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Chapter 7 | The impact of the crisis on the health system and health in Lithuania 227 Table 7.5 Share of the state budget contribution for people insured by the government as a percentage of the official (2-year lagged) average salary in Lithuania State budget contribution per person (%) 2007 2008 2009 2010 2011 2012 2013 2014 2015 26 27 32 33 34 35 36 37 37 Source: Health Insurance Law (Parliament of the Republic of Lithuania, 1996, new edition 2003). Fig. 7.2 Contributions to SHI in Lithuania, 2004–2015 Contributions (€ per year) 800 700 600 500 400 300 200 100 0 416 472 533 559 64 77 88 102 683 124 643 622 175 640 655 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013p 2014f 2015f 677 711 754 216 212 210 221 225 232 Average yearly contribution of economically active person Average yearly contribution for a person insured by the government Notes: p: Preliminary data; f: Forecast. Source: NHIF internal data, 2013 Fig. 7.3 Functioning of the counter-cyclical mechanism of SHI revenue in Lithuania, 2004–2013 1,000 900 800 Revenue (€, million) 700 600 500 400 300 200 100 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Total amount of contributions and additional allocations of state budget Total amount of contributions of economically active population Source: NHIF internal data, 2013.
228 Economic crisis, health systems and health in Europe: country experience contributions (30% of the personal income tax). This was separated into a distinct tax on income (15%) and a health insurance contribution (9% in most cases). The result of the reform was that there were almost no unjustified exceptions left to SHI obligations and the collecting agents (mainly the Social Insurance Fund and the State Tax Office for some groups) substantially increased their effectiveness in enforcing payment of contributions through the implementation of government policy against the shadow economy and tax avoidance. However, as can be seen in Fig. 7.3, due to increasing unemployment and decreasing wages the amount of money collected for SHI from the economically active population declined by 20% in 2009, and by 23.3% in 2010 in comparison to 2008. In 2011, it started to recover slightly, and this trend continued in 2012. In contrast, the amount of state budget contributions for people insured through the state budget rapidly increased and more than doubled between 2007 (€263 million) and 2010 ( €554 million). According to legislation, the expenditure of the SHI fund has to be balanced with its revenues. The fund can accumulate reserves not exceeding 10% of revenue in a given year. The reserve is built up using previous years' surplus revenue and should be used to cover temporary deficits in revenue or for covering unpredictable expenditures. 3.2 Changes to coverage Population entitlement There were no essential changes in population entitlement to health care. SHI coverage has expanded slightly since 2009 through the implementation of clearer and more transparent rules for health insurance contributions as well as better collection. At the beginning of 2012, 91% of the population was covered by health insurance. The remaining 9% of the population (e.g. people who did not declare that they had left the country, those in the shadow economy, the homeless) was entitled to urgent care, which involved acute conditions that may result in serious complications, disability or death. The benefits package Lithuania has quite a broad benefits package. There were no changes to service coverage and scope of services as a result of the financial crisis, with the exception of a reduction in temporary sick leave benefits, administered by the Social Insurance Agency. Before the crisis, sick leave benefit amounted to 85% of salary, while since 2009 those on a sick leave receive 40% of salary between the third and seventh day of their illness, and 80% of their salary subsequently.
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Economic crisis, health systems and
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The European Observatory on Health
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Keywords: DELIVERY OF HEALTH CARE E
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vi Economic crisis, health systems
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viii Economic crisis, health system
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List of abbreviations ACS Health in
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List of tables and figures Tables P
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xvi Economic crisis, health systems
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xviii Economic crisis, health syste
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xx Economic crisis, health systems
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xxii Economic crisis, health system
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xxvi Economic crisis, health system
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Acknowledgements This book represen
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Preface This book maps health polic
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Part I Country case studies
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4 Economic crisis, health systems a
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10 Economic crisis, health systems
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Chapter 4 The impact of the crisis
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Chapter 4 | The impact of the crisi
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Albania Genc Burazeri and Enver Ros
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Country profiles of health system r
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Austria Thomas Czypionka and Maria
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Azerbaijan Fuad Ibrahimov Economic
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Bulgaria Antoniya Dimova and Mina P
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Cyprus Elisavet Constantinou and Ma
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Czech Republic Tomáš Roubal and J
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Estonia Triin Habicht and Mall Lein
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Finland Jan Klavus and Lauri Vuoren
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France Karine Chevreul, Karen Berg
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Germany Klaus-Dirk Henke and Wilm Q
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Iceland Sigrún Gunnarsdóttir and
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Ireland Anne Nolan and Steve Thomas
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Israel Bruce Rosen and Amir Shmueli
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Kazakhstan Ninel Kadyrova and Tata
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Latvia Uldis Mitenbergs and Maris T
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Malta Natasha Azzopardi Muscat Econ
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Montenegro Ratka Knežević Economi
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Norway Anne Karin Lindahl and Jon M
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The Russian Federation Elena Potapc
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Serbia Vukasin Radulovic Economic t
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Spain Enrique Bernal-Delgado, Sandr
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Switzerland Alberto Holly and Phili
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Tajikistan Ghafur Khodjamurodov Eco
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Ukraine Valeria Lekhan and Mariia T
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