Row between private and state health care sectors hampers medical tourism

KLAIPEDA - Private healthcare facilities are vexed over different competitve conditions they and state clinics are facing, but the National Health Insurance Fund (NHIF) says that this is not true and works to convince that equal requirements are being applied to all healthcare service providers. As the dissatisfaction with the policies grows, some private medicine entrepreneurs sue the Ministry of Health, expecting that courts will help chip away a bigger part of NHIF funds.

Obstacles for private facilities
“What I, as many other private healthcare providers, see is that the Ministry and, subsequently, the National Health Insurance Fund is hampering our efforts in expanding the range of medical services offered. Therefore, the patient has fewer options. For example, to go into detail, cancer patients, instead of being given a possibility to seek necessary medical procedures in local private medical centers, have to go to another city, where state clinics are entitled to provide the care. It is not that our clinic doesn’t have the facilities, medicine or competence, but because the ministry has singled out some state-owned clinics to provide the services. That is unfair and breaches competition law,” says Leonas Kacinskas, director of Atgaiva Tau, a healthcare and rehabilitation center.
He says the practice is “particularly dishonest” to cancer patients whose every day worry is on the question of life and death. Besides, transportation fares and travel fatigue should be taken into account when it comes to this kind of patient.

NHIF shrugs off accusations
To gain the right to provide some healthcare services that only state facilities are entitled to, the director has to apply for permission from the competitors, not from the Ministry. “Therefore, it is not surprising that only state clinics continue providing the services. You cannot expect your rival to grant the right,” the director told Diena.lt.
Nevertheless, Viaceslavas Zaksas, director of the Health Supervision Services Department at the NHIF, shrugs off the accusations of being partial. “I want to reiterate that both private and state medical facilities are applied with the same requirements when it comes to providing medical services. I am not saying they are easy to meet, but the bottom line is there is no piece of legislation which would foresee a difference in signing agreements according to the form of ownership of a medical facility,” he said.

The department head, nevertheless, pointed out that the issue has been long triggering a backlash from private medical service providers. “The issue has even reached court a couple of years ago, and, to be precise, the Supreme Administrative Court of Lithuania has announced that the agreement signing practice we’re applying does not breach any law,” Zaksas emphasized.
 
Private entrepreneurs sue the ministry in numbers
But many private medical entrepreneurs defy the ruling and, in a bid to chip away a part of the services - and money! - from state healthcare facilities, bring the Ministry to different-jurisdiction courts, expecting them to change the practice.
Vidmantas Samuitis, director of Bendroji Medicinos Praktika (General Medical Practice), has gone a slightly different way in the bid to fight off the ministry’s regulations. Instead of going to court, he has filed a complaint to the National Competition Board in the hopes that it will pass a favorable decision that may be crucial in future court wrangling. “We have no other choice than to fight for ourselves, as we’ve invested a lot into some medical services that we cannot provide now,” he stressed.

He says his venture built a new healthcare building in which, according to the carefully developed business plan, in-ward secondary-level surgical services are foreseen. “We had expected to do prosthesis as well as certain surgical operations in our equipped block. We’ve even built resuscitation wards, all of which has cost plenty of investment. However, the NHIF does not want to sign an agreement with us for providing the services. The fund explains it by the new order being signed by the Health Minister in 2010. That is very disappointing,” Samuitis said.

Policies hamper medical tourism efforts
The constraints for private medical entrepreneurs go against Lithuania’s pursuit of a larger medical tourism turnout in the country. “The sector has been prioritized in the National Tourism Strategy, but the hindrances we’re dealing with make us doubt the true intentions of state and the Ministry of Health,” Nerijus Savukynas, a medical entrepreneur, told The Baltic Times.

Meanwhile, the Ministry of Economy also hints that the field of health care “should be improved.”
“When we start speaking of medical tourism and its promotion, we inevitably return to the matters of our entire health care system, which still has to improve a lot,” Laura Paulauskiene, head of the Tourism Policies Department (TPD) at the ministry, says.

She stresses this is particularly “evident” as far as medical tourism in the country is concerned. And the latter ministry perhaps is the one on whom private medicine entrepreneurs count on most. “As far as I know, the Ministry of Economy is negotiating with the Ministry of Health on a range of issues, alleviating the private clinics’ situation,” Savukynas pointed out.

The TPD head acknowledged that both ministries are seeking “to work things out,” even if that requires a bit of “jostling” in defense of the core interests. “When interests of different institutions collide, it takes some more time to find solutions and implement changes. Nevertheless, the situation is getting more favorable as we all have started speaking of it openly, and heeding more into each other’s arguments. I do expect positive results at the end of next year,” Paulauskiene said to Diena.lt.

“Certain regulations are needed”
But Zaksas, from the NHIF, says he is convinced of the necessity of having competition in medicine, but, nevertheless, pointed out to the urgency to have “certain regulations” in the field. “We’ve observed that private healthcare facilities are particularly keen on providing some medical services that the NHIF pays best for. Statistically, private facilities provide some 8.6 percent of all health care services, which is similar, for example, in England, with their respective 9 percent,” the NHIF representative noted.

The National Health Insurance Fund has signed agreements over providing health care services with 849 health care facilities. And, out of the total, 550 are run by the private sector. “We hear quite many complaints from private facilities, but, to tell the truth, state clinics have to meet even stricter service requirements. Thus lately we’ve been strictly asking state medical facilities to reduce the number of in-ward provided health care services, but private facilities have not been affected by that,” Zaksas noted.

He, nevertheless, agrees that both sides need “discussions” to come to a common ground and friendlier terms for the ultimate task: better health care in the country.