistance is available quickly, regardless of where they live. To achieve this, we must look at the ambulance network as a whole—the location of ambulance bases, crew composition, daytime and nighttime workloads, and specialized capabilities,” Reimers said.
With a population of less than 1.4 million, Estonia is the least populated of the three Baltic states, a group that also includes Latvia and Lithuania. The Estonian EMS system consists of some 102 operational brigades deployed across 61 ambulance bases. Since 2019, the Health Insurance Fund has fully funded ambulance services, awards contracts through public tenders, and signs funding agreements with providers of ambulance services under universal healthcare coverage financed by taxes.
With the aim to boost the services’ availability to the inhabitants of some 2,222 islands and islets located along the country’s Baltic Sea shore, the authorities have also invested in medical helicopter services.
The 2028 reform plan will allow the country’s EMS to establish additional ambulance bases in all four regions of Estonia.
“Their locations will be selected according to where they can most effectively improve access to emergency care, taking into account distances, population distribution, call volumes, and existing response times,” according to the statement.
Data collected from Estonia’s EMS indicate that ambulance demand is not evenly distributed throughout the day. In 2025, as much as 64% of ambulance calls occurred during the day, and the remaining 36% at night. Taking these figures into consideration, the daytime network will be expanded, and the nighttime network will be reduced, but its full readiness will be preserved.
“As a result, the new model will make a clearer distinction between daytime and nighttime ambulance networks,” the statement said. “The daytime network will be larger, reflecting the higher number of emergency calls during the day. The nighttime network will be smaller but will maintain full readiness to provide emergency care across Estonia.”
Among other elements of the planned reform, the Baltic nation’s medically staffed ambulance service will be preserved, and ambulance crews will continue to be led by a healthcare professional, either a nurse or a physician. Both two-person and three-person crews will continue their operations, but the three-person setup will remain in regions and situations where they are most required. The additional brigades planned under the new model will be predominantly two-person crews.
“For more serious cases, ambulance crews will be supported by mobile intensive care units, while physician support teams will be added in every region,” the statement explained.
In the meantime, as part of the planned ambulance network reform, the Estonian Health Insurance Fund is aiming to kick off a public tender for new ambulance service funding contracts by Sept. 30, 2026. The move is designed to provide ambulance service providers with sufficient preparation time to adapt to the new operating model, according to the fund. The existing ambulance service contracts are to remain valid until the end of 2027.
“We want the preparation and organization of the tender to be as transparent as possible and have therefore involved stakeholders in the ambulance sector throughout the process. We have already received proposals and feedback on both the tender principles and the evaluation criteria,” said Signe Borissov, the head of Partner Relations Services at the Estonian Health Insurance Fund.
“We are now reviewing this feedback internally within the Health Insurance Fund, including with the ambulance steering group, which includes representatives of the Ministry of Social Affairs, the Health Board and the Health Insurance Fund. Where possible, the proposals will be incorporated into the tender before the evaluation criteria are submitted to the Health Insurance Fund's supervisory board for approval,” Borissov added.
About the Author
Jaroslaw Adamowski is a freelance writer based in Warsaw, Poland. He covers various developments related to European and Asian EMS.
