Impact of health spending on hospitalization rates in Baltic countries: a comparative analysis.

INTRODUCTION: This study examines the association between healthcare indicators and hospitalization rates in three high-income European countries, namely Estonia, Latvia, and Lithuania, from 2015 to 2020. METHOD: We used a sex-stratified generalized additive model (GAM) to investigate the impact of select healthcare indicators on hospitalization rates, adjusted by general economic status-i.e., gross domestic product (GDP) per capita. RESULTS: Our findings indicate a consistent decline in hospitalization rates over time for all three countries. The proportion of health expenditure spent on hospitals, the number of physicians and nurses, and hospital beds were not statistically significantly associated with hospitalization rates. However, changes in the number of employed medical doctors per 10,000 population were statistically significantly associated with changes of hospitalization rates in the same direction, with the effect being stronger for males. Additionally, higher GDP per capita was associated with increased hospitalization rates for both males and females in all three countries and in all models. CONCLUSIONS: The relationship between healthcare spending and declining hospitalization rates was not statistically significant, suggesting that the healthcare systems may be shifting towards primary care, outpatient care, and on prevention efforts.

"We want our freedom back, that's our only need": a qualitative study of health and social needs among asylum seekers and undocumented migrants crossing the borders from Belarus to Lithuania.

Background: The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population. Methods: In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor. Findings: 21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced. Discussion: The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs. Conclusion: There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

Trends of alcohol-attributable deaths in Lithuania 2001-2021: epidemiology and policy conclusions.

BACKGROUND: Lithuania, a Baltic country in the European Union, can be characterized by high alcohol consumption and attributable burden. The aim of this contribution is to estimate the mortality burden due to alcohol use for the past two decades based on different relative risk functions, identify trends, and analyse the associations of alcohol-attributable burden with alcohol control policies and life expectancy. METHODS: The standard methodology used by the World Health Organization for estimating alcohol-attributable mortality was employed to generate mortality rates for alcohol-attributable mortality, standardized for Lithuania's 2021 population distribution. Joinpoint analysis, T-tests, correlations, and regression analyses including meta-regressions were used to describe trends and associations. RESULTS: Age-standardized alcohol-attributable mortality was high in Lithuania during the two decades between 2001 and 2021, irrespective of which relative risks were used for the estimates. Overall, there was a downward trend, mainly in males, which was associated with four years of intensive implementation of alcohol control policies in 2008, 2009, 2017, and 2018. For the remaining years, the rates of alcohol-attributable mortality were stagnant. Among males, the correlations between alcohol-attributable mortality and life expectancy were 0.90 and 0.76 for Russian and global relative risks respectively, and regression analyses indicated a significant association between changes in alcohol-attributable mortality and life expectancy, after controlling for gross domestic product. CONCLUSIONS: Male mortality and life expectancy in Lithuania were closely linked to alcohol-attributable mortality and markedly associated with strong alcohol control policies. Further implementation of such policies is predicted to lead to further improvements in life expectancy.

Prevalence and acceptability of psychological and/or economic intimate partner violence, and utilization of mental health services by its survivors in Lithuania.

BACKGROUND: Lithuania has one of the highest averages in the European Union when it comes to psychological and/or economic intimate partner violence (PE-IPV). IPV survivors are several times more likely to have mental health conditions than those without IPV experiences. The aim of this article is to study the prevalence, characteristics and attitudes of PE-IPV survivors in Lithuania, and the predictors of them accessing mental health services. METHODS: A cross-sectional study based on a national survey representative of the adult population. The survey was implemented by a third-party independent market research company employing an online survey panel. Logistic regression models were used in the analysis. RESULTS: Almost 50% of women in Lithuania experience PE-IPV. Females are significantly more likely to experience it than males. The vast majority of women find PE-IPV unacceptable; however, only one-third of survivors seek any type of help. Only one-tenth approach mental health services, with divorcees being at higher odds of doing so. CONCLUSIONS: Further research is needed to explore predictors and contextual factors of why IPV survivors seek mental healthcare, or not. Policy implications include the need to eliminate IPV and mental health stigma; develop accessible mental health services and effective treatment approaches.

Ar gyventojai gali susimokėti už sveikatos priežiūrą?: Nauji duomenys apie finansinę apsaugą Lietuvoje: santrauka

Ši apžvalga – tai šalies tyrimų serijosdalis, kurioje pateikiami naujausiduomenys apie finansinę Europossveikatos sistemų apsaugą. Finansinėapsauga ypač svarbi visuotineisveikatos priežiūros aprėpčiaiir tinkamam sveikatos sistemosfunkcionavimui.

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

The review assesses the extent to which people in Lithuania experience financial hardship when they use health care. The analysis draws on household budget survey data collected in 2005, 2008 and 2012 by Statistics Lithuania. It focuses on two indicators of financial protection: catastrophic out-of-pocket payments and impoverishing out-of-pocket payments. It also considers the presence of access barriers leading to unmet need for health care. This review is part of a series of country-based studies generating new evidence on financial protection in European health systems.

Can people afford to pay for health care?: new evidence on financial protection in Lithuania: summary

This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimension of health system performance.This review assesses the extent to which people in Lithuania experience financial hardship when they use health care. The analysis draws on household budget survey data collected in 2005, 2008 and 2012 by Statistics Lithuania. It focuses on two indicators of financial protection: catastrophic out-of-pocket payments and impoverishing out-of-pocket payments. It also considers the presence of access barriers leading to unmet need for health care.

