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Chapter 6 | The impact of the crisis on the health system and health in Latvia
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While the number of inpatient surgeries fell by 30 000 from 2009 to 2010
(a decrease of 21%), the number of day-care surgeries, which are counted as
outpatient surgeries in Latvia, increased by almost the same number (WHO
Regional Office for Europe, 2013). However, there is some anecdotal evidence
that some of the outpatients may in fact be “hidden” inpatients (with patients
paying for the overnight stays as OOP payments because of limited funding for
inpatient care). Spending on inpatient services was substantially reduced: while
inpatient care accounted for almost 50% of Ministry of Health expenditure in
2008, this share was reduced to below 35% in 2011 and the share of spending on
GP care increased from 9% in 2008 to 14% in 2010 (Table 6.5) (Mitenbergs et
al., 2012). By comparison, home care (medical care provided at home by nurses
or physicians' assistants to chronically ill patients or patients after surgery) was
included in the statutory benefits basket (Mitenbergs et al., 2012). Moreover,
to prevent situations where an ambulance is called unnecessarily, in 2011
a family doctor service was introduced, where everybody can obtain advice over
the phone or other electronic means (e-mail, Skype, MSN Messenger) (Bite,
2012). The consultations are provided by GPs or physicians' assistants and are
available from 5 pm to 8 am during weekdays and around the clock during
weekends and holidays. From 2009, home care for chronically ill patients became
a reimbursable service and the scope for home psychiatric care and care at day
centres was expanded (while at the same time financial incentives were introduced
to shift patients from psychiatric hospitals to social care institutions), creating
further potential for reducing the use of inpatient facilities (World Bank, 2010a).
Table 6.5 Distribution of medical care spending in Latvia, 2005–2010
Area
Percentage
2005 2008 2009 2010
Inpatient 48 50 45 35
Secondary ambulatory 14 18 18 18
GPs 11 9 11 14
Dentists 2 1 1 2
Emergency medical assistance 6 6 6 7
Patient pharmaceuticals 15 15 16 22
Centrally procured pharmaceuticals 4 1 1 2
Settlements with the EU 0 0 1 1
Source: World Bank, 2010a.
In order to improve cost control, a global budget system for hospitals was
introduced in 2010 (replacing per diem fees with additional activity-based
payments). The fixed monthly budget is one-twelfth of the calculated annual
budget and does not depend on the current number of patients in the hospital.