Health care less or careless?

RIGA - Falling ill in Latvia is a costly venture. A lot of people cannot afford to pay for the right treatment or the right medicine. Budget cuts have left the Ministry of Welfare in Latvia with a losing battle against a decrease in services and climbing prices on medicine. The dental care is slightly improving. Still, a lot remains to be done.

The World Health Organization placed Latvia's health care system at 105th place in the world this year. Both Lithuania, 73rd, and Estonia, 77th, ranked higher. The list evaluating health care systems in various countries shows France at the top, followed by Italy and San Marino. In last place, 191st, is Sierra Leone.

Minister of Welfare Andrejs Pozarnovs took WHO's report with ease and did not think the report on health care systems was accurate.

"To look at this investigation, we have to consider the way it was performed and the result itself. The method used to reach that result was not accurate," Pozarnovs said.

After finishing a short conversation on his 350 lats ($583) mobile phone, Pozarnovs said there is a lack of finance for the health care ministry.

"According to the agreement between the government and the World Bank, at least 10 percent of GDP has to go to health care. Yesterday [July 4] the government did not accept the projected budget and particularly not for the welfare ministry, because the budget was not in accordance with the agreement with the World Bank. The budgets for the other ministries were all approved but not our ministry," Pozarnovs said.

In 1997 Latvia's former welfare minister, Vladimirs Makarovs, signed Latvia's health care reform program in Washington, D. C. with representatives from the World Bank.

"In the agreement with the World Bank to reform Latvia's health care system, it says the main accent will be on the primary health care and ambulatory services. The rate of this reform is slow because of lack in funding. We actually receive a smaller and smaller share of the GDP which is why we have to ask more money from patients," Pozarnovs said.

Still, Latvian health care is not only facing problems with budget cuts. More practical problems have started to occur in hospitals and drugstores.

"People do not have money to buy medicine in drugstores. They have no money to pay for medicine in hospitals, either," family doctor Pauls Vaivods, member of the family doctors' association in Latvia, said.

Pozarnovs, however, is trying to solve the problems with steep prices on medicines. Yet he knows his solution will not work in the long run.

"We have suggestions on finding other sources of financing. For example, increase the excise tax on tobacco products. Some part of the financing will, of course, be paid by the patients, but their payment has to be reduced by as much as possible," Pozarnovs said. "We want the part the people pay for health care to be lower and have the government pay a higher percentage of the expenditures. High income families should pay more for the quality of the service."

Vaivods suggested Latvians engage more in sports activities and care more about themselves.

"The only way to save the health care system is with more support from the government," Vaivods said. "If the number of hospitals decreases, it means that people are not able to pay for themselves."

Over the last 10 years, the number of hospitals has dropped noticeably, and the Latvian lifestyle has changed. During those 10 years the Latvian population decreased by 200,000 inhabitants. Compared to the rest of Europe, Latvia has one of the shortest life expectancies, 64 years for men and 76 for women.

The number of doctors could be going down, too.

"We also see negative tendencies with doctors who don't want to work with medicine any more. This is purely a question of salaries which are unsatisfactory. Right now we have more or less enough people. Still, in the future this could be a serious problem if doctors continue this trend," Pozarnovs said.

On the dental side of health care in Latvia things are not looking much brighter.

Dentist Armands Ozolins said people only show their faces when they have a toothache, and that it is common to think that if the mouth has been treated once, it is for all life.

"People have no motivation to clean their teeth. They don't want to go to a dental hygienist. They cannot understand that it is cheaper to come twice a year instead of once every five years," Ozolins said.

"People have no money, and the dentists take no courses. The courses are for free. Still, they are not interested in coming," Ozolins said.

Ozolins is one of the younger generation dentists in Latvia. He finished, what he refers to as, a western education two years ago. He works in a private clinic in Riga.

"The old generation of dentists work just as they did during the Soviet times. They treat a patient for 10 to 15 minutes. It's (bleeping) bull s__t, but they are very cheap. Dentists with a Western education are very good but more expensive. Old generation dentists should retire," Ozolins said.

Dzintra Dauberga, also dentist, does not agree that all older dentists should retire.

"It's not fair, because they have their education too, and they also have to live. Just because they are older, it does not mean their education is worse," Dauberga said.

Pozarnovs still has a card up his sleeve which he hopes will turn things around for the better in Latvia.

"We are doing everything we can to improve our health care. Right now, 28.4 percent of income tax goes to finance health care. The government is looking into the possibilities of increasing minimum wage. That way tax revenue will increase too," Pozarnovs said.