Sustainable development in Wales and other regions in Europe: achieving health and equity for present and future generations

The United Nations 2030 Agenda for Sustainable Development (2015), complemented by the WHO European policy framework and strategy for the 21st century, Health 2020, represents a milestone for human and planetary development. This publication proposes ways of maximizing opportunities to implement these agendas at the national and regional levels across the WHO European Region. Through the Welsh example and case studies from the Czech Healthy Cities National Network and the regions of North Rhine-Westphalia (Germany), Kaunas (Lithuania), Pomurje (Slovenia), and Västra Götaland (Sweden), it aims to enhance understanding of the key role of regions in translating global priorities into effective policies and actions, providing practical examples, which can serve as blueprints for others. The publication maps the sustainable-development journey in the United Kingdom (Wales) from the heart of its constitution to inclusion in Welsh legislation through the Well-being of Future Generations (Wales) Act 2015. It describes the structure of the Act and experience gained in connection with its implementation, focusing on the health sector. It also identifies enablers, challenges and opportunities related to sustainable development in Wales. The activities described in the case studies are framed according to the Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being, recently adopted by the WHO Regional Committee for Europe. The key messages drawn from the common experiences of the regions reinforce the need to invest in improving the determinants of health.

Lithuania: health system review

This analysis of the Lithuanian health system reviews the developmentsin organization and governance, health financing, health care provision,health reforms and health system performance since 2000. TheLithuanian health system is a mixed system, predominantly funded from theNational Health Insurance Fund through a compulsory health insurance scheme,supplemented by substantial state contributions on behalf of the economicallyinactive population amounting to about half of its budget. Public financingof the health sector has gradually increased since 2004 to 5.2% of GDP in2010. Although the Lithuanian health system was tested by the recent economiccrisis, Lithuania’s counter-cyclical state health insurance contribution policies(ensuring coverage for the economically inactive population) helped the healthsystem to weather the crisis, and Lithuania successfully used the crisis as alever to reduce the prices of medicines. Yet the future impact of cuts in publichealth spending is a cause for concern. In addition, out-of-pocket paymentsremain high (in particular for pharmaceuticals) and could threaten healthaccess for vulnerable groups. A number of challenges remain. The primarycare system needs strengthening so that more patients are treated instead ofbeing referred to a specialist, which will also require a change in attitude bypatients. Transparency and accountability need to be increased in resourceallocation, including financing of capital investment and in the payer–providerrelationship. Finally, population health, albeit improving, remains a concern,and major progress can be achieved by reducing the burden of amenable andpreventable mortality.

Improving the lives of children and young people: case studies from Europe, volume 3: school

As part of the European review of social determinants of health and the health divide, experts were commissioned to write case studies addressing childhood and inequality. They identified promising developments with international resonance, described the issues they addressed and how they were led and put into operation, and set out the emerging evidence of their effectiveness.This diverse collection of case studies is presented in three volumes reflecting a “life-course” approach: Volume 3 addresses school, with examples from Croatia, Cyprus, Denmark, Finland, France, Germany, Italy, Lithuania, the Netherlands, Spain and Sweden. Volumes 1 and 2 address the early years and childhood. Some of the case studies review major national policy developments and frameworks, others deal with specific national initiatives or with local projects driven by community organizations, and a few focus on transnational initiatives. They are not necessarily a comprehensive overview of childhood and health in the WHO European Region, but provide examples of innovative practice that will inform and inspire policy-makers, practitioners, managers, educators and researchers, committed to improving the lives of children and young people at country and European levels.

Environment and health performance review: Lithuania

This report describes and evaluates the current environment and health situation in Lithuania. It evaluates the strong and weak points of the national environmental and health status and presents recommendations from independent experts. The conclusions and recommendations are based on a detailed environment and health performance review carried out in the country. The review identified the most important environment and health problems, evaluated the public health impact of environment exposure and reviewed the policy and institutional framework, taking into account the institutional set-up, the policy setting and legal framework, the degree and structural functioning of intersectoral collaboration, and the available tools for action.The WHO Regional Office for Europe developed this project to follow up the commitments made by Member States at the Fourth Ministerial Conference on Environment and Health in Budapest in June 2004 to reduce children’s exposure to environmental hazards. The project was designed to provide the evidence base for developing and implementing such action. The environment and health performance reviews are country-based interdisciplinary assessments the WHO Regional Office for Europe carries out at the request of Member States. Through the environment and health performance reviews, Member States receive support in reforming and upgrading the overall public health system.

10 health questions about the 10

Ten countries joined the previously 15-member European Union (EU15) on 1 May 2004, creating EU25. The health status of the population varies among the new members, and sometimes between them and EU15. Similarly, their health systems show different patterns of development. How does each of the new EU members compare in terms of health to the old members? This book offers a quick and easy way to grasp the essential features of health and health systems in the 10 newcomers. Each chapter provides a concise overview of key health indicators in 1 of the 10, compares these indicators to EU15 averages, summarizes the key aspects of the country’s health system and describes what it has achieved after a decade of health reform. This book is not a comprehensive in-depth study, but an easy guide to the knowledge available. It offers valuable reading for anyone who wants to have a quick, straightforward and accurate entry point to understanding health in the 10 new EU member states.

Health care systems in transition: Lithuania

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).