RIGA - Latvia's Prime Minister Valdis Dombrovskis says that in the case where Health Minister Baiba Rozentale doesn't soon come up with constructive solutions to the financial problems with the health care system, she may have to be replaced, reports news agency delfi.lv. As already reported, severe budget shortfalls at the health ministry, and possible mismanagement of funds, may force the closing of hospitals throughout Latvia, with the loss of hundreds of jobs.
"More than 500 employees at Riga's 1st Hospital may be out of work already this month, with little chance of finding jobs in the Riga Eastern Clinical University Hospital, or Pauls Stradins Clinical University Hospital," says Riga 1st Hospital chief of staff, Andrejs Pavars, reports news agency LETA.
According to Pavars, "neither Eastern nor Stradins hospitals have money to hire additional staff." He also said that some from another group of 400 hospital employees, who could be made redundant at the end of December, may be able to find jobs in the two hospitals sometime later. Pavars complains that "The 1st Hospital is the last to find out about the Ministry's decisions."
After Latvia overcomes the economic crisis, Riga 1st Hospital could resume work, hopes Riga Mayor Nils Usakovs, in an interview on LNT television. Usakovs acknowledges that the city government cannot fund the hospital on its own.
Approximately 570 workers will be laid off at Riga 1st Hospital this month, and management also plans to cut back emergency medical services.
Pavars said that "it is now clear, after two weeks of talks with the Health Ministry and the Riga City Council, the amount of the hospital's services has to be reduced by at least two-thirds." Funding for the hospital is to be reduced by 70 percent.
"The hospital will continue providing emergency medical care services until August 10. After that, the hospital will only accept inpatients, and only as many as it can afford," said Pavars. He added that, starting in the morning on August 10, emergency patients who are delivered to the Riga 1st Hospital in ambulances, or come on their own, will all have to be turned away. "We will be the villains, even though it is not our fault," he said.
President Valdis Zatlers describes the current quarrels over the state budget distribution as 'inconsiderate'. He says that, in case the country's GDP shrinks by 20 percent, the healthcare institution budgets have to also be correspondingly cut by a similar amount, but that "putting hospitals in a no-exit situation should be avoided."
Zatlers believes the biggest problem is that the healthcare system did not adhere to the reform plans that were drawn up already five years ago. For example, investments in the healthcare sector were not controlled or geared to benefit key hospitals.
Commenting on the upcoming closing of Riga 1st Hospital, he explained that the liquidation of the hospital was already planned several years ago but that, thanks to successfully attracting investments, the hospital managed to continue until now. However, the fact that it is the oldest hospital in Latvia does not mean that it is also the best one, he noted.
The financial crisis in healthcare won't end with the closing of the hospital. Rozentale agrees that there is no money left in the health budget that could be redistributed to other hospitals.
She says that "If we take money from somewhere, it will be just a short-term solution. If money is taken from primary care, the normal balance, which Latvia is striving to attain in accordance with Western standards, will be upset, and it cannot be predicted as to what reaction this would cause in the primary care sector." According to the minister, there are just two options: strive for quality healthcare or keep running an extensive network of hospitals.
The People's Party has selected party veteran Gundars Berzins to step in as Rozentale's non-staff advisor. Rozentale is also a People's Party member. Berzins himself, a former health and finance minister, will work without pay.
Riga 1st Hospital will be closed regardless of large investments that have been made in its modernization over the past few years. Riga City Council has invested 2.5 million lats (3.6 million euros) in the hospital between 2000 and 2008, and 1.3 million lats was taken from the hospital's profits in 2007 and 2008 for the purchase of new medical equipment.
European Union (EU) funds in the amount of 284,000 lats were allocated in 2005 for hospital renovation. The agreement with the EU stipulates, however, that the hospital must keep its status unchanged until September 29, 2011.
The Health Ministry has proposed shutting down Riga 1st Hospital on January 1, 2010, with Riga 2nd Hospital set to close its doors this fall.
The funding for Pauls Stradins Clinical University Hospital "will be enough for just a couple of months, and this hospital is also in urgent need of extra money," says Rozentale. She says the money is needed for its large waiting list of patients, and for investments into equipment upgrades and human resources.
Last year almost 48,000 inpatients received treatment at Stradins, with more than 120,000 receiving ambulatory care. On average, a patient spends five days in the hospital, which is approximately half the time spent in other hospitals in Latvia, showing that "the hospital is very effective and has a very professional staff," says the minister.
"Stradins Hospital together with Riga Austrumu (Eastern) Clinical Hospital will be one of the largest university clinics in Latvia, therefore they definitely must not be shut down," she stresses. "The Stradins Hospital works according to the highest Western standards yet it is funded in accordance with Soviet-era principles, therefore the system must be revamped after the crisis, so the hospital could continue to work efficiently," she says.
