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230 Economic crisis, health systems and health in Europe: country experience
more than 80% of financing for primary care) stayed at the previous level.
From July 2010 the lowest point value was gradually restored and remained at
89% until January 2012. There were also three retroactive attempts to partially
compensate providers for significant cuts using the reserves. As a result, during
the crisis and post-crisis period, prices were never reduced by more than 11%
for most services; moreover, primary care had funding priority and experienced
less drastic cuts compared with providers of other health services (Fig. 7.4).
Fig. 7.4 Point value ratios for health care prices in Lithuania, 2009–2012
1.01
0.97
1.01
0.97
0.93
0.89
0.85
0.81
0.77
0.93
0.89
0.85
0.81
0.77
Before
May
2009
Since
May
2009
Since
January
2010
Since
July
2010
Since
October
2010
Since
January
2011
Since
June
2011
Point value ratio
Since
January
2012
Primary health care
(for the rural population
and registration of patients
to the family doctor)
Primary health care
(capitation fee and
preventive services)
Ambulance care
Other services
Source: NHIF internal data, 2013.
With existing reserves and room to increase efficiency, overall, providers
maintained a positive balance in 2009 and 2010. However, by 2011 their
reserves were depleted and there was an increasing number of hospitals declaring
negative financial results in 2011 and 2012 (NHIF internal data, 2013).
Planned provider-payment reforms
A long-term strategy of shifting care from inpatient to outpatient, ambulatory
and day-care settings started in 2003 and continued during the crisis. The
rationale behind this was to reduce existing high rates of inpatient admissions and
increase the use of less resource-intensive services (outpatient visits, day care, day
surgery and short-term hospitalizations). Thus, the hospital payment mechanism
is aimed to incentivize hospitals to provide more of these types of service.
Another important provider-payment reform that was not related to the crisis
was the replacement of local case-based payments (in use since 1997) by DRGs