RIGA - In an effort to get a grip on the crisis facing Latvia's hospital system, Prime Minister Valdis Dombrovskis (New Era) last week sent to Minister of Health Baiba Rozentale (People's Party) his request for a detailed accounting of her budgetary programs, spending and the department's miscellaneous costs. The prime minister says that the problems need to be identified before additional funding decisions can be made, for support of the Ministry.
In January, after cuts to the budget were finalized, the government confirmed that the 2009 budget for the Health Ministry would be 524 millions lats (748.6 million euros), compared to the 2008 budget of 576 millions lats. After amendments to the budget were taken in June, the sum allocated to the ministry was cut further, to 454 millions lats, this approximately equal to the budget in 2006.
The previous health minister, Ivars Eglitis (PP), subsequently resigned his post. Since the beginning of 2009, funding for hospitals has been reduced by 47.3 percent, for health center dispensaries by 24.2 percent, and for pharmaceuticals by 14.6 percent. Reform of the health care system has not brought the expected results.
At the beginning of the year there were 72 hospitals in Latvia. In April, 2009, 13 regional hospitals were closed. Before he left, Eglitis had been working on a plan on the reduction of expenses at the hospitals, and on optimization of resources over the next four years. After these reforms there should remain only 24 hospitals.
It has been decided to increase payments from patients for treatment in hospitals, from the current 5 lats, to 12.5 lats per day, to increase revenues.
Rozentale's initiative for the 24-hour emergency services, which were to start September 1, will go into effect at only 20 hospitals, instead of the full 72 hospitals providing such care at the beginning of the year. Patients will have to pay for treatment now at 14 hospitals, nine hospitals will work as day care outlets, and 29 will render only out-patient services such as polyclinics. This plan is in effect only until the end of December, though Rozentale can't say what will come next.
As she said earlier, money available for all the hospitals' needs isn't sufficient. "Until the end of the year, due to providing urgent medical care to the population, a minimum of 45 million lats is needed. The hospital sector financing decisions were accepted in haste and without due consultation with the experts. I do not believe that 3 percent of GDP is a sufficient sum for providing medical aid to the population," she said.
Nevertheless, the crisis in public health services continues. Some hospitals in the absence of financing have declared that they no longer offer emergency aid to patients. Riga's First Hospital has, from Aug. 10, stopped receiving patients for emergency first aid, and Pauls Stradins Hospital has declared that money for providing emergency care will last only until October.
According to the adviser to the prime minister, Peteris Apinis, the situation will continue to worsen as there is no responsible management. Speaking with news daily Diena, he says that "For the last two to three years we have lived beyond our income, especially in the first half of this year, when the ministry continued to spend thoughtlessly, though it was obvious that it was time to stop. One problem is the very large debts, especially under the short-term credits that have accumulated."
Regarding the future of public health services in Latvia, Apinis said "There are many aspects where it would be possible to involve financing from the EU, and innovative technologies, for example, the transition to the electronic form of service. It essentially would save time for the doctor and the patient."
Rozentale considers that "Investments into medicine and the public health service system are undoubtedly necessary. However, Latvia is not at that step of development to put up money into new technologies when people now die from inaccessibility to care. We cannot allow ourselves to do nothing. For example, Denmark allocates 3,100 euros per person, whereas in Latvia our equivalent is 350 euros per person."
Analysts say that, in Latvia, patients pay a disproportionate amount of the bill, about 48 percent from all payments, whereas in Western Europe this is closer to, on average, 16 percent.
Other problems include the "high rate of hospitalization in Latvia, with patients borrowing to pay expenses. Despite this, many hospitals are not filled even to a 70 percent capacity. It forces us to think that we spend disproportionately more for hospitals, and we do not give proper attention to ambulance services and other out-patient care," said Rozentale.
Trustee with the organization for assistance to people with special needs SUSTENTO, Iveta Neimane, says that their "organization in June 2009, conducted research in the area of providing assistance to the patient, and came to the conclusion that many residents in Latvia, after public health service reform, do not go to hospitals for treatment."
She says that "Sixty-five percent of respondents do not submit to hospitals because of costs. The reason for that is the increase of patient payments, from 50 santimes, to 1 lats, and for going to a specialist, from 5 lats to 15 lats. Even more so, people cannot buy medicines. It is very expensive, and becomes necessary to choose between one's own health, and food for a child, for example. There is also a big difference between Riga and other regions of Latvia."
