The Latvian Health System

European Observatory on Health Systems and Policies

Uldis Mitenbergs

Wilm Quentin

9th Baltic Policy Dialogue,

Riga, Latvia, 13-14 December 2012

Health Systems in Transition

• Describes health system and key reform initiatives

• Enables easy cross-country comparisons

• Provides information to support policy-makers and analysts in the development of

European Observatory on Health Systems and Policies

analysts in the development of health systems

Health Status

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Health Status

IMPACT OF FINANCIAL CRISIS

• SDR per 100000 did not change: 952 (2009) vs 939 (2010)

CHALLENGES

• Reducing mortality and morbidity due to diseases of

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• Reducing mortality and morbidity due to diseases of circulatory system and external causes

Organization and governance

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Organization and governance

IMPACT OF FINANCIAL CRISIS

• The development of a more centralized system

• One institution for purchasing health care

• Delivery system with a focus on primary care

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CHALLENGES

• NHS taking advantage of its single payer status

• More “market” in delivery of services

Financing

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Financing

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Financing

IMPACT OF FINANCIAL CRISIS

• Reducing financing to hospitals, increasing user charges, reducing health worker salaries and administrative spending

• Changes in provider payment mechanisms

• Social Safety Net Strategy

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CHALLENGES

• Increasing public expenditure on health and reducing thedependence on OOP payments

• Reforming provider payment mechanisms to improveefficiency

Physical and human resources

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Physical and human resources

IMPACT OF FINANCIAL CRISIS

• Reduction of the number of hospitals, hospital beds and NHS

contracted hospitals

CHALLENGES

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CHALLENGES

• Management and planning of capital investment (e.g.

buildings, equipment)

• Reductions in excess infrastructure

• Human resources management (age, distribution,

remuneration, retention)

Provision of services

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Provision of services

IMPACT OF FINANCIAL CRISIS

• Substitution of less costly outpatient care for inpatient care

CHALLENGES

• Provider choice and availability, waiting lists, pharmaceuticals

European Observatory on Health Systems and Policies

• Provider choice and availability, waiting lists, pharmaceuticals

Principal health reforms

• Early reforms in the 1990s and early 2000s: initiation of a decentralization and the subsequent reversal

• “Master Plan”(2005–2010): slow and incomplete implementation, officially discontinued at the height of the economic crisis in 2009

• 2009-2012: a shock-type reform: shifting away from hospital

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• 2009-2012: a shock-type reform: shifting away from hospital care , concentrating state functions, establishing NHS, rationalizing paid pharmaceutical care, Social Safety Net Strategy

• “Public Health Strategy for 2011-2017”: “to increase by two years the healthy life years of individuals and to decrease by 20% the potential years of life lost”

Principal health reforms

Government’s agenda:

• Public expenditures on health to 4.5% of GDP by 2014

• Long-term and coherent financial planning, better use of the health care infrastructure

• Human resource development activities, including a new salary policy

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salary policy

• e-health system

• DRG system for hospital payment , quality bonus system for hospitals and GPs

• Cooperation between SEMS, GPs and the home care system

• New regulations and activities regarding state financing for pharmaceutical products

Principal health reforms

“At the end of the day, Latvia is the only country

in the EU that has made structural reforms in

response to the economic crisis. The rest have

either done nothing or have cut across the

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either done nothing or have cut across the

board”

Assessment: Financial protection

The share of OOPs in Latvia is high and has increased since 2008

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Assessment: Financial protection

A large proportion of the population foregoes care because of costs

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Assessment: Equity of access

Unmet need for examination or treatment is higher amongst the poor

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Assessment: Equity of outcomes

Health status improvements for the poor: result of safety net?

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Assessment: Efficiency

Successful shift of expenditures towards ambulatory care

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Conclusions: Findings

• (Healthy) Life expectancy in Latvia remainslow - because of cardiovascular diseases.

• Financial protection remains limited becauseof high OOP payments

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of high OOP payments

• The Social Safety Net Strategy was an important step to protect the poor

• Efficiency of the system is likely to haveconsiderably improved by shifting serviceprovision to ambulatory care

Conclusions: Moving ahead

• Improving population health: Public Health

Strategy and healthy living

• Increasing government spending on health:

reducing OOPs and improving access

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reducing OOPs and improving access

• Spending wisely: increasing coverage of

prescription drugs and extending social safety net

• Further improving efficiency: psychiatric vs. long-

term care, hospital payment and more

competition.