Insurance to help end envelope payments

  • 2007-07-18
  • By Talis Saule Archdeacon

REFORM PLANS: The Health Ministry hopes that normalizing the insurance system will bring an end to 'gratitude' payments to doctors.

RIGA - The Health Ministry, backed by newly inaugurated President Valdis Zatlers, has made the first move in the battle against corruption in the health services.
The ministry has unveiled a plan to implement a system of mandatory medical insurance in what it said would be the first step in putting an end to the twin practices of doctors demanding additional payments and patients offering gratuity payments for medical services.
The plan envisages universal health insurance coverage within two to three years. Egita Pole, director of the communications department of the Health Ministry, said that the plan would not be possible to implement sooner since it requires significant financial resources and the parameters of next year's budget have already been agreed upon.

Ending the practice of doctors accepting envelope payments 's a common practice of making under the table "gratitude" payments for doctors' services 's is one of the first issues that Zatlers has said he will tackle as president (see Page 14). Zatlers, a former surgeon, inadvertently brought the issue to the forefront just prior to the election when he admitted to having earlier accepted envelope payments himself. He has already promised a fast resolution to the problem.
"I will definitely take an active part in solving this issue, because it is important to me that people in Latvia receive normal medical care," Zatlers told Latvian public radio.
"Mandatory insurance will probably increase money. Maybe it will change the way this money is spent," the president said.

Pole explained that they hope the injection of funds into the health care system will eliminate doctors' need for the extra payments.
"If we increase circulation of the amount of money in the health care system, then we can increase doctors' salaries, and maybe these envelope payments will stop as people feel that because they have insurance they won't need to [give gratitude money]," she said.
The system will be based partially on the Estonian system, which has been in place since 1992, and partially on the insurance systems in the Netherlands and Scandinavian countries. It will be designed to help children, the elderly, the poor, the invalid and those who need health coverage the most, Pole said. "The state must protect these people," she said.
When he unveiled the ideas behind the program, Health Minister Vinets Veldre compared it to third party liability insurance for drivers.

The government plans to continue its working groups and consultations with experts and NGOs to develop additional strategies to combat the gratuity payments. Another strategy being discussed is the implementation of harsher laws for doctors who ask for or receive the payments. According to Latvian law, asking for a payment is a crime, while accepting an envelope with cash after a medical service has been rendered is not.
Pole noted that a number of different strategies may be necessary because the problem is so widespread. "It is difficult to stop this because there is a history of it here, [the payments are] a kind of culture in the older population," she said.