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

428 Economic crisis, health systems and health in Europe: country experience
• A combination of per diem fees and activity-based payments was replaced
by global budgets to pay for hospital care (2010).
• Introduction of a DRG-based hospital payment system planned for 2014.
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• Reduction of the number of employees of the Ministry of Health and its
agencies by 55% between 2009 and 2012.
• Numerous agencies closed, including the State Agency of Health Statistics
and Medical Technologies, the State Centre of Medical and Professional
Education and the Public Health Agency (2009).
• Various agencies were reorganized: the Health Payment Centre was
established in 2009 and, in 2011, merged with the Centre of Health
Economics under the umbrella of the Latvian NHS.
Provider infrastructure and capital investment
• The State Emergency Medical Service was established in order to gradually
take over emergency medicine functions from medicare institutions,
centralize the emergency system (provision of emergency care services
used to be decentralized across 39 municipalities) and save administrative
costs (2009).
• The number of hospitals providing inpatient care decreased from 88 in
2008 to 67 in 2010; the number of hospital beds decreased from 746 to
532 per 100 000 inhabitants between 2008 and 2010. At the same time,
the number of the NHS-contracted hospitals decreased from 79 to 39.
• Most specialized hospitals were closed or transformed into day-care and
outpatient institutions; several local hospitals were downgraded to low
intensity “care hospitals” (catering for patients after discharge from acute
care hospitals) (2009 onwards). Some hospitals were still left with excess
infrastructure.
• A pilot e-health system commenced in 2012. The full system will include
e-receipts, e-health records, e-bookings, e-referrals and an e-portal and is
expected to be implemented in 2014.
Priority setting or protocols to change access to treatments, coordination
of care and patterns of use
• Introduction of a programme to increase responsibilities and duties of
family doctors, including increased support of the provision of medical
care at home (2009).
• Social Safety Net resources used to support the introduction of home care
services for the chronically ill, development of day-care centres for the