The Estonian Health Board and the Health Insurance Fund are developing a new emergency medical services model to overhaul the Baltic state’s ambulance network by 2028, according to the two public institutions. The overhaul will introduce a streamlined structure that mostly relies on two-person crews, reduces regional disparities, and cuts back on night-shift ambulance teams based on population distribution, call volumes, travel distances, and historical response times.
2028 Ambulance Overhaul Goals and Network Design
The planned deployment model aims to position ambulance crews closer to patients to improve coverage in areas current networks don’t reach. Estonia has a population of less than 1.4 million and spans roughly 61 ambulance bases housing 102 operational brigades. Authorities also use medical helicopter services to support inhabitants across 2,222 islands and islets along the Baltic Sea shore. Additional ambulance bases will be established across all four regions of Estonia under the 2028 reform plan.
“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 a joint statement.
Reimers noted that patients need fast assistance regardless of location. Achieving this requires evaluating the ambulance network as a whole, including base locations, crew composition, workloads, and specialized capabilities.
Daytime Expansion and Nighttime Adjustments
Data from Estonia’s emergency medical services show that in 2025, 64% of calls occurred during the day, while 36% happened at night. To match this demand, the daytime network will expand, while the nighttime network will shrink while preserving full readiness across the country. Medically staffed services will remain, with crews led by a nurse or a physician.
Both two-person and three-person crews will keep operating, though three-person setups will stay in high-need regions and situations. Additional brigades under the new model will primarily feature two-person crews. Mobile intensive care units will back up crews for serious cases, and physician support teams will join every region, according to the public institutions.
Did You Know? Estonia is the least populated of the three Baltic states—which also include Latvia and Lithuania—and relies on emergency medical services fully funded by the Health Insurance Fund since 2019 under universal healthcare coverage financed by taxes.
Public Tender Timeline and Stakeholder Feedback
The Health Insurance Fund aims to launch a public tender for new ambulance service funding contracts by Sept. 30, 2026. Existing contracts remain valid until the end of 2027 to give providers enough preparation time to adjust.
“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,” said Signe Borissov, the head of Partner Relations Services at the Estonian Health Insurance Fund.
Borissov added that the fund is reviewing stakeholder feedback internally with an ambulance steering group that includes representatives from the Ministry of Social Affairs, the Health Board, and the Health Insurance Fund. Proposals will be incorporated where possible before the supervisory board approves evaluation criteria.
Frequently Asked Questions
When will the new emergency medical services model be introduced in Estonia?
A new streamlined structure is scheduled to be introduced in 2028, according to the Estonian Health Board and the Health Insurance Fund.
How will daytime and nighttime ambulance operations change under the reform?
The daytime network will be expanded to handle 64% of calls that occur during the day, while the smaller nighttime network will maintain full readiness to handle nighttime calls.
When does the Health Insurance Fund plan to launch the tender for new funding contracts?
The fund aims to launch a public tender for new ambulance service funding contracts by Sept. 30, 2026, with existing contracts remaining valid through the end of 2027.
How will the upcoming changes to Estonia’s ambulance network affect emergency response times in your region?
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