Web-economic-crisis-health-systems-and-health-web

Chapter 6 | The impact of the crisis on the health system and health in Latvia
203
shorten hospitalization times. However, there is scope for further improvements
in this area; because of political pressure, too many types of hospital service
were maintained in different regions when keeping only certain types in certain
regions might have been more efficient. The reorganization of health sector
institutions, including mergers and closing down of some agencies, might
have resulted in some efficiency gains but it lacked a clear plan about which
institutions would take over the responsibilities of those that ceased to exist and
some functions were unassigned. The rationalization of pharmaceutical care
was another area where efficiency gains have been achieved.
4.4 Quality of care
Limitations in the number of secondary outpatient visits probably also had a
negative impact on the quality of care (as continuity of care may be affected) as
had financial cuts (providers had to cut expenses and staff) and the introduction
of payment mechanisms such as global budgets.
According to Mitenbergs et al. (2012), the unsatisfactory health status of the
Latvian population, as well as the overall dissatisfaction with the health system
(see Users' experience below), underlines the problem of health service quality.
The majority of citizens (66%) evaluated the overall quality of health care as
bad in 2011 (European Commission, 2011) and 65% thought that the quality
of care in Latvia was worse than in the other EU Member States (European
Commission, 2010). Currently, there is no comprehensive quality management
system that encompasses reliable quality indicators and mechanisms for
monitoring and continuous quality improvement. Analysis of health service
outcomes and quality of care is hampered by a lack of data on key indicators,
such as patient safety, both at national and organizational level. Consequently,
international comparisons on the quality of medical services cannot include
any assessment of the situation in Latvia.
Some data are available but only for preventive care. Immunization data show
that coverage has decreased since 2008 and is now below the EU average for a
number of vaccines and also below WHO's general target of 95%; the reasons
for this reduction include socioeconomic factors and also an increasing number
of people who are opposed to vaccination. Latvia has also tried to improve
cancer care by launching a large-scale public screening programme against
breast cancer, cervical cancer and colorectal cancer in 2009. However, in the
first year, the population response was relatively low: only 7% of the eligible
population received colorectal screening and 21% received breast cancer
screening. According to data from the Centre for Disease Prevention and
Control, five-year (absolute) cancer survival rates in Latvia in 2010 were 66.5%
for breast cancer, 78.2% for cancer of the cervix uteri, 57.3% for colon cancer