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Chapter 6 | The impact of the crisis on the health system and health in Latvia 187 Table 6.2 Health care expenditure trends in Latvia, 2000–2012 2000 2005 2006 2007 2008 2009 2010 2011 2012 THE per capita 479 826 1,014 1,198 1,192 1,088 1,104 1,141 1,188 (US$ PPP) a THE (% GDP) a 6.0 6.4 6.8 7.0 6.6 6.8 6.5 6.0 6.0 Mean annual real growth in THE (%) −1.0 25.0 18.0 −2.0 −9.0 −15.0 −5.0 −2.0 2.0 Mean annual real growth in GGHE (%) −7.0 26.0 33.0 −8.0 −6.0 −19.0 −5.0 −6.0 1.0 GGHE (% THE) 54.4 57.1 64.1 60.7 62.2 59.5 59.5 57.1 56.7 Private health expenditure (% THE) GGHE (% general government expenditure) GGHE (% GDP) OOP expenditure (% THE) OOP expenditure (% private health expenditure) 45.6 42.9 35.9 39.2 37.7 40.5 40.4 42.9 43.3 8.7 10.1 11.4 11.8 10.6 9.3 8.9 8.9 8.9 3.3 3.6 4.4 4.3 4.1 4.1 3.9 3.4 3.4 44.1 40.7 32.4 34.9 33.7 35.3 34.9 37.1 37.4 96.8 94.8 90.4 88.9 89.2 87.2 86.4 86.4 86.4 PHI (% THE) 1.5 2.2 2.4 1.9 1.8 0.8 2.3 2.5 2.5 PHI (% private health expenditure) 3.2 5.2 6.6 4.8 4.8 1.9 5.7 5.7 5.7 Notes: GGHE: General government spending on health; THE: Total health expenditure; a Constant 2005 international dollar. Source: WHO, 2014.
188 Economic crisis, health systems and health in Europe: country experience health care financing. Its population coverage peaked at 16% in 2008 (Financial and Capital Market Commission, 2005–2012); however, even then, most of the population remained exposed to high OOP payments: about 7% of the population reported foregoing care in that year because it was “too expensive”, compared with the average of 2.1% for the EU27 (Eurostat, 2012b). In the pre-crisis years, Latvia focused additional resources on inpatient care, secondary ambulatory services and patient pharmaceuticals. Inpatient expenditure rose by 79% in real terms between 2005 and 2008; secondary outpatient ambulatory payments rose by 121% and spending on pharmaceuticals increased by 73%. In comparison, payments to GPs rose by 45%. In 2008, inpatient and secondary outpatient spending accounted for 68% of total spending on medical care (see Table 6.5 below). FFS was an important element of reimbursement in the hospital and outpatient care sector, incentivizing providers in these sectors to provide more services for each patient. GPs, by comparison, were compensated for the most part through capitation and so had a financial incentive to do less (World Bank, 2010a). Health care delivery Although there were some improvements in the accessibility of day-care services and specialist outpatient care, and the funding for outpatient care increased, the implementation of the Development Programme for Outpatient and Inpatient Health Care Services Providers 2005–2010 (the so-called Master Plan), which was supposed to downsize hospital care and to support the development of ambulatory care, advanced very slowly because of strong opposition from local communities and concerned politicians. There is little doubt that Latvia had an overcapacity of acute care hospitals and beds before the financial crisis. There was almost no change in the number of acute care beds between 2005 and 2007, and in 2007 there were 255 acute care beds per 100 000 people in Latvia, compared with an average of 205 per 100 000 in the EU15 (2006 data) (WHO Regional Office for Europe, 2013). In addition, financing for the inpatient sector was not reduced because of the increasing intensity of hospital care (i.e. higher cost per patient) and the expenditure for inpatient care grew by much more than expenditure on GPs between 2005 and 2008 (World Bank, 2010a; see also Health system financing above). The number of inpatients increased by only 5% and the number of beddays rose by 4% during that period (World Bank, 2010a). The inflation rate in the health care sector was slightly lower than the general inflation rate but at the same time much higher than health care inflation rates observed in the EU27 (Table 6.3). The average length of stay in hospitals was, at 9.44 days in 2007,
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Economic crisis, health systems and
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The European Observatory on Health
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Keywords: DELIVERY OF HEALTH CARE E
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vi Economic crisis, health systems
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viii Economic crisis, health system
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List of abbreviations ACS Health in
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List of tables and figures Tables P
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xxvi Economic crisis, health system
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Acknowledgements This book represen
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Preface This book maps health polic
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Part I Country case studies
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4 Economic crisis, health systems a
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10 Economic crisis, health systems
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Chapter 4 The impact of the crisis
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Albania Genc Burazeri and Enver Ros
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Country profiles of health system r
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Austria Thomas Czypionka and Maria
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Azerbaijan Fuad Ibrahimov Economic
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Bulgaria Antoniya Dimova and Mina P
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Cyprus Elisavet Constantinou and Ma
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Czech Republic Tomáš Roubal and J
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Estonia Triin Habicht and Mall Lein
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Finland Jan Klavus and Lauri Vuoren
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France Karine Chevreul, Karen Berg
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Germany Klaus-Dirk Henke and Wilm Q
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Iceland Sigrún Gunnarsdóttir and
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Ireland Anne Nolan and Steve Thomas
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Israel Bruce Rosen and Amir Shmueli
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Kazakhstan Ninel Kadyrova and Tata
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Latvia Uldis Mitenbergs and Maris T
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Malta Natasha Azzopardi Muscat Econ
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Norway Anne Karin Lindahl and Jon M
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The Russian Federation Elena Potapc
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Serbia Vukasin Radulovic Economic t
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Spain Enrique Bernal-Delgado, Sandr
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Switzerland Alberto Holly and Phili
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Tajikistan Ghafur Khodjamurodov Eco
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Ukraine Valeria Lekhan and Mariia T
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