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Country profiles of health system responses to the crisis | Latvia 429 mentally ill, hiring additional nurses at primary health care facilities and development of a family physician advisory telephone service (since 2009). • Several local hospitals downgraded to low intensity “care hospitals” (2009). • The NHS took over responsibility for developing clinical guidelines and published 11 (2012). Waiting times • No response reported. Health promotion and prevention • Early cervical and breast cancer detection programme established (2009). • Dissolution of the Public Health Agency (2009) and its replacement by the Centre for Disease Prevention and Control (2012).

Lithuania Gintaras Kacevičius and Skirmante Sauliune Economic trends • Lithuania's real per capita GDP contracted sharply in 2009 by 13.4% but recovered the following year. • The unemployment rate increased and remained above the European mean even after the economic recovery. • The cost of borrowing increased substantially in 2009 but 10-year bond rates returned to mean European levels by the following year. • Despite an increase in the size of government spending relative to GDP in 2009, health spending has remained constant as a share of government spending, close to the European mean. OOP expenditure per capita declined slightly in 2009 by 3.4% but in 2011 increased by 10.0% (Lithuania: Figs 1 and 2). Policy responses Changes to public funding for the health system • The state budget for health, including contributions to SHI, increased between 2008 and 2011; health was the only public sector to receive increased funding in 2009. • In comparison to 2008, SHI revenues fell by 20% in 2009 and by further 23% in 2010 as a result of higher unemployment and lower salaries, but began to rise again from 2011; SHI spending fell by 5% between 2008 and 2010 but recovered in 2011. • A tax reform was introduced to separate SHI contributions from personal income tax (2009); the SHI contribution was set at 9% of gross earnings or income for employees and some groups of self-employed people and 9% of the official minimum monthly salary for the rest self-employed and other groups; collection agents (the Social Insurance Fund and the State Tax Office) were forced to increase their effectiveness in enforcing payment of contributions or face penalties; the overall social security contribution rate was increased from 26% in 2006 to 35% in 2012.

Country profiles of <strong>health</strong> system responses to the <strong>crisis</strong> | Latvia<br />

429<br />

mentally ill, hiring additional nurses at primary <strong>health</strong> care facilities <strong>and</strong><br />

development of a family physician advisory telephone service (since 2009).<br />

• Several local hospitals downgraded to low intensity “care hospitals”<br />

(2009).<br />

• The NHS took over responsibility for developing clinical guidelines <strong>and</strong><br />

published 11 (2012).<br />

Waiting times<br />

• No response reported.<br />

Health promotion <strong>and</strong> prevention<br />

• Early cervical <strong>and</strong> breast cancer detection programme established (2009).<br />

• Dissolution of the Public Health Agency (2009) <strong>and</strong> its replacement by the<br />

Centre for Disease Prevention <strong>and</strong> Control (2012).

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