And You Will Be Cured – If They Can: The Silini Government Has Taken on the Reform of Latvia's Hospital Network 0 8

Saving on Doctors

First, about the overall situation in the healthcare system. As is known, the queues to see doctors, especially for planned surgeries under quotas, stretch not just for months but for years. The reason is obvious: a lack of budget funding. This is confirmed by statistics. According to official EU data, Latvia ranks among the last in the EU in terms of healthcare funding (as a percentage of GDP).

Latvia spends only 4.34% of its GDP on healthcare. For comparison, Germany spends 10.09% of its GDP, and France spends 9.71%. Although the incomes of residents in these countries are many times higher than those of Latvians.

It is worth noting that our Baltic neighbors, while not by much, still surpass Latvia in healthcare funding: Lithuania spends 4.93%, and Estonia spends 5.67% of GDP.

Is it any wonder that Latvia is on the list of EU countries where residents spend a lot (pay extra) when paying for medical services? By this indicator, we rank third – only residents of Malta and Bulgaria spend more out of their own pockets on treatment.

Living Well, but Not Long

Our country is also in another anti-top – Latvia has been on the list of EU countries with the lowest expected healthy life expectancy for many years. In 2024, the average number of years of healthy life (without significant functional impairments and disabilities) was 63.1 years, while in Latvia it was only 52.8 years, which is more than ten years behind the EU average.

According to the latest study by the Organisation for Economic Co-operation and Development (OECD), the reasons for the poor health of Latvians lie in four factors:

n lifestyle of the population,

n limited access to timely treatment,

n high patient co-payments,

n insufficient funding for the healthcare sector.

A logical question arises: how does the Ministry of Health plan to address these causes, especially the last three, since officials can hardly influence the lifestyle of the population? Unless they come up with more stories about the dangers of alcohol, cigarettes, and poor nutrition.

Instead of Money – Electronic Accounting

In the absence of finances, the Ministry of Health is overflowing with ideas. As for the queues to specialists, Abu Meri's department will try to reduce them without additional money – by improving the electronic accounting system. That is, referrals will henceforth be only electronic, and it will be possible to eliminate the situation where patients immediately sign up with several specialists of the same profile or for repeated examinations and tests under quotas.

This measure is unlikely to significantly reduce the queues. In any case, it does not apply to planned surgeries or the availability of emergency medical care in hospitals.

The reform approved by the government is also aimed at improving inpatient care. Again, it does not imply any additional financial resources – only the redistribution of existing ones.

What Is the Essence of the Reform?

Until now, as a result of the previous reform, all hospitals providing state-funded care have been divided into 5 categories. Now, it is proposed to divide these 36 hospitals, which have emergency medical departments and emergency rooms, into three levels: multidisciplinary hospitals, regional hospitals, and local ones.

There are also three goals:

first, to improve the speed of patient admission to the hospital for stabilization of their condition,

second – to simplify the hospitalization system itself,

third – to ensure uniform provision of quality medical care throughout the country.

The reality is that, as also stated in the Ministry of Health's informational report, the population of Latvia is aging, and thus the demand for medical services is constantly increasing.

Aging and Illness

In 2024, 63% of Latvia's residents were of working age (from 15 to 64 years). Compared to 2023, their share in the total population has slightly decreased. Seniors aged 65 and older accounted for 21.9% of the total population, with their share increasing by 0.5%.

Meanwhile, the number of people aged 80 and older has increased over the past 30 years from 71,000 to 112,000, making up 6% of all residents of the country.

"The state funding allocated for healthcare institutions to provide inpatient care is still insufficient to cover the growing actual costs of hospitals, which necessitates effective management of hospital networks, influenced by several factors such as demographic trends (aging and low birth rates), a shortage of human resources in healthcare, and unmet healthcare service needs, the availability of outpatient services, as well as the ability of the Emergency Medical Service team to reach a hospital within an hour," officials from the Ministry of Health outlined the situation.

And the Unions Are Against...

On paper, everything looks beautiful and logical. But how does it work in practice? The healthcare workers' union has already issued a statement critically assessing the reform approved by the government: it is, in the unions' opinion, rushed and does not address the existing problems. There is a lack of in-depth analysis, clear criteria, and specific, measurable solutions that would allow for a confident assessment of the impact of the proposed changes on:

• the distribution of hospital functions and the model of long-term development;

• the provision of human resources;

• the employment and working conditions of healthcare workers;

• patient safety;

• the availability of healthcare services across the country.

The fact that hospitals have been "cut up" differently will not result in additional doctors, nurses, and orderlies in hospitals, nor will there be more money. At least, not for now. But if the ambulance can indeed quickly deliver a patient to the nearest hospital and they receive initial medical care and their life is saved, then the reform can already be considered beneficial.

Three Types of Hospitals

So, what will change after the reform is implemented?

Multidisciplinary hospitals (these are university clinics in Riga and hospitals in large cities by Latvian standards) will have to provide all possible special medical care of the highest level, round-the-clock availability of key specialist doctors, including in-person consultations and radiologists, and 24/7 operation of laboratory and imaging diagnostics, as well as intensive care units.

Regional hospitals will have to provide emergency medical care 24/7 with round-the-clock duty of intern doctors (therapists) and a surgeon, as well as continuous operation of imaging and laboratory diagnostics. If necessary, consultations and assistance from an anesthesiologist, gynecologist, neurologist, etc., should be organized.

Local hospitals will have to ensure round-the-clock duty of an intern doctor or surgeon, as well as laboratory and imaging diagnostics with remote work by a radiologist. The task is to stabilize the patient's condition so that they can then be transported to a regional or multidisciplinary hospital if necessary.