Patient insurance and dental care in Estonia: do prices rise?

The Healthcare Provider's Compulsory Liability Insurance Act (tervishoiuteenuse osutaja kohustusliku vastutuskindlustuse seadus, TOKVS), known publicly as patient insurance, entered into force on 1 November 2024.¹ Before it did, dentists criticised it as disproportionately expensive for dental care, with some claiming it would raise treatment prices by up to a tenth. This post examines whether that claim holds and why dental premiums are higher than in other specialties. It is a rewritten version of an opinion piece published by Estonian public broadcaster ERR in 2024, updated to 2026.

Date note: the date of this post (15 November 2024) is the date of the original publication. This English version was written for this website in 2026.

The premium reflects risk, not professional pride

The basic principle of premium calculation is simple: the premium must cover expected losses, claims handling costs and the insurer's cost of capital. If more claims are made against one profession, or a higher share of claims finds treatment deficient, the premium is higher. That is not disrespect for dentists; it is insurance technique.

The same logic applies across all lines. In motor insurance a young, inexperienced driver pays more than an experienced driver with a clean record. In professional indemnity an auditor or structural designer pays more than a low-risk consultant. In D&O the price depends on the sector: directors in finance and energy cost more to insure. There is no reason to expect patient insurance to be different.

Publicly available statistics from Estonia's expert committee on the quality of healthcare services showed, before TOKVS entered into force, that dentistry had in recent years been the specialty generating the most complaints, with deficiencies found in a significant share of them. That is the dataset on which an insurer assesses the risk.

Is a ten per cent price increase plausible?

The claim can be tested with simple arithmetic. If a dental clinic's annual premium is around EUR 2,000 (the order of magnitude publicly discussed in 2024), a ten per cent price increase would imply annual turnover of about EUR 20,000, less than EUR 2,000 a month. That is inconsistent with dentists' incomes and the sector's published financial data. The arithmetic suggests the premium is a fraction of one per cent of a typical clinic's turnover, not a tenth.

Sector profitability leads to the same conclusion. Dental sector profits in 2022 were such that, spread over the sector, a premium of that order can be absorbed without a material price rise. A clinic may of course choose to pass the cost on, but that is a business decision, not an inevitable consequence of insurance.

Why comparisons with earlier voluntary cover and with Finland mislead

Critics often compared the new compulsory cover with earlier voluntary professional indemnity, which was cheaper. The comparison fails for two reasons.

First, the scope of cover differs. TOKVS sets statutory minimum sums insured: EUR 100,000 per claimant, EUR 300,000 per insured event and EUR 3,000,000 per year.² No deductible may be applied to the injured party.³ Voluntary policies often had lower limits and wider exclusions.

Second, it becomes easier to claim. Previously a patient had to pursue the doctor or clinic directly, often in court. Under TOKVS the claim is made to the insurer and disputes may be referred to a conciliation committee operating at the Health Board.⁴ A simpler procedure inevitably produces more claims, and the premium must reflect that.

Comparison with Finland is also problematic. Finnish patient insurance has operated for decades, has a large pool and long loss statistics, and rests on a different legal construction that does not require the provider's liability in the narrow sense. Estonian TOKVS is liability insurance: the insured event requires the provider to be liable for the patient's loss.

What insurance gives dental practices

Insurance is not only a cost. Well-functioning patient insurance gives dentists two important benefits.

First, it mitigates personal financial risk. A serious complication (for example nerve damage during implant placement) can produce a claim exceeding a small clinic's annual profit. Insurance covers both justified claims and the cost of defending unjustified ones.

Second, it reduces conflict with patients. If patients know they have a simple, cost-effective route to compensation, they need not confront the doctor directly or go straight to court. A treatment error becomes an insured event rather than a personal accusation. Over time the system generates data on errors that helps improve quality and, in turn, reduce premiums.

What has changed by 2026

TOKVS has been amended since entry into force. The current version took effect on 1 October 2026 (RT I, 30.06.2026, 33) and changed, among other things, § 4(5) on the insurance obligation and § 20(9) in the list of exclusions.¹ The basic structure (compulsory liability insurance, statutory minimum sums, conciliation committee, limitation periods of 3 and 10 years) is unchanged.⁵

First-year experience confirmed that claims increased but did not explode (see Patient insurance in Estonia: lessons from the first year). That supports the conclusion that dental premiums are not disproportionate and that the main drivers of price increases lie elsewhere.

How a dental clinic can influence its premium

Risk-based pricing means a clinic can influence its premium through its own conduct.

Documentation. Thorough records of the treatment plan, patient information and informed consent reduce both the number and the success of claims. Many disputes concern not the procedure itself but whether the patient was told about the risks.

Quality management. Internal controls, peer consultation in complex cases and analysis of complications show the insurer that risk is managed. A clean claims history is the strongest negotiating argument.

Claims handling. When a patient complains, notify the insurer promptly and do not assume obligations unilaterally that may later hamper the insurer's assessment. Notification duties under the policy matter in liability insurance too.

Group schemes and deductibles. Professional associations and larger clinic chains can negotiate group policies. A higher deductible (which under TOKVS § 12 does not affect the injured party, only the clinic-insurer relationship) may lower the premium.

These measures are not just insurance technique; they are part of good medical practice that also reduces harm to patients and loss of trust.

How patients use the system

In dentistry losses are often smaller than, say, in surgery, but more frequent. Patients should know that dental injuries are compensated through patient insurance where the clinic is liable. Typical cases are nerve damage, an incorrectly placed implant, a complication the patient was not warned of, or treatment that has to be redone elsewhere because it failed.

The small-loss exclusion (below EUR 200) means very small costs must be resolved directly with the clinic. For larger losses, submit the claim to the clinic and ask it to forward it to its insurer, attaching treatment records and evidence of costs. If the insurer's decision is unsatisfactory, the conciliation committee is available.

Conclusion

A higher premium for a higher-risk specialty is a natural feature of insurance. The claim that patient insurance raises dental prices by a tenth does not survive the arithmetic. Rather than criticising it, the dental sector could see insurance as a way to reduce personal liability risk and conflict with patients. If quality improves and losses fall, premiums should fall in the longer run.

Originally published in Estonian: ERR Arvamus, 15 November 2024, "Olavi-Jüri Luik: kohustusliku vastutuskindlustuse mõju hambaravile", https://www.err.ee/1609521295/olavi-juri-luik-kohustusliku-vastutuskindlustuse-moju-hambaravile. Rewritten and updated as of November 2026.

Related pages

• Patient insurance in Estonia
• Professional indemnity in Estonia
• Patient insurance in Estonia: lessons from the first year

References