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Chapter 6 | The impact of the crisis on the health system and health in Latvia
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Although restructuring of health care provision was quite radical and much
has been achieved, there is scope for more improvement. For example, there
are still as many as 42 hospitals, whereas perhaps only 10 or less are needed
(authors' estimates based on Edwards, 2011). However, as the crisis period is
effectively over for Latvia and the pressure to optimize health care provision is
much lower, it will be much more difficult to implement further changes. One
area that was negatively affected by the crisis was that of human resources in
the health sector: to a certain extent, medical professionals and high-quality
state employees found more stable and better paid jobs in other sectors and
countries. Public health was also severely affected by the crisis (e.g. by the
closing of the Public Health Agency) and will take time to strengthen.
The next step for Latvia is to start analysing the reform process and its results.
This will be done in cooperation with the World Bank, particularly with regard
to analysing the effectiveness of the Social Safety Net Strategy.
6. Conclusions
The reform period between 2007 and 2012 can be divided into two stages:
before (2007–2008) and after (2009–2012) the economic crisis. However,
a substantial degree of continuity can be observed throughout both reform
periods. The most important areas of reform (Mitenbergs et al., 2012) were:
• shifting away from hospital care to ambulatory and home care;
• concentrating state functions into fewer institutions (including the
establishment of the NHS, which is now the main institution for the
implementation of state health policies and for ensuring the availability of
health care services in the country);
• reducing the number of staff; and
• rationalizing publicly financed pharmaceutical care.
The first stage of the reform period (2007–2008) was characterized by a
continuing institutional centralization process and a slow shift away from
hospital to outpatient care. As the magnitude of the economic crisis had not yet
emerged, there was no urgent need for reforms. The second stage (2009–2012)
was initiated by the enormous financial constraints resulting from the financial
and economic crisis in 2009 and it witnessed rapid reforms. Several basic health
laws were amended and substantial structural reforms of the health system
were achieved. The reform process was very fast and measures were pushed
through almost without discussion or scientific analyses. During this period,
the Latvian Government succeeded in substantially reducing excessive hospital
capacity and inpatient and secondary outpatient services, while prioritizing