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198 Economic crisis, health systems and health in Europe: country experience
Emergency hospitals receive an additional budget for emergency room and
admission services. The hospitals bear the financial risk of running over their
budgets if they have higher costs, even if they treat more patients or provide more
services. In 2012, a decision was taken to introduce Nord-DRG (the Nordic
DRG scheme) in hospitals in 2014. This is seen as a considerable advantage
compared with the current payment system.
Emergency care restructuring
A reform of the emergency car service was undertaken in 2009 in order to save
financial resources and to increase the effectiveness of service provision in the
pre-hospitalization phase. As a result of the reform, the emergency care services
of 39 municipalities, each with its own unique structures for the provision of
emergency care, were merged into the state service under the supervision of the
Ministry of Health. Consequently, the accessibility and quality of emergency
care in most of the country has been harmonized and inefficiencies have been
reduced. Access also improved through better coordination of emergency care
(there is now a central call centre in Riga providing a single system for the
whole country).
Reductions in health sector salaries and changes to working
conditions
In addition to these changes to the health sector structure, the average monthly
remuneration of all employees working in the health sector decreased by 3%
between 2009 and 2010 (from LVL 446 (€635) to LVL 434 (€618)) while the
average monthly salary stayed the same, at LVL 335 (€477). The average monthly
remuneration of physicians, which includes salary, additional payments and
bonuses, was, according to the Ministry of Health, LVL 657 (€935) in 2010.
Since 2011, there has been a slight increase in salary levels (Mitenbergs et al.,
2012).
Pharmaceutical sector reforms
In 2012, after difficult and controversial discussions, the government amended
the Regulations on the Reimbursement System for Pharmaceuticals and Medical
Devices to rationalize the pharmaceutical care provided by the NHS. The reference
pricing system for pharmaceuticals in the reference list was changed. Previously,
the NHS paid the same (lowest) price (reference price) for all products in the
same reference group (products with similar chemical/therapeutic characteristics)
and pharmacists and patients could choose any one of these products. The patient
would need to pay the difference between the reference price and the actual price
of the chosen drug OOP (in addition to the regular drug co-payment) if the drug
was more expensive than the reference price. According to the new regulations,