Web-economic-crisis-health-systems-and-health-web

Country profiles of health system responses to the crisis | Latvia
427
User charges
• Co-insurance rates for drugs for some conditions (mainly cardiovascular
diseases) increased from 25% to 50% or from 10% to 25% (2009); the
50% rate was lowered to 25% in 2010.
• Introduction of new exemptions from user charges for households with an
income below LVL 120 per family member per month, while households
with an income below LVL 150 per family member per month became
eligible for a 50% reduction in user charges (2009).
• Increase in co-payments for physician and outpatient department visits
and inpatient stays (2009).
• Increase in the cap on OOP payments for an inpatient stay and for a year
(from LVL 80 and LVL 150 to LVL 250 and LVL 400, respectively) (2009).
• Introduction of a co-payment of up to LVL 30 for inpatient surgical
interventions and increased co-payments for various diagnostic services
(up to LVL 25, but not for prescribed laboratory tests) (2009).
• Modification of the reference pricing system so that patients purchasing
any but the cheapest drug in a group must pay the full price as OOP
payment (2012).
• From 2012, only households with an income below LVL 90 per family
member per month would be exempt from user charges (2012).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Introduction of a pay-back system if the NHS drug budget is exceeded,
with €5.6 million paid back to the NHS in 2011.
• Expanded reference price groups to include more drugs and reduced the
number of products in a group for List A drugs (interchangeable products) to
one (the cheapest) (2012).
• Prescriptions for new patients must specify the active ingredient (2012).
• Pharmacists must dispense the cheapest drug in a reference group (2012).
Salaries and motivation of health sector workers
• An average 20% reduction occurred in the salaries of all health workers in
2009 and a fall in overall average monthly remuneration of health sector
workers by 3% between 2009 and 2010, with slight increase in 2011.
Payment to providers
• Increased day-care payment rate in order to shift patients away from
inpatient care (2009).