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224 Economic crisis, health systems and health in Europe: country experience
insured by the state since 2008, and as a result the transfers from the state budget
to the National Health Insurance Fund (NHIF), increased substantially during
the first years of the crisis (see section 2.1 for more detail). There were reserves
amounting to €125 million in the NHIF at the beginning of 2009 (representing
10% of its budget), consisting of savings made from cancelling advance payments
(7.5%) and bonuses (2.5%) to providers. This reserve was utilized to soften the
impact of the crisis over the course of 2009.
3. Health system responses to the crisis
3.1 Changes to public funding for the health system
Health budgets
The NHIF is the single agency responsible for health service purchasing. It
manages the compulsory health insurance scheme, accounting for 80 to 85%
of public health expenditure. NHIF revenues mainly come from two major
sources: health insurance contributions and contributions from the state
budget for the economically inactive population and the unemployed as well
as additional state budget transfers for some targeted programmes delegated to
the NHIF for administration.
Before the crisis, total health expenditure in Lithuania was increasing steadily,
and more than doubled between 2004 and 2008 to €2.1 billion. It started to
decline in 2009, falling by 6% in comparison to 2008, and by a further 4% in
2010. However, by 2011, total health expenditure had increased almost to the
2008 level (Table 7.4).
Despite the economic downturn, the transfers from the state budget to the
health sector (including contributions to the compulsory health insurance
scheme as part of the NHIF's revenue) increased from €493.5 million in 2008
(100%) to €563.9 million in 2009 (114%), to €664.8 million in 2010 (135%)
and €643.2 million in 2011 (131%) (Statistics Lithuania, 2013) due to the
counter-cyclical mechanism in place and the increasing share of contributions
for the inactive population and the unemployed. In light of the massive cuts
in other public sectors, maintaining this increase was definitely a challenge for
the Government and for the Ministry of Finance; however, the provisions of
the Law on Health Insurance, which stipulate the level of the state budget
contribution, were adhered to. Consequently, despite the crisis, the health
sector was one of the sectors that received more funding as a proportion of total
government expenditure in 2009. Between 2007 and 2009, there were also
expenditure increases in the social sector whereas substantial reductions were
implemented in general public services and in the defence budget.