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Chapter 7 | The impact of the crisis on the health system and health in Lithuania
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maintained. Second, in line with reform of the hospital network, some services
(surgery, obstetrics) were moved from local to larger hospitals.
To some extent, the measures taken during the crisis enabled the health system
to manage with less. The most successful example is the implementation of the
Drug Plan, which reduced pharmaceutical expenditure and improved patients'
access to pharmaceuticals. In addition, reductions in the prices of health care
services forced providers to maintain provision of services with lower levels
of funding.
There is no comprehensive information related to changes in the quality of
care. However, the maintenance of service provision levels by providers facing
reduced budgets presumably resulted in cuts to the salaries of medical personnel,
which could potentially have had a negative impact on quality of care.
4.4 Quality of care
According to the population survey conducted by the NHIF (2012a), waiting
times and large co-payments were named as the main barriers to accessing
health care. Between 2009 and 2011, the share of respondents indicating that
they had experienced difficulties in accessing care with regard to visits to a
specialist increased from 38% to 58%, for diagnostic tests from 27% to 40%,
and for elective surgery from 11% to 19%. According to the same survey, the
share of respondents assessing quality of care as low increased from 13% in
2009 to 28% in 2011. However, this was a general judgement not based on any
specific aspect of quality.
4.5 Transparency and accountability
The tax reform of 2008 brought positive changes to transparency and
accountability to tax payers. The separation of the SHI contribution into a
separate component and improved collection served as a signal to tax payers,
quantifying their input into the public financing of health care as well as
emphasizing their duty to make the required contribution. Moreover, under
strict fiscal discipline, general transparency and accountability in public
finances has improved. For example, the Ministry of Finance initiated the
implementation of a system for national budget monitoring while the Cabinet
and the Ministry of Finance have tightened the terms of use of the compulsory
health insurance fund's reserve.
4.6 Impact on health
While the financial crisis has not had an obvious impact on the overall health
status of the population in Lithuania, falling incomes and rapid growth in