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Chapter 7 | The impact of the crisis on the health system and health in Lithuania
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contributions (SHI contributions from the economically active population and
transfers from the budget for those insured by the state) in combination with a
counter-cyclical mechanism proved its capacity to counteract falling revenues
and to ensure that the share of public spending on health remained intact
during the crisis.
Because of the time lags involved, it is still too early to assess the mediumto
long-term impact of the crisis on the health system and population health
in Lithuania.
6. Conclusions
Lithuania's health care system experienced substantial financial pressure under
the large contraction of the country's economy in 2009 (GDP fell by almost
15%). The health system was not properly prepared for the crisis because of
the existing inefficiencies in the inpatient sector and primary health being
limited in its role in providing appropriate curative and preventive services in
the community. At the same time, Lithuania's health financing model based
on a single purchaser, a mix of SHI revenue sources, and a counter-cyclical
mechanism, proved its vitality as public financing for health care was affected
much less than the economy in general.
The main policy during the crisis period was to maintain access to the health
benefits package provided by the publicly funded health care system. In order
to do this, providers were forced to increase efficiency through reductions
in the prices of services covered by the NHIF, restructuring of the hospital
network and introducing incentives to treat more patients in primary care and
outpatient settings. As a result, there were no changes in health coverage during
the crisis. The main drawbacks of the reform measures undertaken during the
crisis period were the reduction to health care workers' salaries and hospitals
growing financial deficits. While service utilization data showed no major
changes, it is difficult to interpret these data because of changes in population
numbers. However, population surveys and the increase in OOP payments
indicate that some reductions in access to care have been experienced.
As demonstrated by the Drug Plan, well-designed and properly implemented
complex measures can decrease expenditure without impairing accessibility
(of medicines) even in conditions of crisis.
The crisis seems to have had a short-term impact on the population's mental
health, reflected in the increases in depression, addiction disorders and suicides
rates. In addition, there has been an increase in HIV incidence among injecting
drug users. At the same time, there has been a decrease in road traffic accidents
and alcohol-related morbidity and mortality, as well as temporal reductions in