Latvia: health system review

ABSTRACT

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The life expectancy in Latvia has improved over the last two decades and was 71.1 years in 2005. This value is comparable to those in other eastern Europeanand former Soviet Union countries but is the lowest among the Baltic and Nordic countries. Health care services in Latvia are financed mainly by taxation through the state budget as well as by out-of-pocket (OOP) payments, voluntary healthinsurance (VHI) and other direct payments. Although entitlement to health care services is universal in Latvia, equity in access to services is compromised due to high levels of OOP payments by consumers. Health care services at the primary level are provided mainly by general practitioners (GP) who work independently and act as gatekeeper for specialized services. Latvia’s health care system has undergone major changes since the country achieved independence in 1991. Reform policy since then has included amongst others adoption of a Public Health Strategy in 2001 (which aims at developingan integrated approach of prevention and treatment at all levels of the health care system), reform of health care financing (e.g. payment for hospital services, introduction of a primary health care payment system based on capitation and fund holding, pooling and channelling of almost all funds for health care through the centralized State Compulsory Health Insurance Agency (SCHIA)), regulations of the pricing system for pharmaceuticals and introduction of a centralized health management information system. However, patients and health care consumers are concerned with regard to quality of the health careservices, long waiting lists and access to specialized care.